替普瑞酮对幽门螺杆菌阴性萎缩性胃炎的黏膜保护作用及临床疗效研究

发布时间：2018-05-21 03:26

本文选题：替普瑞酮 + 萎缩性胃炎　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨替普瑞酮对幽门螺杆菌(Helicobacter pylori,Hp)阴性萎缩性胃炎患者的黏膜保护作用及临床疗效,为萎缩性胃炎的规范化治疗提供理论依据。方法:选取2016年1月至2016年12月在中国人民解放军海军总医院消化内科门诊及住院部就诊,经胃镜及病理检查诊断为萎缩性胃炎,且13C尿素呼气试验为Hp(-)的患者120名。将这120名患者随机分为替普瑞酮组(替普瑞酮胶囊)、铋剂组(胶体果胶铋胶囊)和安慰剂组(海军总医院药剂科自制淀粉药丸),每组40人,分别治疗12周,同时给予饮食习惯调查及指导。三组患者分别于治疗前(0周)及治疗后(12周)行胃镜下观察、病理组织活检及胃黏膜组织和微循环因子检测,并收集治疗前后的症状积分。比较三组患者间胃镜下胃黏膜病变程度积分、胃黏膜病理积分及症状积分的统计学差异性;比较三组患者分别于治疗前后胃黏膜组织因子(三叶因子1、氨基己糖)及微循环因子(胃泌素、前列腺素E2)变化的统计学差异并比较治疗后各组间的差异性。结果:1、治疗12周时评估胃镜下疗效,替普瑞酮组、铋剂组、安慰剂组总有效率分别为85%、75%、10%;替普瑞酮组较铋剂组无显著差异(χ~2=1.25,P0.05);替普瑞酮组与铋剂组胃镜下疗效均优于安慰剂组(P0.05)。2、治疗12周时评估胃黏膜病理组织变化情况,替普瑞酮组、铋剂组、安慰剂组总有效率分别为95.0%、87.5%、7.5%;替普瑞酮组较铋剂组无显著统计学差异(χ~2=0.63,P0.05);替普瑞酮组与铋剂组胃黏膜病理组织变化情况均优于安慰剂组(P0.05)。3、治疗12周时胃黏膜组织因子(三叶因子1、氨基己糖)及微循环因子(胃泌素、前列腺素E2)变化情况,替普瑞酮组与铋剂组均较安慰剂组有显著统计学差异(P0.05),替普瑞酮组较铋剂组无显著统计学差异(P0.05);替普瑞酮组与铋剂组治疗后较治疗前均有显著统计学差异(P0.05),安慰剂组治疗后较治疗前无显著统计学差异(P0.05)。4、治疗12周时评估症状改善情况,替普瑞酮组、铋剂组、安慰剂组总有效率分别为80%、75%、7.5%;替普瑞酮组较铋剂组无显著统计学差异(P0.05);替普瑞酮组与铋剂组症状改善情况情况均优于安慰剂组(P0.05)。5、铋剂组治疗过程中发生3例便秘,2例恶心。替普瑞酮组发生1例头痛。替普瑞酮组及铋剂组不良反应发生率分别为2.5%及12.5%。结论:(1)胃黏膜出现萎缩时微循环因子及萎缩部位的胃黏膜组织因子发生变化。胃黏膜萎缩部位三叶因子1(Trefoil Factor 1,TFF1)分泌减少。(2)萎缩性胃炎患者经治疗后TFF1含量显著增加,表明萎缩较前好转;经治疗后血清胃泌素水平显著上升,可能与萎缩好转相关。(3)三组患者经治疗后,观察组胃黏膜氨基己糖及血清前列腺素E2(Prostaglandin E2,PGE2)含量均较治疗前显著增加,观察组较对照组有显著统计学意义。胃黏膜保护剂能够显著增加氨基己糖及PGE2含量,即增强了胃黏膜保护因素。(4)替普瑞酮结合健康饮食宣教能够明显改善非Hp感染的萎缩性胃炎患者的上腹饱胀、上腹痛、嗳气、恶心、食欲减退等症状,且能调节胃黏膜组织因子及微循环因子至正常水平,修复胃黏膜,对Hp阴性的萎缩性胃炎具有良好的治疗效果,并且不良反应发生率较低,因此可于临床实践中推广应用。
[Abstract]:Objective: To investigate the protective effect and clinical effect of tipri on Helicobacter pylori (Hp) negative atrophic gastritis, and to provide a theoretical basis for the standardized treatment of atrophic gastritis. Methods: from January 2016 to December 2016, the Department of Gastroenterology and inpatient department of Navy PLA General Hospital were selected. Patients were diagnosed as atrophic gastritis with gastroscopy and pathological examination, and 120 patients with 13C urea breath test were Hp (-). The 120 patients were randomly divided into tepreone group (tepreone capsule), bismuth group (Colloidal Bismuth Pectin Capsules) and placebo group (self-made starch pill) in Navy General Hospital, 40 people in each group for 12 weeks, and at the same time, at the same time. The three groups were observed before the treatment (0 weeks) and after the treatment (12 weeks), the pathological biopsy and gastric mucosa tissue and microcirculation factors were detected, and the symptom scores before and after the treatment were collected. The score of the gastric mucosa lesion degree under the gastroscope, the pathological score of the gastric mucosa and the symptom score were compared between the three groups. Statistical difference in the three groups of patients before and after treatment were compared with the changes of gastric mucosal tissue factor (Trifolium factor 1, amino hexose) and microcirculation factor (gastrin, prostaglandin E2) and the differences after treatment. Results: 1, the therapeutic effect was evaluated at 12 weeks, tepreone group, bismuth group, and placebo. The total effective rate of the group was 85%, 75%, 10%, and there was no significant difference between the tepreone group and the bismuth