旋覆代赭汤加味治疗肝胃郁热型胃食管反流病疗效及其机制

Clinical Effect and Mechanism on Patients with Liver Stomach Heat Stagnation Type Gastroesophageal Reflux Disease Treated with Jiawei Xuanfu Daizhe Decoction

目的:观察肝胃郁热型胃食管反流病(GERD)患者空腹血浆Ghrelin水平的变化以及旋覆代赭汤加味治疗GERD的临床疗效,并探讨其作用机制。方法:70例肝胃郁热型GERD患者随机分为两组,中药治疗组(CT)予旋覆代赭汤加味口服8周,西药治疗组(WT)予奥美拉唑、吗叮啉口服8周。正常健康人群30例为对照组(NC)。观察治疗前各组空腹血浆Ghrelin水平的变化,治疗4周、8周及停药后随访24周后两治疗组的临床效果及空腹血浆Ghrelin水平的变化。结果:治疗前GERD患者的空腹血浆Ghrelin水平明显低于正常对照组(P<0.05);治疗4周、8周后两治疗组各项典型症状均明显改善,反流症状积分均显著降低,空腹血浆Ghrelin水平高于治疗前水平(P<0.05);治疗4周后中药治疗组可以明显改善GERD患者各项典型症状,但总有效率低于西药治疗组,空腹血浆Ghrelin水平低于西药治疗组,差异均有统计学意义(P<0.05);治疗8周后中药治疗组总有效率及空腹血浆Ghrelin水平与西药治疗组相比,差异均无统计学意义(P>0.05);停药后随访24周后,两治疗组各有2例失访,中药治疗组症状复发率低于西药治疗组(P<0.05),中药治疗组空腹血浆Ghrelin水平高于西药治疗组水平(P<0.05)。结论:旋覆代赭汤加味能有效改善肝胃郁热型GERD临床症状;与奥美拉唑、吗叮啉口服比较,其长期效果更为显著,复发率低;其机制可能是通过增加血浆Ghrelin水平来发挥作用。

Objective ： To observe fasting plasma ghrelin level changes in patients with liver stomach heat stagnation type gastroesophageal reflux disease （ GERD ）and clinical effect on GERD patients treated with Jiawei Xuanfu Daizhe Decoction, and to explore its mechanism. Methods ： 70 cases of liver stomach heat stagnation type gastroesophagea] reflux disease were randomly divided into two groups. The Chinese medicine treatment group （ CT group, n=35 ）with Jiawei Xuan^u Daizhe Decoction for 8 weeks, the Western medicine treatment group （ WT group, n=35 ） with oral administ ration of omeprazole capsule and domperidone tablet for 8 weeks. 30 healthy people as normal control group （ NC group, n=30 ）. The changes of fasting plasma ghrelin levels were measured before treatment. The clinical effect and the changes of fasting plasma ghrelin levels of two treatment groups were observed at 4 weeks, 8 weeks after treatment and 24 weeks follow up after drug withdrawal, respectively. Results ： The fasting plasma ghrelin levels of patients with GERD before treatment were significantly lower than that of normal control group （ P〈0.05 ）. After 4 weeks＇ and 8 weeks＇ treatment, the typical symptoms of two treatment groups were both significantly improved, the reflux symptom score were decreased significantly and the levels of fasting plasma ghrelin were both higher than that of before treatment （ P〈0.05 ）. After 4 weeks＇ treatment, CT group could significantly improve the symptoms of GERD patients, but the total effective rate was lower than that of WT group, and fasting plasma ghrelin level was also lower than that of WT group, the difference was statistically significant （ P〈0.05 ）. Compared with WT group, the total effective rate of CT group and the level of fasting plasma ghrelin in CT group after 8 weeks＇ treatment was both not significantly different （ P〉0.05 ）. Two patients in each group were lost in 24 weeks follow up after drug withdrawal, respectively. The symptom recurrence rate of CT group was lower than that of WT group （ P〈0.05 ） and the level of fasting plasma ghrelin in CT group was higher than that of WT group （ P〈0.05 ）. Conclusion ： Jiawei Xuanfu Daizhe Decoction can effectively improve symptoms of patients with liver stomach heat stagnation type GERD. Compared with omeprazole and morpholine oral, its long-term effect is more significant and the recurrence rate is lower, which the mechanism may exert its role by increasing the plasma ghrelin levels.