疏肝降逆和胃方治疗肝胃不和型非糜烂性胃食管反流病临床研究  

Clinical study on Shugan Jiangni Hewei recipe in treating non-erosive gastroesophageal reflux disease with disharmony of liver and stomach

作　　者：何美君 白光[2] 李晶 孟子惠 王天佐 陈艺楠 Pawat Thanavachirasin HE Meijun;BAI Guang;LI Jing;MENG Zihui;WANG Tianzuo;CHEN Yi’nan;Pawat Thanavachirasin(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110033 [3]泰国清莱皇太后大学中西医结合医学院,泰国清莱57100

出　　处：《陕西中医》2021年第11期1539-1543,共5页Shaanxi Journal of Traditional Chinese Medicine

基　　金：第三届国医大师传承工作室及全国名中医传承工作室建设项目[辽中医药函字(2018)76号];第四批全国优秀中医(临床、基础)优秀人才研修项目[国中医药人教发(2017)24号];盛京脾胃学术流派活态传承研究[辽卫中综合字(2021)19号];中医消化领域优势病种(慢性萎缩性胃炎)专科专病循证能力提升专项(2019XZZX-XH008)。

摘　　要：目的:评价疏肝降逆和胃方改善肝胃不和型非糜烂性胃食管反流病(NERD)的临床疗效,并探讨治疗前后血清中神经生长因子(NGF)表达量的变化与NERD患者焦虑等症状的相关性。方法:回顾性收集72例NERD患者分为中药组37例和西药组35例,中药组予疏肝降逆和胃方治疗,西药组采用奥美拉唑肠溶片治疗,比较两组中医证候积分,临床疗效以及焦虑、抑郁的得分变化。检测两组治疗前后血清NGF、P物质(SP)的表达水平,并分析NGF表达量与焦虑等症状的相关性。结果:两组中医证候积分组内比较显示,治疗后中药组和西药组的烧心、反酸、腹胀、嗳气症状与治疗前比较差异均有统计学意义(P<0.05)。在善太息、胸胁胀满方面,中药组在治疗后与治疗前比较,差异均有统计学意义(P<0.01)。两组的纳差症状治疗后与治疗前比较差异无统计学意义(P>0.05)。治疗后组间比较显示,中药组的烧心、反酸、嗳气积分均低于西药组(P<0.05)。在腹胀方面,两组疗效相当,组间比较差异无统计学意义(P>0.05)。中药组临床总有效率为86.5%,高于对照组的68.6%(χ2=10.68,P<0.05)。中药组在改善焦虑抑郁评分中优于西药组(P<0.05),且治疗后两组血清NGF、SP水平比较差异均有统计学意义(P<0.01)。Pearson相关性分析提示两组治疗前后的NGF水平与善太息,焦虑评分成正相关(P<0.05),与胸胁胀满、抑郁评分无相关性(P>0.05)。结论:疏肝降逆和胃方具有较好的临床疗效,且NERD患者血清NGF的表达量与其焦虑状态成正相关。其发挥疗效的机制可能是通过降低了血清NGF、SP的水平,从而改善了NERD食管内脏高敏感。Objective:To evaluate the clinical efficacy of Shugan Jiangni Hewei recipe in improving liver-stomach discord non-erosive gastroesophageal reflux disease(NERD),and to explore the changes in serum NGF expression before and after treatment and anxiety and other symptoms of NERD patients relevance.Methods:Retrospective collection of 72 patients with NERD,divided into 37 cases of Chinese medicine group and 35 cases of western medicine group.The Chinese medicine group was treated with Shugan Jiangni Hewei prescription,and the western medicine group was treated with omeprazole intestine Dissolving tablets treatment,comparing the scores of TCM syndromes,clinical efficacy,anxiety and depression scores between the two groups.The expression levels of serum nerve growth factor(NGF)and substance P(SP)in the two groups before and after treatment were detected,and the correlation between NGF expression and anxiety and other symptoms was analyzed.Results:Comparison of TCM syndrome scores between the two groups,the comparison within the group showed that the symptoms of heartburn,acid reflux,abdominal distension,and belching in the TCM group and the western medicine group after treatment were significantly different from those before treatment(P<0.05).In terms of Shantaixi and fullness of the thorax,only the traditional Chinese medicine group had significant differences after treatment than before treatment(P<0.01).There was no difference in anorexia symptoms between the two groups after treatment and before treatment(P>0.05).After treatment,the comparison between groups showed that the scores of heartburn,acid reflux and belching in the Chinese medicine group were lower than those in the western medicine group(P<0.05).In terms of abdominal distension,the two groups have the same curative effect,and there is no statistical difference between the groups(P>0.05);the total clinical effective rate of the Chinese medicine group is 86.5%,which is higher than 68.6%of the control group(χ2=10.68,P<0.05);Chinese medicine group was better

关 键 词：非糜烂性胃食管反流病 疏肝降逆和胃方 焦虑抑郁 内脏高敏感 神经生长因子 

分 类 号：R571[医药卫生—消化系统]