个性化膏方治疗慢性胃炎的临床研究:498例回顾性病例系列分析和专家访谈  

Treatments for chronic gastritis with individualized Chinese herbal paste: A retrospective case-series study of 498 patients and an expert interview

作　　者：侯政昆[1] 陈瑞芳[2] 刘凤斌[1] 常少琼[2] 黄志帮 HOU Zheng-kun;CHEN Rui-fang;LIU Feng-bin;CHANG Shao-qiong;HUANG Zhi-bang(Department of Gastroenterology,First Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Preventive Medicine,First Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Graduate College,Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院脾胃病科,广东广州510405 [2]广州中医药大学第一附属医院治未病科,广东广州510405 [3]广州中医药大学研究生院,广东广州510405

出　　处：《中草药》2021年第23期7280-7292,共13页Chinese Traditional and Herbal Drugs

基　　金：国家自然科学基金项目(81774450);广东省教育厅“创新强校工程”重点领域项目(2020ZDZX3011);广东省科技计划项目(2017A020215107);广州市珠江科技新星专项(201710010077);广州中医药大学第一附属医院“创新强院”工程治未病专项(2019ZWB08)。

摘　　要：目的总结分析个性化中医膏方治疗慢性胃炎的治疗方案。方法采用回顾性病例系列分析和专家采访结合的设计。回顾2013年1月至2018年8月到广州中医药大学第一附属医院就诊且诊断为慢性胃炎脾虚湿蕴证、脾虚气滞证、肝胃不和证的患者资料,治疗方案均采用个性化中医膏方。首先,提取患者的证型和用药等信息,采用单因素分析、多因素分析、因子分析相结合的方法建立膏方治疗慢性胃炎不同证型的初步方案。然后,进行专家采访并录音,转录后进行文本分析,修改方案至无新信息出现。统计分析采用SPSS 17.0和R软件。结果最终纳入使用个性化膏方的慢性胃炎患者498例,男性224例(45%),女性274例(55%),平均年龄(41.87±12.22)岁,脾虚湿蕴证患者263例(52.8%),脾虚气滞证患者27例(5.4%),肝胃不和证患者208例(41.8%),共使用中药196种。经过单因素分析、二分类回归分析和因子分析,初步确定膏方治疗慢性胃炎3个证型分别有40、32、41味中药。陈瑞芳教授对该方案进行了10次评阅和修改。结合所有证据,最终确定所有证型均以半夏泻心汤联合党参、黄芪、丹参加减为君药组;脾虚湿蕴证联合参苓白术散、葛根芩连汤、藿香正气散加减;脾虚气滞证联合黄芪建中汤、四君子汤、小柴胡汤加减;肝胃不和证联合四逆散、四君子汤、保和丸加减。同时,根据不同体质、证型、症状、天气、地域等灵活化裁,并注意饮食管理和情绪调节。结论明确建立了个性化中医膏方治疗慢性胃炎的方案,为后续的组方分析和临床研究提供了基础,具有较好的方法学和报告质量。Objective To summarize and analyze the individualized Chinese herbal paste (CHP) in the treatment of chronic gastritis patients. Methods Combining retrospective case-series analysis and expert interview, the clinical data of patients diagnosed as chronic gastritis with spleen deficiency and dampness accumulation (SDDA), spleen deficiency with qi stagnation (SDQS), or disharmony of liver-stomach (DLS) syndrome in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2013 to August 2018 were reviewed. All patients accepted treatments with individualized CHP. Firstly, the patient’s syndrome characteristics and medication information were extracted, such as age, gender, syndrome types, medications, etc. Single factor analysis, multiple factor analysis and factor analysis were used to establish the preliminary treatment plans for different syndrome types of chronic gastritis with CHP. Then, the preliminary treatment plans were reviewed and modified by clinical expert with manuscript transcription and text analysis until no more information occurred. The statistical analysis was conducted with SPSS 17.0 and R software. Results A total of 498 patients with chronic gastritis using CHP were included, including 224 males (45%), 274 female (55%), average age of (41.87±12.22) years, and 263 (52.8%), 27 (5.4%), 208 (41.8%) patients with SDDA, SDQS, DLS syndrome respectively. A total of 196 traditional Chinese medicines (TCMs) were used. After univariate analysis, dichotomous regression analysis and factor analysis, 40, 32, and 41 TCMs were identified for the above three syndromes with CHP. Then, Professor Rui-fang Chen reviewed and revised the scheme for 10 rounds. All types of syndromes taking the Banxia Xiexin Decoction (半夏泻心汤) combined with Dangshen (Codonopsis Radix), Huangqi (Astragali Radix), and Danshen (Salviae Miltiorrhizae Radix et Rhizoma) as sovereign medicinal group. The SDDA syndrome should be treated combined with Shenling Baizhu Powder (参苓白术散), Gegen Qinl

关 键 词：慢性胃炎 膏方 脾虚气滞 脾虚湿蕴 肝胃不和 专家访谈 

分 类 号：R285.64[医药卫生—中药学]