李振华脾胃肝脏腑同治辨证方法治疗慢性萎缩性胃炎脾胃气（阳）虚型的临床研究

发布时间：2017-12-28 03:22

本文关键词：李振华脾胃肝脏腑同治辨证方法治疗慢性萎缩性胃炎脾胃气（阳）虚型的临床研究　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:1.观察李振华脾胃肝脏腑同治特色辨证方法的代表方香砂温中汤治疗慢性萎缩性胃炎(CAG)脾胃气(阳)虚患者的有效性与安全性;2.评价李振华脾胃肝脏腑同治特色辨证方法较一般辨证方法的优势;3.探讨香砂温中汤的部分作用机理。方法:收集符合本研究病例纳入标准并除外排除标准的慢性萎缩性胃炎200例。按西医诊断标准和中医辨证标准分为治疗组99例,对照组101例。前组以李振华脾胃肝脏腑同治辨证方法进行治疗,后组以一般辨证方法进行治疗。两组中有查Hp阳性者,可联合杀灭幽门螺旋杆菌四联疗法治疗14天,停药1月后可用C13呼气试验复查,检查结果无论阳性或阴性都应继续按治疗组或对照组方案进行。疗程均为6个月,研究期间停用本实验以外的药物。于开始治疗前及疗程结束后统计两组中医主症、次症及症状总积分和主要症状积分的变化,观察两组治疗前后的主症减轻及消失时间、症候及胃黏膜病理的变化,统计数据后进行分析。结果:1.两组治疗后中医主症、次症、症状总积分均较治疗前减少,差异具有统计学意义(P0.05),提示两组均能改善CAG患者的症状;治疗组治疗后主症减轻及消失时间均小于对照组,且差异具有显著性(P0.05),提示治疗组在减轻及改善CAG患者主要症状的时间上高于对照组,尤其是胃脘胀满、胃脘隐痛、食后不易消化等方面(P0.05);治疗组症候治愈率为67.8%,高于对照组53.5%(P0.05);总有效率为94.9%,高于对照组93.1%(P0.05)。2.治疗组胃黏膜萎缩治愈率为67.8%,高于对照组53.5%(P0.05);总有效率为73.9%,高于对照组42.6%(P0.05)。3.治疗组胃黏膜肠上皮化生治愈率为67.8%,高于对照组53.5%(P0.05);总有效率为47.9%,高于对照组40.7%(P0.05)。4.在所纳入的全部200份病例中,胃黏膜异型增生的共计有22例,由于其样本量少,统计结果缺乏可检验性,故未在文中具体描述。5.在本研究观察过程中,未见明显不良反应。结论:1.李振华教授脾胃肝脏腑同治辨证法可明显改善CAG脾胃气(阳)虚型患者的一般状况、主要症状,临床疗效确切;且其在改善及治愈症状的时间上优于一般辨证方法。2.李振华教授脾胃肝脏腑辨证法可明显改善及逆转CAG脾胃气(阳)虚型患者胃黏膜的萎缩,其综合疗效优于一般辨证方法。3.李振华教授脾胃肝脏腑辨证法较一般辨证方法在改善及逆转CAG脾胃气(阳)虚型患者胃黏膜的肠化方面无显著差异。4.李振华教授脾胃肝脏腑同治辨证方法疗效肯定、安全可靠,可广泛应用于临床。5.香砂温中汤治疗CAG近期疗效确切,其作用机理可能有保护、修复胃黏膜,促进胃排空、减轻症状,抗炎、增强免疫,改善循环、抑制萎缩等。
[Abstract]:Objective: To observe the liver spleen and stomach syndrome differentiation methods 1. Li Zhenhua Fu Tongzhi characteristics representative of Xiangsha Wenzhong Decoction in treating chronic atrophic gastritis (CAG) Spleen Qi (Yang) the efficacy and safety of virtual patients; 2. Li Zhenhua stomach liver organs Tongzhi differentiation methods than the general characteristics of dialectical method; 3. to investigate the mechanism of the effect of Xiangsha Wenzhong the soup. Methods: 200 cases of chronic atrophic gastritis, which were in accordance with the standard of this study and excluded from the standard, were collected. The treatment group was divided into 99 cases in the treatment group and 101 in the control group, according to the diagnostic standard of Western medicine and the standard of TCM syndrome differentiation. The former group was treated with the method of syndrome differentiation of Li Zhenhua's spleen and stomach liver and liver, and the latter group was treated with the general method of syndrome differentiation. In the two group, Hp positive patients were found to be able to kill Helicobacter pylori quadruple therapy for 14 days. After stopping the drug in January, the C13 breath test could be used to check the results. No matter positive or negative, the results should be continued according to the treatment group or the control group. The course of treatment was 6 months, and the drug was discontinued during the study. After the beginning of treatment and after the course of treatment, the changes of TCM syndromes, secondary symptoms, total symptom scores and main symptom scores of two groups were statistically analyzed. The changes of symptoms, symptoms, and gastric mucosal pathology in two groups before and after treatment were observed. Results: 1. of the two groups after treatment of TCM main symptoms and secondary symptoms, symptom scores were significantly reduced compared with before treatment, the difference was statistically significant (P0.05), suggesting that the two groups could improve the symptoms of CAG patients; the treatment group after treatment main symptoms alleviated or disappeared time were less than the control group, and the difference is significant (P0.05), the treatment group in reducing and improving the main symptoms of the patients with CAG time higher than that of control group, especially epigastric fullness, epigastric pain, after the food is not easy to digest and other aspects (P0.05); syndrome treatment group cure rate was 67.8%, 53.5% higher than the control group (P0.05); the total effective rate was 94.9%, higher than that of the control group 93.1% (P0.05). 2. the cure rate of gastric mucosa atrophy in the treatment group was 67.8%, higher than that of the control group (53.5% (P0.05)), and the total effective rate was 73.9%, higher than that of the control group (42.6% (P0.05)). 3. the cure rate of intestinal metaplasia in gastric mucosa was 67.8% in the treatment group, higher than that of the control group (53.5% (P0.05)), and the total effective rate was 47.9%, higher than that of the control group (40.7% (P0.05)). 4. in all the 200 cases of gastric dysplasia, a total of 22 cases, because of the small sample size, the lack of statistical test, it is not at the specific description. 5. in the study of this study, no obvious adverse reaction was found. Conclusion: 1. professor Li Zhenhua spleen liver organs Tongzhi dialectical method can obviously improve the CAG Spleen Qi (Yang) deficiency symptoms of general conditions and type of patients, clinical curative effect; and its superior in improvement and cure time of the symptoms on the general methods of syndrome differentiation. 2. professor Li Zhenhua spleen liver organs dialectical method can significantly improve the CAG and reversion of Spleen Qi (Yang) deficiency type in patients with gastric mucosal atrophy, the overall effect is better than the general method of differentiation. 3. professor Li Zhenhua spleen liver organs dialectical method than general dialectical method in improving CAG and reversion of Spleen Qi (Yang) no significant difference of intestinal mucosa in patients with type of deficiency of stomach. 4. professor Li Zhenhua's spleen and stomach liver and liver syndrome differentiation method is effective, safe and reliable, and can be widely used in clinical practice. The recent curative effect of 5. Xiangsha Decoction in the treatment of CAG precise temperature, its mechanism may protect and repair the gastric mucosa, promoting gastric emptying, reduce symptoms, anti-inflammatory, enhancing immunity, improving blood circulation, inhibit atrophy.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

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