顽固性幽门螺杆菌感染者行为干预治疗的临床研究和证型分布特点

发布时间：2018-04-23 06:05

本文选题：幽门螺杆菌 + 行为干预　；参考：《南京中医药大学》2016年硕士论文

【摘要】：背景：随着人类对HP研究的不断深入,人们正在逐渐认识到HP感染相关胃病是一种传染病。我们推测顽固性HP感染与未切断传播途径至再感染有关,切断传播途径有助于提高顽固性HP感染的根除,目的：采用三联疗法联合行为干预治疗顽固性HP感染,探讨行为干预在顽固性HP感染治疗中的作用。并总结分析顽固性HP感染者的证型分布特征。方法：选择2015年2月至2016年1月期间南京市中医院脾胃科门诊和住院病房符合Hp感染诊断标准的患者(多次Hp阳性或者治疗多次未成功患者),共60例,并采用随机分组与单肓法将其分为对照组(30例)和治疗组(30例)。对照组患者以PPI三联疗法配合铋剂：奥美拉唑20mg,2次/日、阿莫西林克拉维酸钾1.0g,2次/日,克拉霉素片0.5g,2次/日,枸橼酸铋钾胶囊220mg,2次/日。治疗组在PPI三联的同时予以切断传播途径的行为干预同步治疗。疗程均为10d,临床观察周期为1个月,1个月后采用C13呼气试验的方法复查HP根除情况。对相关资料进行统计学分析,比较治疗前后的临床疗效,同时对感染患者在性别、年龄、吸烟、家庭饮食习惯、外出就餐等多方而进行调查分析,以及研究顽固性幽门螺杆菌感染者的证型分布特点,探讨证型分布规律。结果：(1)经治疗后,60例患者中治疗组和对照组的临床有效率分别是56.7%与36.7%。与对照组相比,治疗组临床有效率提高20%,但无统计学差异(P0.05),治疗组根除Hp与家庭饮食习惯、外出就餐之间有统计学意义(P0.05),治疗组患者经行为干预治疗后明显改变了生活习惯,且减少在外就餐是顽固性HP感染治愈的促进因素(OR值为29；95%可信区间为3.5-241.1)(2)本研究中顽固性HP感染者中医症状分布特点由高到低排列为：腹胀(75.0%)嗳气(65.0%)口臭(48.3%)便溏(31.7%)胃痛(16.7%),其症状分布中多表现为腹胀,嗳气；本研究中顽固性HP感染者中医证型分布特点由高到低排列为：脾虚夹湿证(28.3%)肝气犯胃证(21.7%)脾胃虚寒证(20.0%)肝胃郁热证(15.0%)寒热夹杂证(11.7%)胃络瘀血证(3.3%)其症型分布中多见脾虚夹湿证。结论：本研究提示行为干预有助于HP的根除,治疗HP应注意切断传播途径。顽固性幽门螺杆菌患者中多见脾虚夹湿证。
[Abstract]:Background: with the development of human research on HP, people are gradually realizing that HP infection is an infectious disease. We speculate that intractable HP infection is related to non-cutting transmission route to re-infection. Cutting off transmission pathway is helpful to improve the eradication of refractory HP infection. Objective: to treat refractory HP infection by triple therapy combined with behavioral intervention. To explore the role of behavioral intervention in the treatment of refractory HP infection. The distribution characteristics of the syndrome type of refractory HP infection were summarized and analyzed. Methods: from February 2015 to January 2016, 60 patients (multiple HP positive or unsuccessful treatment) who met the diagnostic criteria of HP infection in the outpatient and inpatient wards of the Department of spleen and stomach, Nanjing traditional Chinese Medicine Hospital, were selected. They were randomly divided into control group (n = 30) and treatment group (n = 30). Patients in control group were treated with PPI triple therapy combined with bismuth: omeprazole 20 mg / d, amoxicillin clavulanate 1.0 g / d, clarithromycin tablet 0.5 g / d, bismuth potassium citrate capsule 220 mg / d. The treatment group was treated simultaneously by cutting off the transmission route by behavioral intervention in combination with PPI. The course of treatment was 10 days, and the clinical observation period was 1 month. After one month, HP eradication was reexamined by C 13 breath test. To carry on the statistical analysis to the related data, to compare the clinical curative effect before and after the treatment, at the same time to carry on the investigation and analysis to the infected patient in the sex, the age, the smoking, the family diet habit, the dining out and so on. To study the distribution characteristics of the syndrome type of intractable Helicobacter pylori infection, and to explore the distribution law of the syndrome type. Results the clinical effective rates of the treatment group and the control group were 56.7% and 36.7% respectively. Compared with the control group, the clinical effective rate in the treatment group increased by 20%, but there was no statistical difference (P 0.05). The treatment group eradicated HP and family eating habits, and there was significant difference between eating out and eating out. The patients in the treatment group changed their living habits obviously after behavioral intervention. The OR value of reducing eating out is 290.95% confidence interval is 3.5-241.1 / 2) in this study, the distribution of TCM symptoms of obstinate HP infection is from high to low: abdominal distension 75.0) belching (65.0) bad breath 48.33.0) loose stool 31.7m) The symptoms of stomach pain were mostly abdominal distension. Belching; In this study, the distribution of TCM syndromes in obstinate HP infections ranged from high to low as follows: spleen deficiency and dampness syndrome 28. 3C) liver-qi invading stomach syndrome 21. 7) spleen stomach deficiency cold syndrome 20. 0) liver and stomach stagnation heat syndrome 15. 0) cold and heat inclusion syndrome 11. 7) stomach collaterals stasis syndrome 3. 3) spleen deficiency and dampness syndrome. Conclusion: this study suggests that behavioral intervention is helpful to the eradication of HP and should be severed in the treatment of HP. Spleen deficiency and dampness syndrome are more common in obstinate Helicobacter pylori patients.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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