铝碳酸镁与泮托拉唑在反流性食管炎治疗中的作用比较研究

发布时间：2018-05-10 08:09

本文选题：铝碳酸镁 + 反流性食管炎　；参考：《南华大学》2014年硕士论文

【摘要】：目的：通过观察反流性食管炎(Reflux Esophagitis,RE)患者经铝碳酸镁联合多潘立酮治疗前后的临床疗效、内镜下食管炎愈合情况、药物不良反应及表皮生长因子受体(Epidermal Growth Factor Receptor,EGFR)的表达变化情况，探讨铝碳酸镁在反流性食管炎中的临床疗效和EGFR在RE中的表达及临床意义。方法：根据2005年美国胃肠病学会最新发表的反流性食管炎的诊治指南[1]及2000年中华医学会消化内镜学会制定的反流性食管炎的诊断及治疗方案（试行）[2]，经胃镜检查，选取64例我院2012年11月-2013年10月消化内科门诊及住院确诊为反流性食管炎的患者。将入选的反流性食管炎患者按照就诊先后顺序编号，按随机数字表随机分入观察组和对照组：观察组（33例）给予铝碳酸镁1.0g Tid餐后两小时温水泡服，多潘立酮10mg Tid餐前半小时口服，治疗周期为8周；对照组（31例）给予泮托拉唑40mg Bid晨起空腹及睡前服用，多潘立酮10mg Tid餐前半小时口服，治疗周期为8周。入选观察组及对照组患者均于开始治疗前及治疗8周后分别行血、尿、粪常规、肝肾功能、电子胃镜检查及行食管组织活检，应用免疫组化法测定食管黏膜EGFR的表达水平。结果：两组间治疗前患者烧心、反酸及胸痛症状积分比较差异无统计学意义（P＞0.05），按各组方案治疗8周后，两组治疗后均可显著降低RE患者症状积分，，差异均有统计学意义（P＜0.05），两组间治疗后症状积分比较差异无统计学意义（P＞0.05）；两组间治疗前内镜下反流性食管炎表现比较差异无统计学意义（P＞0.05），两组患者在第8周时复查胃镜，内镜下治愈率和有效率相比差异无统计学意义（P＞0.05），两组间治疗后内镜下表现比较无统计学意义（P＞0.05）；按各组方案治疗8周后，两组间治疗后不良反应比较差异有统计学意义（P＜0.05）；两组间治疗前EGFR阳性表达率比较差异无统计学意义（P＞0.05），按各组治疗方案治疗8周后，两组EGFR阳性表达率均较治疗前逐渐升高，差异有统计学意义（P＜0.05）。结论：1.铝碳酸镁缓解RE患者临床症状的疗效与泮托拉唑相当，而铝碳酸镁大大减少了药物不良反应，且能迅速中和酸性和碱性的反流物，在治疗酸碱混合性反流方面有广泛的应用前景。 2.铝碳酸镁可能通过上调EGFR表达促进反流性食管炎愈合，提示EGFR可能在食管炎的修复过程中起着重要作用。
[Abstract]:Objective: to observe the clinical efficacy, endoscopic esophagitis healing, adverse drug reactions and the expression of epidermal growth factor receptor epidermal Growth Factor receptor (EGFR) in patients with reflux esophagitis reflux before and after treatment with magnesium bicarbonate and domperidone. To investigate the clinical effect of magnesium bicarbonate in reflux esophagitis and the expression of EGFR in RE and its clinical significance. Methods: according to the guidelines for the diagnosis and treatment of reflux esophagitis published by the American Gastroenterology Society in 2005 [1] and the diagnostic and therapeutic plan for reflux esophagitis developed by the Chinese Medical Association of digestive endoscopy in 2000 (trial), gastroscopy was performed. 64 patients with reflux esophagitis were selected from November 2012 to October 2013. Patients with reflux esophagitis were randomly divided into observation group (n = 33) and control group (n = 33). Domperidone 10mg Tid was taken orally half an hour before meal, the treatment period was 8 weeks, the control group was treated with pantazol 40mg Bid on an empty stomach and before bedtime, and domperidone 10mg Tid was taken half an hour before meal, the treatment period was 8 weeks. The patients in the observation group and the control group were treated with blood, urine, fecal routine, liver and kidney function, electronic gastroscopy and esophageal biopsy before treatment and 8 weeks after treatment, respectively. The expression of EGFR in esophageal mucosa was determined by immunohistochemical method. Results: there was no significant difference in the score of heartburn, acid regurgitation and chest pain between the two groups before treatment (P > 0.05). The difference was statistically significant (P < 0.05), there was no significant difference in symptom score after treatment between the two groups (P > 0.05), and there was no significant difference in the manifestations of endoscopic reflux esophagitis between the two groups before treatment (P > 0.05). There was no significant difference in the cure rate and the effective rate between the two groups (P > 0.05), but there was no significant difference between the two groups (P > 0.05). There was no significant difference in the expression rate of EGFR between the two groups before and after treatment (P > 0.05). After 8 weeks of treatment, the positive expression rate of EGFR in the two groups was gradually higher than that before treatment. The difference was statistically significant (P < 0.05). Conclusion 1. The efficacy of magnesium bicarbonate in relieving clinical symptoms in patients with RE was comparable to that of pam Tora, while magnesium bicarbonate significantly reduced adverse drug reactions and quickly neutralized acid and alkaline reflux. In the treatment of acid-base mixed reflux has a wide range of applications. 2. It is suggested that EGFR may play an important role in the repair of esophagitis by upregulating the expression of EGFR to promote the healing of reflux esophagitis.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

【参考文献】