group (x ~2=1.25, P0.05). The efficacy of the tepreone group and the bismuth group was better than that of the placebo group (P0.05).2, and the pathological changes of the gastric mucosa were evaluated at 12 weeks. The total effective rate of the tepreone group, the bismuth group and the placebo group was 95%, 87.5%, 7.5%, respectively. There was no significant difference between the tepreone group and the bismuth group (x ~2=0.63, P0.05); the pathological changes of gastric mucosa in the tepreone group and the bismuth group were better than those of the placebo group (P0.05).3. The changes of gastric mucosal tissue factor (Trifolium factor 1, amino hexose) and microcirculation factor (gastrin, prostaglandin E2) in the group of tepreone at 12 weeks, and the tepreone group and the group of tepreone There was significant difference between the bismuth group and the placebo group (P0.05). There was no significant difference between the tepreone group and the bismuth group (P0.05). There was significant difference between the tepreone group and the bismuth group before the treatment (P0.05). There was no significant difference between the placebo group and the pre treatment group (P0.05).4. The symptoms were evaluated at 12 weeks. The total effective rate of the tepreone group and the bismuth group was 80%, 75%, 7.5%, respectively, and there was no significant difference between the tepreone group and the bismuth group (P0.05). The improvement of the symptoms of the tepreone group and the bismuth group was better than that of the placebo group (P0.05).5, and 3 cases of constipation, 2 nausea in the bismuth group and 1 of the tepreone group in the bismuth group. Cases of headache. The incidence of adverse reactions in the tepreone group and the bismuth group was 2.5% and 12.5%. respectively: (1) the microcirculation factor and the gastric mucosal tissue factor in the atrophy of gastric mucosa were changed. The decrease of the trifoliate factor 1 (Trefoil Factor 1, TFF1) in the atrophy of the gastric mucosa was reduced. (2) the TFF1 content of the atrophic gastritis patients after treatment. The level of atrophy was better than before, and the level of serum gastrin increased significantly after treatment. (3) after treatment, the contents of amino hexose and serum prostaglandin E2 (Prostaglandin E2, PGE2) in the gastric mucosa of the three groups were significantly higher than those before the treatment. The observation group had significant statistical significance compared with the control group. Mucosal protective agents can significantly increase the content of amino hexose and PGE2, that is, enhancing the protective factors of gastric mucosa. (4) tepridone combined with healthy diet education can obviously improve the upper abdominal distention, upper abdominal pain, belching, nausea, anorexia and other symptoms of non Hp infected atrophic gastritis, and can regulate gastric mucosal tissue factor and microcirculation factor. To the normal level, the repair of gastric mucosa has good therapeutic effect on Hp negative atrophic gastritis, and the incidence of adverse reactions is low, so it can be applied in clinical practice.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.32

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