“健脾通络汤”治疗慢性萎缩性胃炎脾胃虚弱证的临床疗效及安全性研究

发布时间：2018-01-02 09:47

本文关键词：“健脾通络汤”治疗慢性萎缩性胃炎脾胃虚弱证的临床疗效及安全性研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景慢性萎缩性胃炎属于胃癌前疾病,是胃癌发生的重要环节之一。慢性萎缩性胃炎在老年人患病率高,且发病年龄趋于年轻化,一般认为其与幽门螺旋杆菌感染、非甾体类药物使用、不良的生活习惯、十二指肠反流、免疫因素等密切相关。病理活检是确诊慢性萎缩性胃炎的金标准。目前西医治疗方式包括根除幽门螺杆菌治疗、对症治疗、十二指肠胃反流的治疗以及内镜下手术治疗。治疗效果不甚理想,复发率高,症状易反复,药物副作用多等。中医在治疗慢性萎缩性胃炎方面经验丰富,具有明显的优势与特色,表现在改善症状、逆转胃黏膜腺体萎缩、肠化及不典型增生,延缓或阻止病情进展、提高患者的生存质量、防止癌变等方面,且安全可靠、不良反应较少。研究目的本研究以导师多年的临床经验总结为基础,观察导师经验方"健脾通络汤"对慢性萎缩性胃炎的临床疗效及安全性。研究内容本论文分为文献综述和临床研究两部分:第一部分文献综述回顾总结近些年关于CAG的现代医学研究进展和中医药研究现状。慢性萎缩性胃炎属于中医的"痞满"、"胃脘痛"、"胃痞"等范畴,以"痞、胀、痛"为三大主症。本病主要病因病机为脾胃虚弱,寒、痰、湿、热等邪困扰脾胃,阻滞气机,脾胃气机升降失司,或脾胃气阴两虚,胃络失养,久则痰瘀毒邪深入胃络所致。病性总属本虚标实、虚实夹杂之证。中医的诊断以宏观辨证和微观辨证结合,治疗以辨证论治、专方专药等治疗为主,将胃镜与辨证结合,延伸四诊内容。西医治疗存在局限性,对于病理的逆转尚无确切的解决方案。第二部分临床观察研究方法收集慢性萎缩性胃炎且中医辨证为脾胃虚弱证患者,共纳入144例,予慢性萎缩性胃炎脾胃虚弱证的患者导师经验方"健脾通络汤"口服治疗,连续服药12周,于第0、2、4、6、8、10及12周由研究者填写调查表。疗程结束后行胃镜及胃黏膜病理组织学检查,进行疗效评价。同时对血常规、肝肾功能及心电图等安全性指标进行评价。计量资料使用T检验,以均数±标准差表示,计数资料使用χ2检验,等级资料应用秩和检验。应用SPSS21.0统计分析系统进行本次试验研究所有的统计计算分析。研究结果"健脾通络汤"对慢性萎缩性胃炎脾胃虚弱证的疗效显著,其治疗的总有效率为88.19%,其中痊愈率为9.03%,显效率为39.58%,有效率为39.58%。可改善胃黏膜的病理状态,在一定程度上逆转腺体萎缩、肠化和异型增生,其中:胃窦部萎缩治疗的总有效率为82.76%,肠化生治疗的总有效率为86.14%,异型增生的总有效率为100%,慢性炎症的总有效率为64.42%;胃角部萎缩治疗的总有效率为78.95%,肠化生治疗的总有效率为75.00%,异型增生的总有效率为100%,慢性炎症的总有效率为51.11%;胃体部位萎缩的总有效率为88.24%,肠上皮化生的总有效率为58.33%,异型增生的总有效率为100%,慢性炎症的总有效率为45.65%。治疗期间患者无不良反应发生,血常规、肝功能、肾功能指标均在正常值范围内,心电图检查与治疗前无差异,安全级别1级。研究结论:"健脾通络汤"在治疗脾胃虚弱证慢性萎缩性胃炎效果明显,可迅速改善患者临床胃脘症状,对萎缩、肠化及异型增生均有逆转作用,且安全可靠,无不良反应发生。
[Abstract]:On the background of chronic atrophic gastritis to gastric precancerous disease, is one of the important link of gastric cancer. Chronic atrophic gastritis in the elderly high prevalence rate, and the incidence in younger age, generally considered the infection with Helicobacter pylori, non steroidal drug use, bad habits, duodenal reflux, immune factors closely related. Biopsy is the gold standard for diagnosis of chronic atrophic gastritis. The western medicine treatment includes Helicobacter pylori eradication therapy, symptomatic treatment, twelve refers to the treatment of surgery and endoscopic gastric reflux. The therapeutic effect is not ideal, high recurrence rate, the symptoms of easy relapse, the side effects of the drug. Many Chinese in the treatment of chronic atrophic gastritis with rich experience, has obvious advantages and characteristics, in improving symptoms, reversal of gastric mucosa gland atrophy, intestinal metaplasia and atypical hyperplasia, delay or prevent disease Progress, improve the quality of life of patients, prevent cancer and other aspects, and it is safe and reliable, less adverse reaction. The purpose of this study is to summarize the clinical experience of tutor based on tutor experience "Jianpi Tongluo Decoction" clinical efficacy and safety of chronic atrophic gastritis. The research content of this paper is divided into two parts literature review and clinical research: the first part is literature review summary in recent years modern medical studies on the progress of CAG and traditional Chinese medicine research. Chronic atrophic gastritis belongs to Chinese medicine, "fullness", "stomachache", "Weipi" and so on, "swelling, swelling, pain" as the three main symptoms. The main pathogenesis is weakness of the spleen and stomach, cold, wet, phlegm, heat