“温阳健脾汤”治疗脾胃虚弱型慢性萎缩性胃炎的临床疗效观察

发布时间：2018-01-10 18:22

本文关键词：“温阳健脾汤”治疗脾胃虚弱型慢性萎缩性胃炎的临床疗效观察　出处：《北京中医药大学》2016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(Chronic atrophic gastritis CAG)是慢性胃炎的一种类型,其病程长,复发率较高,是消化系统的多发病、难治性疾病。慢性萎缩性胃炎由正常胃黏膜一炎症一萎缩一肠上皮化生一不典型增生一胃癌的演变规律已被大家公认。基于此,慢性萎缩性胃炎也已被明确定为癌前疾病,严重威胁人类健康。亚洲是慢性萎缩性胃炎发生的主要地区,其中又以中国和日本的发病率最高,且有相当一部分患者最后会恶化演变为胃癌。在年龄分布上,慢性萎缩性胃炎是老年人的常见病、多发病,其发病率随着年龄的增长也相应的增高。所以,及早的发现和识别癌前病变,进行有效的随访监测,最好能干预和阻断其恶化就成为降低胃癌发病率和死亡率的有效措施之一。慢性萎缩性胃炎作为一种由多种致病因素导致的消化系统慢性疾病,目前现代医学对其仍无特殊、有效的治疗方法,仍以对症治疗为主,而且西医治疗存在着复发率高、副作用较多等诸多弊端。近些年来,中医在慢性萎缩性胃炎的治疗上依靠合理的辨证论治,联合应用中药、中成药、针灸等多种治疗手段,取得了显著的治疗效果。中医治疗不仅可以在短时间内有效的改善患者的临床症状,最重要的是还可以在一定程度上逆转已经发生病变的胃粘膜,从而进一步阻止慢性萎缩性胃炎癌变的发生。可以说中医中药在慢性萎缩性胃炎的治疗方面拥有巨大的优势和广阔的前景。研究目标本研究是在导师治疗慢性萎缩性胃炎的临床经验的指导下,对其经验方“温阳健脾汤”治疗脾胃虚弱型慢性萎缩性胃炎的临床疗效进行观察,并借助专业的统计分析对其给予客观评价,从而为中医辨证论治脾胃虚弱型慢性萎缩性胃炎提供临床思路和依据。研究内容导师周斌主任医师通过总结长期的临床实践,主张临床上慢性萎缩性胃炎多以脾胃虚弱为主要病机,又结合中医关于脾肾“先天”和“后天”的相互资生关系理论,主张应以“温阳健脾、化瘀通络”作为慢性萎缩性胃炎的基本治则,并依据此治疗原则组方“温阳健脾汤”来治疗脾胃虚弱型慢性萎缩性胃炎,观察其治疗前后临床症状、胃镜及病理的变化。本次研究分为文献综述和临床实验研究两个部分。文献综述：比较系统的回顾和总结了慢性萎缩性胃炎现代医学的诊疗进展,并对慢性萎缩性胃炎所属的中医范畴、中医病因病机、辨证分型以及辨证治疗进行了系统的阐述。临床试验研究：收集中医辨证为脾胃虚弱型慢性萎缩性胃炎患者的病例,应用“温阳健脾汤”对其进行12周为一疗程的治疗,并在一个疗程结束后进行一定时间的随访,通过比较服药前后患者临床症状和胃镜、病理结果的变化,探讨“温阳健脾汤”治疗脾胃虚弱型慢性萎缩性胃炎的临床疗效。研究结果研究结果显示“温阳健脾汤”治疗脾胃虚弱型慢性萎缩性胃炎具有显著的疗效,其症状疗效总有效率为90.59%,其中痊愈率10.59%,显效率52.94%,有效率27.06%。在病理疗效方面,胃粘膜萎缩在胃窦的总有效率为83.05%,胃体为100%,胃角为64.52%；肠化在胃窦的总有效率为90.76%,胃体为73.33%,胃角为73.33%；本次研究中不典型增生在胃窦、胃角未出现无效病例,而胃体部因未收集到出现不典型增生的病例,这里不予讨论。结论“温阳健脾汤”对于治疗中医辨证为脾胃虚弱型的慢性萎缩性胃炎有很好的临床疗效,不仅能显著改善患者的临床症状,还能在不同程度上逆转胃粘膜的萎缩、肠化以及不典型增生。并且随着治疗时间的延长,患者的临床症状和胃粘膜病理的改善程度也是逐渐提高的。另外,通过一个疗程结束后的随访发现,停服“温阳健脾汤”后,仍有某些症状可以得到继续缓解,可见中药在降低复发率方面有一定的优势。
[Abstract]:On the background of chronic atrophic gastritis (Chronic atrophic gastritis CAG) is a type of chronic gastritis and its long duration, high recurrence rate, is a disease of the digestive system, refractory disease. Chronic atrophic gastritis from normal gastric mucosa inflammation a atrophy of intestinal metaplasia dysplasia gastric cancer a a evolution has been recognized. Based on this, chronic atrophic gastritis has been clearly identified as a precancerous disease, a serious threat to human health. Asia is the main area of chronic atrophic gastritis, and the incidence of China and Japan was high, and there is a considerable number of patients will eventually deteriorate the evolution of gastric cancer in the age distribution, chronic atrophic gastritis is a common disease in the elderly, the incidence, the incidence rate increased with age also increased. Therefore, the early discovery and identification of precancerous lesions, monitored effectively The best, can intervene and block the deterioration has become one of the effective measures to reduce the morbidity and mortality of gastric cancer. Chronic atrophic gastritis is caused by a variety of pathogenic factors of chronic diseases of digestive system, modern medicine to still no special, effective treatment for symptomatic treatment, still exist, and Western medicine treatment the recurrence rate is high, more side effects and many other disadvantages. In recent years, Chinese medicine in the treatment of chronic atrophic gastritis through reasonable diagnosis and treatment, the combination of traditional Chinese medicine, Chinese medicine, acupuncture and other therapies, the treatment effect was significant. The clinical symptoms of TCM treatment not only in a short period of time can effectively improve the patient's and the most important is also to some extent can reverse the pathological gastric mucosa, so as to further prevent the canceration of chronic atrophic gastritis. It can be said in Chinese Medicine Have a huge advantage and broad prospects for the treatment of chronic