和胃降逆汤加减治疗胃食管反流病64例

Addition and Subtraction Treatment of Hewei Jiangni Decoction in Treating Gastro-esophageal Reflux Disease(Stagnancy Heat of the Liver and Stomach) with 64 Cases

目的:观察和胃降逆汤加减治疗胃食管反流病(GERD)(肝胃郁热证)的近期和远期疗效及对生活质量的影响。方法:随机按数字表法将128例GERD患者分为西药组和观察组各64例。西药组服用奥美拉唑镁肠溶片,20 mg/次,早、晚各1次;枸橼酸莫沙必利片,5 mg/次,3次/d。观察组服用奥美拉唑镁肠溶片同西药组,并采用和胃降逆汤加减治疗,1剂/d。两组疗程均为8周。进行治疗前后肝胃郁热证评分、食管黏膜内镜和反流性疾病问卷(RDQ)量表及生活质量评价;对痊愈患者进行6个月的随访观察,计算复发率及复发时食管黏膜内镜评分。结果:观察组中医证候疗效总有效率为93.75%,优于西药组的81.25%(P<0.05);观察组胃镜下炎症疗效总有效率为90.62%,优于西药组的75.0%(P<0.05);观察组治疗后肝胃郁热证评分、食管黏膜内镜评分和RDQ量表评分均低于西药组(P<0.01);治疗后观察组SF-36健康量表除身体疼痛维度外其他维度评分均高于西药组(P<0.01);随访6个月,观察组复发率为23.5%低于西药组的64%,观察组复发时食管黏膜内镜评分也低于西药组(P<0.01)。结论:在质子泵抑制剂治疗的基础,和胃降逆汤加减能减轻GERD(肝胃郁热证)近期症状,提高治愈率,提高患者生活质量,并能降低远期复发率。

Objective：Short-term and long-term effects of modified Hewei Jiangni decoction in treating Gastro-esophageal reflux disease （GERD） （stagnancy heat of the liver and stomach type） and to quality of lives were investigated.Method：One hundred and twenty-eight patients with GERD were randomly divided into western medicine groupand observation group （64 cases,respectively）.Patients in western medicine group received Omeprazole Magnesium enteric-coated tablets,20 mg each time,taken at the morning and evening.Mosapride citrate tablets,5 mg each time,three times per day.Patients in observation group received Omeprazole Magnesium enteric-coated tablets and the dose was same as which in western medicine group,and also received treatment of modified Hewei Jiangni decoction,1 dose per day.Course of treatment in both groups was 8 weeks.Scores of symptoms of stagnancy heat of the liver and stomach,endoscopic of esophageal mucosa,reflux diagnostic questionnaire （RDQ） and life quality were evaluated before and after treatment.Recovered patients received a 6-moth follow-up,recurrence rates and scores of endoscopic of esophageal mucosa were graded.Result：The total effective rate of improvement of traditional Chinese medicine syndrome in observation group was 93.75％,whic h issuperior to that in western medicine group （81.25％） （P ＜ 0.05）.The total effective rate of elimination of inflammation in observation group was 90.62％,which is superior to that in western medicine group （75％）（P ＜ 0.05）.Scores symptoms of stagnancy heat of the liver and stomach,endoscopic of esophageal mucosa and RDQ in observation group were all lower than those in western medicine group （P ＜ 0.01）.Except for score of physical pain,the SF36 scores of health scale in observation group were higher than those in western medicine group （P ＜ 0.01）.During the 6-mouth follow-up,recurrence rate in observation group was 23.5％,which is lower than that in western medicine group （64％）,and when it relapse,score of endoscopic of esophageal mucosa in observation group was lower than that in western medicine group （P ＜ 0.01）.Conclusion：Based on the treatment of proton pump inhibitor,treatment of modified Hewei Jiangni decoction not only relieve short-term symptoms of GERD （stagnancy heat of the liver and stomach type）,but also improve cure rate and quality of lives,furthermore reduce long-term recurrence rate.