紫苏四香散加味方治疗慢性糜烂性胃炎（肝胃郁热型）的临床疗效观察

发布时间：2018-06-14 08:36

本文选题：紫苏四香散加味方 + 泮托拉唑钠肠溶胶囊　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的通过观察紫苏四香散加味方联合西药(泮托拉唑钠肠溶胶囊)治疗肝胃郁热型慢性糜烂性胃炎的临床疗效及其对相关炎性因子的影响,进一步探讨该方药在防治CEG上的作用机理,客观的评价其安全性和有效性,为临床治疗CEG提供更广泛的思路和理论依据。方法选取从2015年3月至2016年4月于武汉市中心医院中医科及消化内科的门诊及住院部的经胃镜确诊为慢性糜烂性胃炎,经过中医辨证后为肝胃郁热型的患者60例,然后随机的分为两组即治疗组和对照组。两组患者中若有幽门螺旋杆菌(Hp)感染者,先给予根除Hp治疗2周。之后对照组的患者给予泮托拉唑钠肠溶胶囊口服,40mg/次,2次/日;治疗组的患者是在对照组的基础上给予导师的经验方即紫苏四香散加味方治疗,方药主要由下列药物组成:紫苏梗10克,藿香10克,香附20克,降香10克,沉香10克,木香10克,黄芪15克,丹参15克,蒲公英15克,鸡内金15克,炒二芽各20克,枳壳10克,厚朴10克,海螵蛸15克,炙甘草6克,中药饮片及中药煎剂均由湖北天济饮片公司提供,每天1剂,口服,200ml-250ml/次,2次/日。60例患者的疗程均为8周。治疗结束之后,观察两组患者治疗前后的中医证候的相关疗效、单个中医临床症状的疗效、中医症状的总积分、消化内镜下胃黏膜的改善情况、Hp的转阴率、临床的综合治疗效果及两组患者治疗后的炎性因子水平(包括CRR和IL-6水平)以及患者治疗期间的不良反应。除此之外,还有停药2周后对治疗有效患者的随访观察,观察其在随访6个月中的复发情况。收集数据后采用SPSS19.0软件来进行统计学分析计算,计量资料服从正态分布的采用t检验,非正态分布的采用非参数检验;无序的计数资料用卡方检验,有序的计数资料用非参数检验。结果(1)在改善患者的单个中医症状的相关疗效方面,比如其胃痛、饱胀感、嗳气、泛酸症状的改善,两组患者比较有统计学差异(P0.05);(2)在降低患者的中医症状总积分方面,在治疗前,治疗组及对照组的总积分分别为15.40±1.19,14.87±1.33,治疗后的分别为3.67±0.71,7.30±0.88,治疗后两组患者的总积分均较治疗前有所下降,但治疗组降低的更为明显,两组比较有统计学意义(P0.05)。(3)在改善患者中医证候方面,治疗组的有效率为96.67%,对照组的有效率为73.33%,其中治疗组差异更为显著,两组间比较提示有差异(P0.05)。(4)在消化内镜下胃黏膜改善的方面,治疗组的有效率为90.00%,对照组的有效率为66.67%。经过统计学的计算比较,得出两组之间的数据具有统计学的意义(P0.05)。(5)在两组患者的炎症因子的变化方面,治疗后,两组CRP、IL-6水平均降低;且治疗组在治疗后的CRP、IL-6水平均低于对照组在治疗后水平,经比较,P0.05,两组之间有统计学意义。(6)在根除Hp方面,治疗组和对照组的转阴率分别为40.00%、13.33%,经过比较得出两组之间有统计学意义(P0.05)。(7)在临床综合疗效方面,治疗组与对照组的总有效率分别为93.33%、70.00%,经比较,差异具有统计学意义(P0.05)。(8)治疗结束6个月后,随访治疗有效患者,治疗组及对照组复发率分别为7.14%、47.62%,差异具有统计学意义(P0.05)。结论(1)在缓解慢性糜烂性胃炎患者的中医临床症状、降低患者的中医证候积分、修复胃镜下胃黏膜的糜烂程度以及抗Hp上,泮托拉唑钠肠溶胶囊及紫苏四香散加味方均能够达到治疗效果,但紫苏四香散加味方联合泮托拉唑肠溶胶囊其治疗效果更为明显。(2)紫苏四香散加味方联合泮托拉唑钠肠溶胶囊在治疗CEG的同时,能够有效地改变患者的相关炎性因子即C反应蛋白和白介素-6的水平,为临床治疗CEG提供了新的思路。(3)紫苏四香散加味方在治疗CEG上有一定的疗效,具有多靶点作用、副作用少的特点,可与常规治疗方法结合使用,值得推广应用。本研究方通过中医辨证论治有效缓解CEG的临床症状,从而延缓病情的进一步恶化,丰富了中医药治疗CEG的方法。
[Abstract]:Objective To observe the clinical effect and the influence on the related inflammatory factors of the liver and stomach depressed chronic erosive gastritis by observing the effect of the four fragrant powder of Perilla powder plus the Pantoprazole Sodium Enteric-coated Capsules and the Western Medicine (Pantoprazole Sodium Enteric-coated Capsules) on the chronic erosive gastritis of the liver and stomach depression, and further explore the mechanism of the prescription in the prevention and control of the chronic erosive gastritis, and objectively evaluate the safety and effectiveness of the drug in order to provide a more effective treatment for the clinical treatment of CEG. Methods from March 2015 to April 2016, 60 patients with chronic erosive gastritis diagnosed as chronic erosive gastritis were selected from the outpatient and inpatient department of the Department of traditional Chinese medicine and the digestive department of Wuhan City Center Hospital from March 2015 to April 2016. After the TCM syndrome differentiation, the patients were randomly divided into two groups, the treatment group and the control group. Two groups of patients were affected. The patients with Helicobacter pylori (Hp) infection were given Hp for 2 weeks. Then the patients in the control group were given Pantoprazole Sodium Enteric-coated Capsules orally, 40mg/ times, 2 times. The patients in the treatment group were given the experience of the tutor on the basis of the control group, namely, the Perilla four fragrant powder plus flavour prescription, and the prescription of the medicine was mainly composed of the following drugs: perilla. 10 grams of terrier, 10 gram of patchouli, 10 grams of incense, 10 grams of incense, 10 grams of wood incense, 15 grams of Astragalus, 15 g of Danshen, 15 grams of dandelion, 15 grams of dandelion, 15 grams of chicken inside and 15 grams, two buds and 20 grams of stir fry, Fructus aurantii bark, cortex magnolia, fried licorice, herbal decoction and decoctions of traditional Chinese medicine are provided by Hubei Tianji beverage company, daily, oral, oral, times, and times Daily.60 patients were treated for 8 weeks. After the treatment, the therapeutic effects of TCM syndromes before and after treatment were observed, the clinical symptoms of single Chinese medicine, the total score of TCM symptoms, the improvement of gastric mucosa under digestive endoscopy, the