马来酸曲美布汀治疗老年反流性食管炎患者中的疗效观察

Effect of Trimebatine maleate on reflux esophagitis in elderly patients

目的观察马来酸曲美布汀在治疗老年反流性食管炎患者中的作用。方法回顾性研究，收集2010-2014年我院具有典型胃食管反流病症状、且经胃镜确诊的老年反流性食管炎患者160例，食管压力测定、24h食管pH-阻抗监测证实存在病理性酸性胃食管反流，均给予质子泵抑制剂（PPI）埃索美拉唑20mg，3次／d，餐前服用，共8周，数字抽签随机分为4组（每组40例）：（1）加用盐酸伊托必利（盐酸伊托必利组）50mg，3次／d，餐前服用；（2）加用枸橼酸莫沙必利（枸橼酸莫沙必利组）5mg，3次／d，餐前服用；（3）加用马来酸曲美布汀（马来酸曲美布汀）200mg，3次／d，餐前服用；（4）对照组不应用促进动力药。服药4、8周时随访，分别观察4组症状改善情况，8周后复查内镜、食管压力测定、24h食管pH一阻抗监测。结果治疗8周后，盐酸伊托必利组、枸橼酸莫沙必利组、马来酸曲美布汀组、对照组总有效率分别为97．5％（39例）、95．0％（38例）、92．5％（37例）、77．5oA（31例）；内镜检查结果提示，治愈率分别为70．0％（28例）、62．5％（25例）、72．5％（29例）、67．5％（27例），有效率87．5％（35例）、92．5％（37例）、87．5％（35例）、87．5％（35例），组间比较差异无统计学意义；食管下括约肌静息压（LESP）、食管下括约肌松弛率（LESR）、食管体部下段蠕动波压力（LEPP）及食管体部异常收缩百分数与治疗前比较，盐酸伊托必利组、枸橼酸莫沙必利组改善更明显，对照组变化差异无统计学意义；24hpH〈4．0总时间百分比、立位时间百分比、卧位时间百分比和卧位反流次数、卧位反流〉5min次数、卧位最长反流时间与治疗前比较，其他3组较对照组改善明显；盐酸伊托必利组、枸橼酸莫沙必利组、马来酸曲美布汀组与治疗前比较非酸反流次数减少，差异有统计学意义（P〈0．01），与对照组比较，差异亦有统计学意义（P〈0．05）；盐酸伊托必利组和枸橼酸莫沙必利组液体和气体反流次数与对照组比较，差异有统计学意义（均P〈0．05），与对照组比较，其他3组近段反流次数改善（均P〈0．05）。结论促动力药物联合PPI治疗反流性食管炎老年患者改善临床症状、上消化道动力方面均优于单独应用PPI.马来酸曲美布汀具有与枸橼酸莫沙必利和盐酸伊托必利相似的改善食管动力的作用，可能是通过选择性改善食管动力、下食管括约肌压力及胃排空功能，对老年患者安全、有效。

Objective To investigate the effect of Trimebutine mateate on reflux esophagitis in elderly patients. Methods A total of 160 elderly patients with typical esophageal reflux symptoms diagnosed as reflux esophagitis by gastroscope, with concomitant gastroesophageal disease confirmed by esophageal motility manometry and 24 h esophageal pH impedance monitoring acid reflux, were selected and retrospectively analyzed. AIL patients were treated with proton pump inhibitor （PPI） esomeprazole 20 mg tid, antecibum（AC） for 8 weeks, and randomly divided into four groups： group A （itopride hydrochloride 50 mg rid, AC）, group B （citrate mosapride 5 mg rid, AC）, group C （trimebutine maleate 200 mg tid, AC）, group D（treated without prokinetic drugs）. After 4 and 8 weeks of therapy, the symptom improvements were observed in the four groups. Endoscopy, esophageal motility manometry, 24h esophageal pH impedance monitoring were performed in the 160 cases after 8 weeks of treatment. Results The total effective rate was 97. 5%（39 cases）, 95.0%（38 cases）, 92.5%（37 cases）and 77.5%（31 cases）in group A, B, C and D respectively after 8 weeks of treatment. Endoscopic examination showed that the cure rate was 70.0% （28 cases）, 62.5% （25 cases）, 72.5%（29 cases）, 67.5%（27 cases）, and the effective rate was 87.5%, （35 cases）, 92.5% （37 cases）, 87.5%（35 cases）and 87.5%（35 cases）in group A, B, C and D respectively after 8 weeks of treatment, without statistically significant differences in the cure rate and effective rate between the four groups. The results of esophageal motility manometry showed that the lower esophageal sphincter pressure（LESP）, lower esophageal sphincter relaxation （LESR）, lower esophageal peristaltic wave pressure（LEPP） and percentage of abnormal esophageal body contraction had significant difference before versus after treatment in group A and t3, but not in control group. The improvements in the percentage of total time of ph〈4.0, the percentage of time of pHi4 at standing position, the percentage of time of pH〈4 at supine position, supine reflux times, the times of supine reflux〉5 min, the longest reflux time（min）at supine position were more significant in group A, B and C than in group D. Compared with pre treatment, the times of nowacid reflux were reduced significantly in group A, B and D（all P〈0.01）, and there was a significant difference（P〈0.05）between the three （A, B, C）groups and group D（P〈0.05）. There were significant differences in the times of reflux liquid and gas reflux between the group A, B and D（P〈0.05）. The proximal reflux times were improved more significantly in group A, B and C after treatment than in control group（P〈0.05）. Conclusions Prokinetic drugs combined with PPI therapy has better effect than single PPI application in improving the clinical symptoms and upper gastrointestinal motility in elderly patients with RE. Trimebutine maleate is safe and effective in the elderly, and has a similar effect on esophageal motility with mosapride citrate and itopride hydrochloride, which may be involved in selectively improving esophageal motility, lower esophageal sphincter pressure and gastric emptying function.