加味清中汤治疗上腹痛综合征脾胃湿热证的临床研究  

Clinical Study on Jiawei Qingzhong Decoction in Treating Upper Abdominal Pain Syndrome with Spleen and Stomach Damp-heat Syndrome

作　　者：麦联任 曾微微 谢红丹[1] MAI Lianren;ZENG Weiwei;XIE Hongdan(Department of Spleen,Stomach and Liver Diseases,Hainan Provincial Hospital of Traditional Chinese Medicine,Haikou 570203 Hainan,China)

机构地区：[1]海南省中医院脾胃肝病科,海南海口570203

出　　处：《中药新药与临床药理》2022年第2期255-260,共6页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：海南省卫生计生行业科研项目(20A200281)。

摘　　要：目的评价加味清中汤治疗上腹痛综合征(EPS)脾胃湿热证的临床疗效及对内脏敏感性和脑-肠轴的影响。方法将120例患者随机分为对照组和观察组,每组各60例。对照组口服达立通颗粒,观察组口服加味清中汤,均连续服用1个月。于治疗前后观察上腹痛、上腹烧灼感、功能性消化不良症状日记(FDSD)、尼平消化不良指数(NDI)和脾胃湿热证评分;以液体营养餐负荷试验(LNLT)比较两组初始感觉阈值时饮入量(TV)和最大饱足感时饮入量(MV);检测治疗前后5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)、P物质(SP)、胃动素(MTL)、胃泌素(GAS)、胃饥饿素和血管活性肠肽(VIP)水平。并对其安全性进行评价。结果观察组愈显率为80.00%(44/55),高于对照组的59.26%(32/54)(χ^(2)=5.552,P<0.05)。治疗后,两组患者上腹痛、上腹烧灼感和脾胃湿热证评分显著下降(P<0.01),且观察组评分低于对照组(P<0.01)。治疗后,两组患者上腹部相关症状和整体症状严重程度评分均显著下降(P<0.01),且观察组评分低于对照组(P<0.01)。治疗后,两组患者TV和MV显著升高(P<0.01),且观察组TV和MV高于对照组(P<0.01)。治疗后,两组NDI量表紧张/焦虑、日常生活的影响、饮食、认知/自控力和工作/学习5个因子评分均显著下降(P<0.01),且观察组患者5个因子评分更低(P<0.01)。治疗后,两组5-HT、CGRP水平显著下降,SP水平明显升高(P<0.01);且观察组患者5-HT、CGRP水平低于对照组(P<0.01),SP水平高于对照组(P<0.01);两组MTL、GAS、胃饥饿素水平均显著升高,VIP水平下降(P<0.01);观察组患者MTL、GAS、胃饥饿素高于对照组(P<0.01),VIP水平低于对照组(P<0.01)。没有发现加味清中汤和达立通颗粒相关的不良反应。结论加味清中汤能调节EPS脾胃湿热证患者内脏神经敏感性和脑肠互动关系,改善近端胃功能,有效减轻临床症状,提高生活质量,临床愈显率优于达立通颗粒,且使用安全Objective To observe the clinical efficacy of Jiawei Qingzhong decoction in treating epigastric pain syndrome(EPS)with spleen-gastric damp-heat syndrome and its influence on visceral sensitivity and brain-gut axis.Methods One hundred and twenty patients were randomly divided into control group and observation group,60 cases in each group. In the control group,Dalitong granules were taken orally,and course continued for one month. Patients in the observation group continuously took Jiawei Qingzhong decoction for one month. The upper abdominal pain, upper abdominal burning sensation were observed, and the functional dyspepsia symptom diary(FDSD),nipin dyspepsia index(NDI)and spleen and stomach damp-heat syndrome grade were recorded and scored.The liquid nutrient meal load test(LNLT)was conducted to compare the threshold volume(TV)and maximum volume(MV)of the two groups. 5-hydroxytryptamine(5-HT),calcitonin gene-related peptide(CGRP),substance P(SP),motilin(MTL),gastrin(GAS),ghrelin and vasoactive intestinal peptide were detected. A safety evaluation was also conducted. Results The observation group became more effective at 80.00%(44/55),which was higher than 59.26%(32/54)in the control group(χ^(2)=5.552,P<0.05). After treatment,the scores of upper abdominal pain,burning sensation in the upper abdomen, and spleen-stomach damp-heat syndrome of the two groups were significantly decreased(P<0.01), while the scores of upper abdominal pain, burning sensation in the upper abdomen and spleen-stomach damp-heat syndrome in the observation group were lower than those in the control group(P<0.01).After treatment, the upper abdomen-related symptoms and overall symptom severity scores of the two groups of patients decreased significantly(P<0.01). The upper abdomen-related symptoms and overall symptom severity scores of the observation group were lower than those of the control group(P<0.01). The TV and MV of the observation group were higher than those of the control group(P<0.01). After treatment, the scores of the five factor

关 键 词：上腹痛综合征 脾胃湿热证 加味清中汤 南药 内脏敏感性 脑-肠轴 

分 类 号：R285.6[医药卫生—中药学]