疏肝和胃颗粒治疗幽门螺杆菌感染慢性非萎缩性胃炎（肝胃郁热证）的临床观察

发布时间：2019-05-18 10:16

【摘要】：目的:本观察采用“疏肝理气,燥湿和胃”的治法,应用自拟方疏肝和胃颗粒治疗幽门螺杆菌感染的慢性非萎缩性胃炎(肝胃郁热证),通过临床观察,客观评价疏肝和胃颗粒治疗幽门螺杆菌感染的慢性非萎缩性胃炎(肝胃郁热证)的有效性及安全性。为中医药治疗幽门螺杆菌感染的慢性非萎缩性胃炎提供用药依据。方法:将来自长春中医药大学附属医院肝脾胃病科门诊符合幽门螺杆菌感染的慢性非萎缩性胃炎(肝胃郁热证)诊断的患者共60位,按1:1的比例随机分为治疗组和对照组。治疗组:疏肝和胃颗粒,每次1袋,每日3次;对照组:西药三联(奥美拉唑肠溶片20mg,克拉霉素500mg,阿莫西林1000mg),每日2次,上方药物连续应用2周后,继续单独服用奥美拉唑肠溶片2周(每日1次)。两组药物疗程均为4周。并分别记录治疗前后中医症状、胃黏膜改变、Hp转阴率、不良反应,并在治疗结束后的第15天随访复发情况。结果:(1)两组患者在治疗前年龄、性别、病程、中医症状积分、胃黏膜积分方面比较,统计学无显著差异(P0.05),具有可比性。(2)治疗后单项症状的改善:返酸这一症状的改善,两组治疗效果未见明显的统计学差异(P0.05)。但是,在胃脘疼痛、脘腹胀满、纳差、恶心、嗳气、小便黄这6个症状改善方面,有统计学差异(P0.05),治疗组的效果优于对照组。(3)治疗后中医症候总积分情况:较治疗前均有所降低,但治疗组症状积分下降幅度更大。在中医证候改善方面比较,有显著统计学差异(P0.01),治疗组优于对照组。(4)胃黏膜改变比较:治疗组30例愈显率53.33%,总有效率为80.00%;对照组30例愈显率40%,总有效率为73.33%。经秩和检验,治疗组和对照组在治疗后改善胃粘膜情况上无差异。(5)Hp改善比较:治疗组30例中,治疗后Hp(-)14例,Hp(+)16例,总转阴率为46.67%;对照组30例中,治疗后Hp(-)22例,Hp(+)8例,总转阴率为73.33%;有统计学差异(P0.05),对照组在治疗后Hp转阴率优于治疗组。(6)总体疗效比较:治疗组30例患者愈显率70%,总有效率为86.67%;对照组30例患者愈显率36.67%,总有效率为73.33%。有显著统计学差异(P0.01)。治疗组的总体临床疗效优于对照组。(7)安全性比较:两组药物均为出现不良反应事件。(8)随访:治疗结束2周后随访受试者,治疗组患者随访时症状积分无明显改变,对照组随访时较治疗后明显增高。两组比较有显著统计学差异(P0.05),说明在症状改善方面治疗组的远期疗效优于对照组。结论:由以上得出的数据说明疏肝和胃颗粒在治疗幽门螺杆菌感染的慢性非萎缩性胃炎(肝胃郁热证)过程中所有的患者未出现明显的不良反应,且总体疗效及症状改善均优于对照组,由此证明了本方法能够有效消除或改善患者的临床症状,提高他们的生活质量且安全无毒副作用。进一步验证并丰富了中医理论的科学性和实用性,为以后临床上治疗幽门螺杆菌感染的慢性非萎缩性胃炎的患者提供了有意的参考。
[Abstract]:Objective: to observe the method of "soothing the liver and regulating qi, dryness and dampness and stomach" and using self-made prescription Shugan and Wei granule to treat chronic non-atrophic gastritis (hepatogastric stagnation and heat syndrome) with HP infection. Objective evaluation of the efficacy and safety of Shugan Hewei granule in the treatment of chronic non-atrophic gastritis (hepatogastric depression-heat syndrome) infected with HP. It provides drug basis for traditional Chinese medicine in the treatment of chronic non-atrophic gastritis with HP infection. Methods: a total of 60 patients with chronic non-atrophic gastritis (hepatogastric depression and heat syndrome) diagnosed by HP infection were randomly divided into treatment group and control group according to the proportion of 1:1. Treatment group: Shugan and Wei granule, one bag at a time, 3 times a day; Control group: omeprazole enteric-coated tablets (omeprazole enteric-coated tablets 20 mg, clarithromycin 500 mg, amoxicillin 1000mg), twice a day, after 2 weeks of continuous administration of omeprazole enteric-coated tablets, continue to take omeprazole enteric-coated tablets alone for 2 weeks (once a day). The course of treatment of both groups was 4 weeks. The symptoms of traditional Chinese medicine, the changes of gastric mucosa, the negative rate of Hp and the adverse reactions were recorded before and after treatment, and the recurrence was followed up on the 15th day after treatment. Results: (1) there was no significant difference in age, sex, course of disease, TCM symptom score and gastric mucous membrane score between the two groups before treatment (P 0.05). There was no significant difference in the effect of treatment between the two groups (P 0.05). (2) the improvement of single symptom after treatment: there was no significant difference in the effect of