evil stomach distress, stagnation of Qi, spleen and stomach qi dysfunction, or spleen qi and yin deficiency, stomach meridian dystrophy, long the phlegm and blood stasis toxin into stomach meridian disease caused. The total of this standard is false, false is mixed The diagnosis of Chinese medicine syndrome. In macro and micro differentiation combined with syndrome differentiation, treatment based on syndrome differentiation, specific drug treatment, combination of gastroscope and syndrome differentiation, extended diagnostic content. The limitations of Western medicine treatment, solution for pathological reversal. In the second part, there is no precise clinical observation research methods of chronic atrophy gastritis and TCM for patients with spleen stomach deficiency, a total of 144 patients were enrolled, patients with tutor experience "to the chronic atrophic gastritis of spleen stomach deficiency of Jianpi Tongluo Decoction oral treatment, medication for 12 weeks and 12 weeks in the 0,2,4,6,8,10 survey by researchers. In the end of the treatment after gastroscopy and gastric mucosal histopathology. To evaluate the curative effect. At the same time to evaluate the blood routine, liver and kidney function and ECG and other safety indicators. Using T test measurement data, the mean standard deviation of that the 2 test was used for count data, etc. Grade data using rank sum test. This test studied all the statistical analysis using SPSS21.0 statistical analysis system. The results of the study "effect of Jianpi Tongluo Decoction on chronic atrophic gastritis of spleen stomach deficiency significantly, the total effective rate of treatment was 88.19%, the cure rate was 9.03%, the effective rate was 39.58%, efficiency for 39.58%. can improve the pathological state of gastric mucosa, to a certain extent, reverse the gland atrophy, intestinal metaplasia and dysplasia, including: gastric antrum atrophy treatment the total effective rate was 82.76%, the treatment of intestinal metaplasia of the total effective rate was 86.14%, abnormal hyperplasia of the total effective rate was 100%, the total efficiency of chronic inflammation 64.42%; stomachcorner atrophy treatment the total effective rate was 78.95%, the treatment of intestinal metaplasia dysplasia, the total effective rate was 75%, the total effective rate was 100%, chronic inflammation of the total efficiency of 51.11%; gastric body atrophy of the total efficiency of 88.24 %, intestinal metaplasia dysplasia, the total effective rate was 58.33%, the total effective rate was 100%, chronic inflammation of the total efficiency of 45.65%. during the treatment of patients with no adverse reactions, blood routine, liver function, renal function indexes were in the normal range, electrocardiogram and no difference before treatment, security level 1 conclusions: "Jianpi Tongluo Decoction" in the treatment of spleen stomach deficiency syndrome of chronic atrophic gastritis is obvious, it can rapidly improve the clinical symptoms of patients with stomach, atrophy, intestinal metaplasia and dysplasia were reversed, and it is safe and reliable, no adverse reaction.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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