negative rate of Hp, the effect of clinical combined therapy and the inflammatory factor water after the treatment of the two groups of patients. Level (including CRR and IL-6 levels) and adverse reactions during the treatment of patients. Besides, there were 2 weeks of follow-up observation on the effective patients after stopping drugs, and observed the recurrence of the patients during the follow-up period of 6 months. The data were collected by SPSS19.0 software for statistical analysis, and the measurement data were subject to normal distribution by t test. The nonparametric test was used in the state distribution; the disordered count data were checked with chi square, and the ordered counting data were tested by nonparametric tests. Results (1) the two groups had statistical differences (P0.05) in the improvement of the patient's single TCM symptoms, such as stomachache, satiety, belching, and Pantothenic symptoms (P0.05); (2) in reducing the patient The total integral of TCM symptoms was 15.40 + 1.19,14.87 + 1.33 before treatment and 3.67 + 0.71,7.30 + 0.88 after treatment. The total integral of the two groups after treatment was lower than before the treatment, but the treatment group decreased more obviously, the two groups were statistically significant (P0.05). (3) the improvement of the patients was improved. In TCM syndrome, the effective rate was 96.67% in the treatment group and 73.33% in the control group. The difference in the treatment group was more significant, and the difference between the two groups was different (P0.05). (4) the effective rate of the treatment group was 90% in the digestive endoscopy, and the effective rate of the control group was compared with the statistical calculation of 66.67%.. The data between the two groups had statistical significance (P0.05). (5) in the two groups of patients with the changes in inflammatory factors, after treatment, the two groups of CRP, IL-6 water decreased, and the treatment group after the treatment of CRP, IL-6 water was lower than the control group after the treatment level, P0.05, two groups have statistical significance. (6) in the eradication of Hp, treatment, treatment. The negative rate of the group and the control group was 40%, 13.33%, and the difference between the two groups was statistically significant (P0.05). (7) in the clinical comprehensive efficacy, the total effective rate of the treatment group and the control group was 93.33%, 70%, the difference was statistically significant (P0.05). (8) after the end of the treatment for 6 months, the treatment of effective patients, treatment, treatment, treatment, treatment, treatment, treatment, treatment, and treatment The recurrence rate of the group and the control group was 7.14%, 47.62%, and the difference was statistically significant (P0.05). Conclusion (1) in alleviating the clinical symptoms of chronic erosive gastritis, reducing the score of TCM syndrome, repairing the erosion degree of gastric mucosa under the gastroscope and anti Hp, the Pantoprazole Sodium Enteric-coated Capsules and the four flavour of perilla and perilla were all able to be used. The treatment effect was achieved, but the effect of the combination of Perilla four fragrant powder plus pantoprazole enteric coated capsules was more obvious. (2) the combination of Perilla four fragrant powder and Pantoprazole Sodium Enteric-coated Capsules combined with the treatment of CEG could effectively change the related inflammatory factors of the patient, namely, the level of C reaction to egg white and interleukin -6, and provide a clinical treatment for the treatment of CEG. 3. (3) the decoction of four fragrant powder and flavour of Perilla has a certain effect on the treatment of CEG. It has the characteristics of multiple targets and less side effects. It can be used in combination with the conventional treatment method, which is worth popularizing. This study can effectively alleviate the clinical symptoms of CEG through TCM syndrome differentiation, thus postpone the further deterioration of the condition and enrich the traditional Chinese medicine. The treatment of CEG.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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