acid regurgitation between the two groups (P 0.05). However, there were significant differences in the improvement of six symptoms: epigastric pain, epigastric distension, anorexia, nausea, belching and urination yellow (P 0.05). The effect of the treatment group was better than that of the control group. (3) the total score of TCM symptoms after treatment: it was lower than that before treatment, but the symptom score of the treatment group decreased more significantly. In the improvement of TCM syndromes, there was significant difference (P01), the treatment group was better than the control group. (4) comparison of gastric mucous membrane changes: the effective rate of 30 cases in the treatment group was 53.33%, and the total effective rate was 80.00%; In the control group, the effective rate was 40% and the total effective rate was 73.33%. There was no difference in the improvement of gastric mucosa between the treatment group and the control group by rank sum test. (5) comparison of Hp improvement: among 30 cases in the treatment group, 14 cases of, Hp () (-) in the treatment group had 16 cases of, Hp () after treatment, the total negative conversion rate was 46.67%; In the control group, there were 22 cases of Hp (-) and 8 cases of, Hp () after treatment, the total negative conversion rate was 73.33%. There was significant difference (P 0.05). The negative rate of Hp in the control group was better than that in the treatment group after treatment. (6) comparison of the overall efficacy: the effective rate of 30 patients in the treatment group was 70%, and the total effective rate was 86.67%. In the control group, the effective rate was 36.67% and the total effective rate was 73.33%. There was significant statistical difference (P 0.01). The overall clinical efficacy of the treatment group was better than that of the control group. (7) Safety comparison: there were adverse events in both groups. (8) follow-up: after 2 weeks of treatment, there was no significant change in the symptom score of the patients in the treatment group. The follow-up period in the control group was significantly higher than that after treatment. There was significant difference between the two groups (P 0.05), indicating that the long-term effect of the treatment group was better than that of the control group in symptom improvement. Conclusion: the data obtained above show that Shugan and Wei granules have no obvious adverse reactions in the treatment of chronic non-atrophic gastritis (hepatogastric depression and heat syndrome) caused by HP infection. The overall curative effect and symptom improvement were better than those in the control group, which proved that this method could effectively eliminate or improve the clinical symptoms of patients, improve their quality of life and have no toxic and side effects. It further verifies and enriches the scientific and practical theory of traditional Chinese medicine, and provides an intentional reference for the clinical treatment of patients with chronic non-atrophic gastritis infected with HP in the future.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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