电针联合达立通颗粒治疗胃食管反流病的临床疗效及其作用机制

Clinical efficacy of electroacupuncture combined with Dalitong granule for gastroesophageal reflux disease and its mechanism

目的:观察电针联合达立通颗粒治疗胃食管反流病的临床疗效及其安全性并探讨其作用机制。方法:500例胃食管反流病患者随机分为联合组、电针组、达立通组及西药组,每组125例。电针组穴取足三里、中脘、内关、太冲、公孙,每日1次,共6周;达立通组予达立通颗粒6g口服,每日3次;联合组予上述电针及达立通颗粒治疗;西药组口服莫沙比利5mg,每日3次,奥美拉唑20mg,每日2次,阿米替林25mg,每日2次。评价4组患者治疗前、治疗结束时及治疗结束后48周食管24hpH<4及胆红素吸收值(Abs)≥0.14总反流次数、长时间反流次数、立位时间百分比、卧位时间百分比及总时间百分比,并观察症状积分、内镜评分、生活质量评分及不良反应。结果:与治疗前比较,治疗结束时各组食管内酸反流、胆汁反流、内镜评分和症状积分均明显下降(均P<0.01),生活质量评分明显上升(均P<0.01),联合组上述指标优于其他组(均P<0.05);与治疗结束时比较,治疗后48周上述指标在联合组和电针组无明显反复(均P>0.05),达立通组和西药组则明显反复(均P<0.05),联合组近期和远期总有效率均显著高于其他组(P<0.05,P<0.01),各组均无严重不良反应发生。结论:电针和达立通颗粒均能显著抑制食管内酸和胆汁反流,降低内镜评分,缓解胃食管反流症状,提高生活质量,但联合应用效果更好,并具有较好的安全性和远期疗效,这与其抑制胃酸分泌、促胃肠动力及抗抑郁功能密切相关。

Objective To observe the clinical efficacy and safety of electroacupuncture combined with Dalitong granule for gastroesophageal reflux disease and to explore the therapeutic mechanism.Methods Five hundred cases diagnosed as gastroesophageal reflux disease were randomly divided into a combination group,an electroacupuncture group,a Dalitong granule group,and a western medication group,125 cases in each group.The electroacupuncture group was treated with acupuncture at Zusanli（ST 36）,Zhongwan（CV 12）,Neiguan（PC 6）,Taichong（LR 3） and Gongsun（SP 4）,once daily for 6 weeks;the Dalitong granule group was treated with oral administration of Dalitong granule 6 g,three times daily;the combination group was treated with above two met-hods;the western medication group was treated with oral administration of Mosapride 5 mg,three times daily,Omeprazole 20 mg,twice daily and Amitriptyline 25 mg,twice daily.The total refluxing times,times of long-term reflux,percentage of upright time,percentage of supine time,percentage of total time of the 24-hour intraesophageal pH4 or bilirubin absorbance value（Abs）≥0.14,symptom score,endoscopic score,life quality score and adverse reaction were observed before treatment,at the end of treatment and 48 weeks after treatment in four groups.Results Compared with those before treatment,esophageal acid reflux,bile reflux,endoscopic score and symptom score were decreased significantly at the end of treatment in four groups（all P0.01）,while score of life quality was increased significantly（all P0.01）.The improvements of above indices in the combination group were superior to other groups（all P0.05）.Compared with the end of treatment,changes of above indices were not obvious in both of combination group and electroacupuncture group 48 weeks after treatment（all P0.05）,but these indices all recurred significantly in other two groups（all P0.05）.The short and long-term total effective rates in the combination group were superior to other groups（P0.05,P0.01）.No serious adverse reaction occurred in four groups.Conclusion Electroacupuncture and Dalitonggranule can both inhibit esophageal acid reflux and bile reflux,decrease endoscopic score,alleviate the symptom of gastroesophageal reflux and improve life quality,but the effect of combination is much better with safety and long-term efficacy,which is correlated with their acid inhibition,gastrointestinal motility and antidepressant effects.