芩连生肌愈疡汤治疗脾胃湿热型糜烂性胃炎临床观察

发布时间：2018-08-06 21:36

【摘要】：目的通过观察芩连生肌愈疡汤结合西医三联疗法对于脾胃湿热型HP阳性、重度糜烂性胃炎患者临床症状的改善、内镜下糜烂愈合效果及HP清除率的改善,以评定芩连生肌愈疡汤对糜烂性胃炎治疗的有效性。方法1.研究对象:收集自2015年2月至2016年2月于笔者导师门诊就诊的共42例病例,均在1周内经胃镜确诊为慢性糜烂性胃炎,并经碳13呼气试验诊断为HP阳性,同时按中医标准诊断为慢性胃炎脾胃湿热型。将受试者随机分为治疗组21例及对照组21例,两组患者在年龄、性别、病程及临床证候上均无明显差异。2.治疗方法:治疗组与对照组均先予以标准三联疗法治疗:泮托拉唑钠肠溶胶囊40mg,每日2次;克拉霉素胶囊500mg,每日2次;阿莫西林胶囊1.0g,每日2次;共10天。10天后对照组继续服用泮托拉唑钠肠溶胶囊4周,治疗组改服中药芩连生肌愈疡汤,每7天为一个疗程,共服用4个疗程。3.观察指标:两组治疗前后的组间及组内临床证候积分的比较;两组间治疗后临床证候疗效的比较;两组间治疗后胃镜下糜烂性胃炎分级及糜烂愈合疗效的比较;两组间治疗后HP转阴率的比较;4.统计学分析方法:所收集数据均应用SPSS 20.0统计软件进行分析,满足正态分布的,对于计量资料,治疗前后组内比较用配对样本t检验,组间比较用独立样本t检验;计数资料采用x2检验。等级资料用秩和检验。所得结果P0.05为有统计学差异;P0.01表示有显著统计学差异;P0.05表示无统计学意义。结果1.治疗前对比两组样本间的性别、年龄、病程、证候疗效积分均提示无统计学差异,具有可比性。2.对比组间治疗后临床证候疗效,治疗组21例,临床痊愈1例,显效6例,有效10例,无效4例,总有效率81%;对照组21例,临床痊愈0例,显效2例,有效11例,无效8例,总有效率62%。经独立样本秩和检验后P0.05,提示其临床证候疗效有统计学差别。3.对比组间治疗后胃镜下糜烂愈合情况,治疗组21例,痊愈2例,显效4例,有效13例,无效2例,总有效率90.47%;对照组21例,临床痊愈2例,显效3例,有效11例,无效5例,总有效率76.19%。经独立样本的秩和检验后,P0.05,提示两组疗法对于胃镜下糜烂愈合的疗效无明显差异,但治疗组有效率高于对照组。4.对比组间治疗后HP转阴率,治疗组21例,阴性19例,阳性2例,转阴率为90.48%;对照组21例,阴性17例,阳性4例,转阴率为80.95%。经c2检验,P=0.05,提示两组疗法对HP清除最终效果无明显差异,但就样本而言,治疗组有效率高于对照组。结论生肌愈疡汤是湖北省中医大师张介眉教授的经验方,笔者导师在此基础上加黄连、黄芩用于治疗脾胃湿热型糜烂性胃炎,临床观察显示其可有效改善患者临床证候,对于HP阳性患者,在三联疗法基础上使用,有助于提高HP清除率及促进镜下糜烂愈合。尤其在改善临床证候方面,效用优于泮托拉唑,是治疗糜烂性胃炎的有效方剂。
[Abstract]:Objective to observe the improvement of clinical symptoms of HP positive and severe erosive gastritis, the curative effect of endoscopic erosion healing and the improvement of HP clearance rate in patients with spleen and stomach damp-heat type by the combination of Qinlianshengjiyu decoction and western medicine. To evaluate the effectiveness of Qinlianshengjiyu decoction in the treatment of erosive gastritis. Method 1. Participants: from February 2015 to February 2016, 42 patients with chronic erosive gastritis were diagnosed as chronic erosive gastritis by gastroscopy from February 2015 to February 2016, and HP positive was diagnosed by carbon-13 breath test. At the same time according to the criteria of traditional Chinese medicine diagnosis of chronic gastritis spleen-stomach damp-heat type. The subjects were randomly divided into treatment group (n = 21) and control group (n = 21). There was no significant difference in age, sex, course of disease and clinical syndrome between the two groups. Treatment methods: the treatment group and control group were treated with standard triple therapy: pam Tora sodium enteric capsule 40 mg twice a day, clarithromycin capsule 500 mg twice a day, amoxicillin capsule 1.0 g twice a day; After 10 days and 10 days, the control group continued to take pam Tora sodium enteric-coated capsules for 4 weeks. The treatment group was changed to take Qinlianshengjiyu decoction, a course of treatment every 7 days, a total of 4 courses of treatment. 3. Observation measures: comparison of clinical syndromes between and within groups before and after treatment, comparison of clinical syndromes efficacy after treatment between two groups, comparison of grade of erosive gastritis and curative effect of erosive gastritis under gastroscopy between two groups after treatment, and comparison of curative effect of erosive gastritis and erosive healing between two groups after treatment. The comparison of HP negative conversion rate between the two groups was 4. 5%. Statistical analysis method: all the collected data were analyzed by SPSS 20.0 statistical software to satisfy the normal distribution. For the metrological data, the matched sample t test was used before and after treatment, and the independent sample t test was used to compare the data between groups. The count data were examined by x 2 test. Rank data are tested by rank sum. The results showed that there was significant statistical difference between P0.01 and P0.01. P05 indicated that there was no statistical significance. Result 1. Before treatment, the gender, age, course of disease, syndromes of the two groups of samples showed no statistical difference, comparable. 2. There were 21 cases of clinical cure, 6 cases of remarkable effect, 10 cases of effective, 4 cases of ineffective, total effective rate of 81 cases in the treatment group, 21 cases in the control group, 0 cases in clinical cure, 2 cases in remarkable effect, 11 cases in effective, 8 cases in invalidation. The total effective rate is 62. After the independent sample rank sum test, P0.05, it indicated that its clinical syndromes curative effect has the statistical difference. 3. In the treatment group, 21 cases were cured, 4 cases were effective, 13 cases were effective, 2 cases were ineffective, the total effective rate was 90.477.21 cases in the control group were clinically cured, 3 cases were effective, 11 cases were effective, 5 cases were ineffective. The total effective rate is 76.19. The results showed that there was no significant difference between the two groups in the healing of erosion under gastroscope, but the effective rate in the treatment group was higher than that in the control group. 4. There were 21 cases in the treatment group, 19 cases in the negative group, 2 cases in the positive group, and 90.48% in the control group, while in the control group, 17 cases were negative, 4 cases were positive, and the negative rate was 80.95%. The results of c2 test showed that there was no significant difference between the two groups in the final effect of HP removal, but the effective rate in the treatment group was higher than that in the control group. Conclusion Shengjiyu Yang decoction is an experiential prescription of Professor Zhang Jiemei, a master of traditional Chinese medicine in Hubei Province. On this basis, the author's tutor added Coptis chinensis and Scutellaria baicalensis to treat erosive gastritis of damp-heat type of spleen and stomach. The clinical observation shows that it can effectively improve the clinical symptoms of the patients. For HP positive patients, it is helpful to improve HP clearance rate and promote the healing of erosion under microscope. Especially in improving clinical syndromes, the effect is better than pam Tora, it is an effective prescription for erosive gastritis.
【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】：2016
【分类号】：R259

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