atrophic gastritis. The goal of this research is the clinical experience in the treatment of chronic atrophic gastritis in the teacher under the guidance of the clinical curative effects of the experience of "Wenyang Jianpi Decoction" in the treatment of chronic atrophic gastritis of spleen stomach deficiency were observed, and with the help of professional statistics give the analysis on the objective evaluation, so as to provide clinical basis for TCM syndrome differentiation of spleen and stomach type of chronic atrophic gastritis. The research content of Professor Zhou Bin by summing up the long-term clinical practice, advocates of clinical chronic atrophic gastritis with spleen and stomach is the main pathogenesis, and the combination of traditional Chinese medicine on spleen and kidney "congenital" and "acquired" mutual promotion relations theory, should be the "Wenyang Jianpi Huayu Tongluo," as the basic treatment for chronic atrophic gastritis, and on the basis of the treatment principle The prescription "Wenyang Jianpi Decoction" in treating chronic atrophic gastritis of spleen stomach deficiency, clinical symptoms were observed before and after treatment, the change of gastroscope and pathology. This study is divided into two parts: literature review and clinical trials. Literature review: systematic reviews and summarizes the advances in diagnosis and treatment of chronic atrophic gastritis in modern medicine, and category of TCM on chronic atrophic gastritis of the TCM etiology and pathogenesis, syndrome differentiation and treatment were described. Clinical research: collect syndrome of spleen and stomach type of chronic atrophic gastritis patients cases, application of "Wenyang Jianpi Decoction on the treatment for 12 weeks a course of treatment, and for a certain period of time in the end after a period of follow-up, by comparing before and after treatment in patients with clinical symptoms and gastroscope, pathological changes of the results, to explore the" Wenyang Jianpi Decoction "in the treatment of spleen stomach deficiency The clinical curative effect of weak type of chronic atrophic gastritis. Results: the results showed that the significant efficacy of Wenyang Jianpi Decoction "in the treatment of chronic atrophic gastritis of spleen stomach deficiency symptoms, the total effective rate was 90.59%, the cure rate was 10.59%, the effective rate was 52.94%, efficiency of 27.06%. In pathological effect, gastric mucosa atrophy in the antrum of the total efficiency was 83.05%, gastric body 100%, gastric angle 64.52%; intestinal metaplasia in gastric antrum of the total efficiency of 90.76%, gastric body 73.33%, gastric angle was 73.33%; the study of atypical hyperplasia in the gastric antrum, gastric angle does not appear invalid cases, and the body of the stomach because of the uncollected dysplasia cases, will not be discussed here. Conclusion Wenyang Jianpi Decoction has good curative effect for the treatment of TCM syndrome of spleen and stomach type of chronic atrophic gastritis, not only can significantly improve the clinical symptoms of the patients, but also in different The degree of reversal of gastric mucosal atrophy, intestinal metaplasia and atypical hyperplasia. And with the prolongation of treatment time, the degree of improvement in clinical symptoms and pathology of gastric mucosa is also gradually increased. In addition, through a course after the follow-up, stop taking "Wenyang Jianpi Decoction", there are still some symptoms you can continue to ease, the traditional Chinese medicine has some advantages in reducing the recurrence rate.

【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】：2016
【分类号】：R259

【相似文献】