旋覆代赭汤加味治疗肝胃不和型难治性胃食管反流病的临床疗效及对胃肠激素的影响  

Effect of Modified Xuanfu Daizhe Decoction on Refractory Gastroesophageal Reflux Disease of Disharmony between Liver and Stomach Syndrome and Its Influence on Gastrointestinal Hormones

作　　者：唐丽明[1] 宋宁[1] 熊鹰[1] 杜红跃 季蕊新 袁红霞[2] TNAG Liming;SONG Ning;XIONG Ying;DU Hongyue;JI Ruixin;YUAN Hongxia(Santan Hospital in Nankai District,Tianjin 300193,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津市南开区三潭医院,天津300193 [2]天津中医药大学,天津301617

出　　处：《辽宁中医杂志》2020年第11期109-112,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：天津市卫生健康委员会中医中西医结合科研项目(2017089)。

摘　　要：目的观察旋覆代赭汤加味治疗肝胃不和型难治性胃食管反流病(GERD)的临床疗效以及对心理状态、生活质量、血浆中胃肠激素水平的影响,探讨难治性GERD的中医临床治疗方法。方法选取该院2017年10月—2019年1月收治并自愿加入本研究符合肝胃不和辨证分型的难治性GERD患者80例,采用随机数字表法分为中医治疗组和西药治疗对照组,每组40例。西药治疗对照组采用新一代PPIs药物-埃索美拉唑联合促胃肠动力药莫沙必利,中医治疗组以旋覆代赭汤为基本方加味进行治疗。所有患者均连续治疗4周,比较两组临床症状的减轻程度;采用匹兹堡睡眠质量指数(PSQI)问卷、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)分别评价两组患者治疗前后睡眠、焦虑、抑郁情况;胃镜检查进行GERD分类诊断;酶联免疫吸附法(ELISA)检测治疗前后血浆胃泌素(gastrin,GAS)、胃动素(motilin,MTL)、胆囊收缩素(cholecystokinin,CCK)以及血管活性肠肽(vasoactive intestinal peptide,VIP)水平。结果中医治疗组总有效率高于西药治疗对照组(P<0.05);中医治疗组PSQI总分、HAMA、HAMD评分均显著低于西药治疗对照组(P<0.05);胃镜下GERD分类情况两组无显著差异。治疗前两组患者血浆4种胃肠激素水平比较无统计学意义。治疗后中医治疗组GAS、MTL水平较本组治疗前显著升高(P<0.01),而CCK、VIP水平较治疗前显著降低(P<0.01)。西药对照组治疗前后除GAS、MTL水平较本组治疗前显著升高(P<0.01)外,CCK、VIP水平治疗前后差异无显著性。结论加味旋覆代赭汤能显著减轻肝胃不合型难治性GERD患者消化道临床症状及心理状态、生活质量,其机制可能与调节胃肠激素水平,改善胃肠道功能有关。Objective To observe the clinical effect of Modified Xuanfu Daizhe Decoction on refractory gastroesophageal reflux disease(GERD) of disharmony between liver and stomach syndrome and its influence on psychological status,quality of life and plasma gastrointestinal hormone levels,and explore the clinical treatment of refractory GERD in traditional Chinese medicine.Methods Eighty patients with refractory GERD of disharmony between liver and stomach syndrome who were admitted to our hospital from October 2017 to January 2019 and volunteered to participate in this study were selected.They were randomly divided into the traditional Chinese medicine treatment group and the Western medicine control group with 40 cases in each group.The control group was treated with a new generation of PPIs-Esomeprazole combined with Mosapride,a gastrointestinal motility drug.The treatment group was treated with Modified Xuanfu Daizhe Decoction.All patients were treated for 4 weeks.The alleviation degree of clinical symptoms was compared between the two groups.Sleep quality index(PSQI),Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD) were used to evaluate the sleep,anxiety and depression of the two groups before and after treatment.GERD was classified by gastroscopy.The plasma gastrin(GAS),motilin(MTL),cholecystokinin(CCK) and vasoactive intestinal peptide(VIP) were detected by enzyme-linked immunosorbent assay(ELISA) before and after treatment.Results The total effective rate of TCM treatment group was higher than that of Western medicine control group(P<0.05).The total PSQI score,HAMA and HAMD score of traditional Chinese medicine treatment group were significantly lower than those of Western medicine control group(P<0.05).There was no significant difference in GERD classification under gastroscopy between the two groups.There was no significant difference in plasma levels of 4 gastrointestinal hormones between the two groups before treatment.After treatment,the levels of GAS and MTL in the traditional Chinese medicine

关 键 词：旋覆代赭汤 耳针 难治性胃食管反流病 心理状态 生活质量 胃肠激素 

分 类 号：R571[医药卫生—消化系统]