中西医结合治疗难治性反流性食管炎的临床疗效及对脑肠肽指标的影响  

Clinical effect of integrated Traditional Chinese and Western Medicine on refractory reflux esophagitis and its influence on brain-gut peptide index

作　　者：梁宇晗 何慧彬 郑敏 赵琰 王石红 LIANG Yuhan;HE Huibin;ZHENG Min;ZHAO Yan;WANG Shihong(Hebei College of Traditional Chinese Medicine,Shijiazhuang,050011,China;Department of Spleen and Stomach Diseases,the First Affiliated Hospital of Hebei College of Traditional Chinese Medicine)

机构地区：[1]河北中医学院,石家庄050011 [2]河北中医学院第一附属医院脾胃病科

出　　处：《中国中西医结合消化杂志》2023年第6期456-462,共7页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：国家中医临床研究基地建设项目[No:国中医药科技函(2018)131号];河北中医学院科研能力提升一般项目(No:KTY2019003);河北省重点研发计划中医药创新专项(No:202231104010136)。

摘　　要：目的:观察健脾疏肝汤联合雷贝拉唑治疗难治性反流性食管炎的临床疗效。方法:将2020年10月-2022年10月收治的难治性反流性食管炎患者随机分为对照组和研究组。对照组(43例)给予雷贝拉唑钠肠溶片(20 mg/次,1次/d)联合枸橼酸莫沙必利片(5 mg/次,3次/d)治疗,研究组(42例)给予健脾疏肝汤(200 mL/次,2次/d)联合雷贝拉唑钠肠溶片(20 mg/次,1次/d)治疗,均连续治疗8周。治疗前后分别观察两组患者的胃食管反流病-Q积分(gastroesophageal reflux disease,GERD-Q)、中医证候积分、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、内镜下黏膜积分情况;检测两组患者血清中脑肠肽指标P物质(substance P,SP)、5-羟色胺(5-hydroxytryptamine,5-HT)、胆囊收缩素(cholecystokinin,CCK)、胃动素(motilin,MTL)、胃泌素(gastrain,GAS)的水平,并观察研究期间出现的不良反应,治疗结束后第12周对GERD-Q积分<8分的患者进行随访,记录复发情况。结果:治疗后研究组GERD-Q积分(烧心、上腹疼痛、恶心、影响睡眠及总积分方面)、中医证候积分(胸骨后不适、胃脘胁肋痛、大便溏薄、咽部不适、抑郁或急躁易怒、胸闷喜太息、乏力体倦及总积分方面)、HAMA评分、内镜下黏膜积分均低于对照组,差异有统计学意义(P<0.05);研究组总有效率为90.5%,高于对照组的72.1%,差异有统计学意义(P<0.05);治疗后研究组的SP、MTL、GAS水平高于对照组,5-HT、CCK水平低于对照组,均差异有统计学意义(P<0.01);两组的不良反应发生率比较差异无统计学意义(P>0.05);治疗结束后第12周进行随访,研究组的复发率低于对照组,差异有统计学意义(P<0.05)。结论:健脾疏肝汤联合雷贝拉唑能够明显改善难治性反流性食管炎患者的临床症状,缓解焦虑状态,修复食管黏膜,可能与改善脑肠肽指标、促进食管动力、降低食管敏感性有关,且安全性良好,复发率低。Objective To observe the clinical effect of Jianpi Shugan Decoction combined with Rabeprazole on refractory reflux esophagitis.Methods From October 2020 to October 2022,patients with refractory reflux esophagitis were randomly divided into control group and experimental group.The control group(43 cases)were given Rabeprazole Sodium Enteric-Coated tablets(20 mg,one time/day)and Mosapride Citrate tablets(five mg,three times/day),the test group(42 cases)were given Jianpi Shugan Decoction(200 mL,two times/day)and Rabeprazole Sodium Enteric-Coated tablets(20 mg,one time/day),all treated continuously for eight weeks.Before and after treatment,the levels of gastroesophageal reflux disease-Q(GERD-Q),Traditional Chinese Medicine(TCM)syndrome,Hamilton anxiety scale(HAMA)and endoscopic mucosal integral in the two groups were observed.Substance P(SP),5-hydroxytryptamine(5-HT),cholecystokinin(CCK),motilin(MTL),and gastricin(GAS)in the serum of the two groups were observed.The adverse reactions were observed.The patients with GERD-Q scores less than eight were followed up 12 weeks after treatment,and the relapse was recorded.Results After treatment,GERD-Q score(heartburn,epigastric pain,nausea,affecting sleep and total score),TCM symptom score(retrosternal discomfort,epigastric hypochondriac pain,loose stool,throat discomfort,depression or impatience,chest distress,dyspnea,fatigue and total score),HAMA score and endoscopic mucosal score in the experimental group were lower than those in the control group.The total effective rate of the experimental group was 90.5%higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the levels of SP,MTL and GAS in the experimental group were higher than those in the control group,and the levels of 5-HT and CCK were lower than those in the control group,with statistical differences(P<0.01).There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Jianpi Shugan Decoction combined wi

关 键 词：健脾疏肝汤 难治性反流性食管炎 脑肠轴 肝郁脾虚 

分 类 号：R473.5[医药卫生—护理学]