香砂六君子汤联合针刺疗法治疗功能性消化不良临床疗效观察

Clinical Efficacy of Xiangsha Liujunzi Tang Combined with Acupuncture Therapy in Treatment of Syndrome of Deficiency of Spleen Qi and Stomach Qi of Functional Dyspepsia

目的:观察和评价香砂六君子汤联合针刺疗法治疗脾胃气虚证功能性消化不良的临床疗效及其对患者血浆胃动素(MOT)和血清胃泌素(GAS)水平的影响。方法:选取2014年1月—2016年8月在广西中医药大学附属瑞康医院消化内科住院被诊断为脾胃气虚证功能性消化不良的120例患者,按照随机数字表法分为治疗组(62例)和对照组(58例)。治疗组采用口服香砂六君子汤联合针刺疗法治疗,对照组给予口服盐酸伊托必利分散片联合复方阿嗪米特肠溶片治疗,2周为1疗程,两组患者连续治疗2个疗程,治疗结束后对两组中临床痊愈的患者进行为期2个月的随访。观察并分析比较两组患者的中医证候积分、临床总体疗效、血浆MOT和血清GAS水平变化、汉密尔顿焦虑量表(HAMA)评分和17项汉密尔顿抑郁量表(HAMD-17)评分、不良反应以及远期疗效。结果:治疗结束后,治疗组患者中医证候积分,HAMA评分和HAMD-17评分均明显低于对照组(P<0.05);治疗组临床疗效总有效率为88.71%,高于对照组的74.14%(P<0.05);治疗组患者血浆MOT水平明显高于对照组(P<0.05),血清GAS水平明显低于对照组(P<0.05);两组患者治疗期间均未出现明显的不良反应;治疗组病情复发率为11.11%,明显低于对照组的44.44%(P<0.05)。结论:香砂六君子汤联合针刺疗法治疗脾胃气虚证功能性消化不良可以显著提高临床疗效,安全性好,能够改善患者焦虑抑郁状态,并且能够提高远期疗效,其作用机制可能与升高血浆MOT水平和降低血清GAS水平相关。

Objective： To observe and evaluate the clinical efficacy of Xiangsha Liujunzi Tang combined with acupuncture therapy in the treatment of syndrome of deficiency of spleen Qi and stomach Qi of functional dyspepsia and investigate its effect on motilin on plasma（ MOT） and serum gastrin（ GAS） levels. Method： The120 cases of patients with syndrome of deficiency of spleen Qi and stomach Qi of functional dyspepsia from January2014 to August 2016 in Department of Gastroenterology,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine were selected as research subjects and were randomly divided into treatment group（ 62 cases）and control group（ 58 cases）. The patients in treatment group received oral Xiangsha Liujunzi Tang combined with acupuncture therapy,and the patients in the control group were treated with itopride hydrochloride dispersible tablets combined with compound azimtamide enteric-coated tablets treatment. Both groups were treated for 2courses,2 weeks/course. After the end of treatment,the patients with clinical recovery were followed up for 2months. The two groups were observed and compared in traditional Chinese medicine（ TCM） syndrome scores,the overall curative effect and the changes of plasma MOT and serum GAS levels,the Hamilton Anxiety Scale（ HAMA） score and the 17 item Hamilton Depression Rating Scale（ HAMD-17） score,adverse reaction and longterm curative effect. Result： After the treatment,TCM syndrome scores,HAMA scores and HAMD-17 scores in the treatment group were significantly lower than those in control group（ P〈0. 05）; the total effective rate of the treatment group was 88. 71%,significantly higher than 74. 14% in control group（ P〈0. 05）; the plasma MOT level was significantly higher than that of control group（ P〈0. 05）,and the serum GAS level was significantly lower than that of control group（ P〈0. 05）. No obvious adverse reactions were found during the period of treatment in two groups; the relapse rate was 11. 11% in treatment group,significantly lower than 44. 44% in control group（ P〈0. 05）. Conclusion： The curative effect of Xiangsha Liujunzi Tang combined with acupuncture therapy in the treatment of syndrome of deficiency of spleen Qi and stomach Qi of functional dyspepsia can significantly increase the clinical efficacy,safety,improve the anxiety and depression of the patients,and can improve the long-term curative effect. Its mechanism may be related to increasing the level of plasma MOT and decreasing the levels of GAS.