黄连温胆汤加减辨治胆汁反流性胃炎伴失眠肝胃郁热证的疗效及机制探讨  

Study on the effect and mechanism of Huanglian Wendan Decoction in the treatment of bile reflux gastritis with insomnia of syndrome of heat stagnation of liver and stomach

作　　者：赵晓杰 顾勇[1] ZHAO Xiaojie;GU Yong(The Fifth People’s Hospital of Jiangyin City,Jiangyin 214400,Jiangsu,China)

机构地区：[1]江苏省江阴市第五人民医院,江苏江阴214400

出　　处：《现代中西医结合杂志》2020年第28期3102-3106,3118,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察黄连温胆汤加减辨治胆汁反流性胃炎伴失眠肝胃郁热证的临床效果,探讨其对患者胃黏膜保护、睡眠改善的作用机制。方法选择2018年3月—2019年3月于江阴市第五人民医院就诊的100例胆汁反流性胃炎伴失眠肝胃郁热证患者为研究对象,随机分为观察组和对照组各50例,对照组患者给予枸橼酸莫沙必利分散片、铝碳酸镁片口服,观察组患者在对照组治疗基础上给予黄连温胆汤加减口服,2组疗程均为8周。比较2组患者治疗前后24 h反流次数、最长反流时间、内镜下胃黏膜组织病理积分、匹兹堡睡眠质量指数量表(PSQI)评分,检测2组治疗前后血清中胃饥饿素(Ghrelin)、环氧化酶-1(COX-1)、γ-氨基丁酸(GABA)、5-羟色胺(5-HT)水平,统计2组治疗效果。结果与治疗前比较,2组患者治疗后的24 h反流次数显著减少,最长反流时间显著缩短,内镜下血管扩张、固有层水肿、炎症浸润程度评分和PSQI中主观睡眠质量、睡眠障碍、入睡时间、睡眠时间、睡眠效率、日间功能障碍、催眠药物评分均显著降低,血清Ghrelin、COX-1、GABA、5-HT水平均显著升高,差异均有统计学意义(P均<0.05);与对照组比较,观察组上述指标改善更明显(P均<0.05)。对照组、观察组的总有效率分别为78%(39/50)、92%(46/50),观察组显著高于对照组(P<0.05)。结论黄连温胆汤加减辨治胆汁反流性胃炎伴失眠肝胃郁热证疗效确切,可更好地保护胃黏膜和改善睡眠质量,其机制可能与调节血清Ghrelin、COX-1水平以修复胃黏膜及上调神经递质含量有关。Objective It is to observe the clinical effect of Huanglian Wendan Decoction on bile reflux gastritis with insomnia of syndrome of heat stagnation of liver and stomach,and to explore its mechanism of protecting gastric mucosa and improving sleep.Methods 100 patients with bile reflux gastritis and insomnia of syndrome of heat stagnation of liver and stomach treated in the Fifth People’s Hospital of Jiangyin City from March 2018 to March 2019 were selected as the research objects,and they were randomly divided into observation group and control group,50 cases in each group.The patients in the control group were treated with mosapride citrate dispersible tablets and magnesium hydrotalcite tablets by oral administration,and the patients in the observation group were treated with Huanglian Wendan Decoction on the basis of the treatment of the control group.The treatment course of the two groups was 8 weeks.The 24 h reflux frequency,the longest reflux time,histopathological score of endoscopic gastric mucosal,Pittsburgh Sleep Quality Index(PSQI)scores of the patients before and after treatment were compared between the two groups,the levels of serum ghrelin(Ghrelin),cyclooxygenase-1(COX-1),γ-aminobutyric acid(GABA),serotonin(5-HT)before and after treatment were detected in the two groups,and the curative effects of the two groups were evaluated.Results Compared with before treatment,the times of regurgitation at 24 hours after treatment were significantly reduced,the longest reflux time was significantly shortened,the endoscopic histopathological scores of vasodilatation,lamina propria edema,inflammatory infiltration and the scores of subjective sleep quality,sleep disorders,time to fall asleep,sleep time,sleep efficiency,daytime dysfunction,and hypnotic drug in PSQI were all significantly reduced,and the levels of serum Ghrelin,COX-1,GABA,and 5-HT were significantly increased in the two groups,and the differences were statistically significant(P all<0.05).Compared with the control group,the above indicators of the

关 键 词：胆汁反流性胃炎 失眠 肝胃郁热证 黄连温胆汤 

分 类 号：R573.3[医药卫生—消化系统]