中医“和法”治疗胃癌术后反流性食管炎的疗效  

Therapeutic effect of traditional Chinese medicine harmonizing method on refluxesophagitis after gastric cancer surgery

作　　者：赵志幸 郭启涛 史晓花 刘亚莉 李路宝 霍献红 杨玉巧[1] ZHAO Zhixing;GUO Qitao;SHI Xiaohua;LIU Yali;LI Lubao;HUO Xianhong;YANG Yuqiao(Handan Hospital of Traditional Chinese Medicine,Handan 056001,China)

机构地区：[1]邯郸市中医院,河北邯郸056001

出　　处：《长春中医药大学学报》2024年第5期536-541,共6页Journal of Changchun University of Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(2019381)。

摘　　要：目的探讨中医“和法”联合针刺治疗胃癌术后反流性食管炎的疗效及对血清miR-223、miR-181a的影响。方法选取2019年3月-2022年8月于我院行胃癌手术后出现反流性食管炎的患者86例为研究对象,按照随机数字表法分为对照组和观察组,各43例。对照组采用奥美拉唑肠溶胶囊和多潘立酮片,观察组在对照组基础上,采用柴胡加龙骨牡蛎汤加减联合针刺治疗。比较2组患者临床疗效、中医症状积分、胃肠激素、炎症因子、miR-223、miR-181a等指标。采用Pearson相关分析miR-223、miR-181a与炎症因子的关系,采用多因素Logistic回归和ROC曲线分析miR-223、miR-181a对反流性食管炎复发的预测价值。结果观察组总有效率高于对照组(P<0.05)。治疗后,观察组的中医症状积分低于对照组(P<0.001),观察组的GAS、MTL水平高于对照组(P<0.001),观察组的白细胞介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均低于对照组(P<0.001),观察组miR-223水平低于对照组,miR-181a水平高于对照组(P<0.001)。血清miR-223水平与IL-1β、IL-6、TNF-α水平呈正相关(P<0.001),血清miR-181a水平与IL-1β、IL-6、TNF-α水平呈负相关(P<0.001)。miR-223为反流性食管炎复发的独立危险因素(OR=2.184,P<0.001),miR-181a为反流性食管炎复发的独立保护因素(OR=0.268,P<0.001)miR-223、miR-181a及二者联合预测的AUC分别为0.837、0.811、0.934,二者联合预测优于各自单独预测效能(Z=7.168、9.376,P<0.001)。结论中医“和法”联合针刺能提高胃癌术后反流性食管炎患者疗效,改善症状,调节胃肠激素,抑制炎症反应,降低血清miR-223水平,提高miR-181a水平,血清miR-223、miR-181a均是反流性食管炎复发的独立影响因素,二者联合对反流性食管炎复发有很好的预测价值。Objective To explore the therapeutic effect of traditional Chinese medicine"harmonizing method"combined with acupuncture on reflux esophagitis after gastric cancer surgery and its effect on serum miR-223 and miR-181a.Methods 86 patients with reflux esophagitis after gastric cancer surgery in Handan Hospital of Traditional Chinese Medicine from March 2019 to August 2022 were selected as the research objects.According to random number table method,they were divided into the control group and the observation group,with 43 cases in each group.The control group was treated with omeprazole enteric-coated capsules and domperidone tablets,and the observation group was treated with Adjusted Chaihulonggumuli Decoction combined with acupuncture on the basis of the treatment of the control group.The clinical efficacy,traditional Chinese medicine(TCM)symptom scores,gastrointestinal hormones,inflammatory factors,miR-223,miR-181a and other indicators were compared between two groups.Pearson correlation analysis was used to analyze the relationship between miR-223,miR-181a and inflammatory factors.Multivariate Logistic regression and ROC curve were used to analyze the predictive value of miR-223 and miR-181a for reflux esophagitis recurrence.Results The total effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,the TCM symptom score of the observation group was lower than that of the control group(P<0.001).After treatment,the levels of GAS and MTL in the observation group were higher than those in the control group(P<0.001).After treatment,the levels of interleukin(IL)-1β,IL-6 and tumor necrosis factor-α(TNF-α)in the observation group were lower than those in the control group(P<0.001).After treatment,the level of miR-223 in the observation group was lower than that in the control group,and the level of miR-181a was higher than that in the control group(P<0.001).The serum level of miR-223 was positively correlated with the levels of IL-1β,IL-6 and TNF-α(P<0.001),and the

关 键 词：中医“和法” 胃癌术后 反流性食管炎 肝胃不和型 miR-223 miR-181a 

分 类 号：R256.3[医药卫生—中医内科学]