五花芩钱汤治疗胆热犯胃型非糜烂性胃食管反流病的临床研究

Clinical Study of Wuhua Qinqian Decoction in the Treatment of Non-erosive Gastroesophageal Reflux Disease Due to Gallbladder Heat Invading Stomach

目的 研究五花芩钱汤治疗胆热犯胃型非糜烂性胃食管反流病(NERD)的临床疗效。方法 选取2017年1月至2018年9月于南京中医药大学附属昆山医院行胃镜检查及24h食管多通道腔内阻抗pH(MIIpH)监测,诊断为胆热犯胃型NERD的患者60例,随机分为治疗组和对照组各30例。治疗组予五花芩钱汤口服,对照组予奥美拉唑肠溶胶囊口服,疗程均为8周。比较2组治疗前后中医证候积分及疗效和24hMIIpH监测结果的变化情况。结果 治疗组中医证候积分改善情况及疗效均优于对照组(P<0.05~0.01),在治疗口苦咽干、心烦失眠症状上治疗组更具优势(P<0.05~0.01)。24h食管MIIpH监测结果,治疗后2组反流物的酸碱性及德米斯特(DeMeester)积分(除对照组弱碱反流外)均有改善(P<0.01),组间比较,在酸反流与弱酸反流的改善方面2组疗效相当(P>0.05),在弱碱反流方面,治疗组改善情况优于对照组(P<0.01)。治疗组DeMeester积分的改善优于对照组(P<0.05)。结论 五花芩钱汤对胆热犯胃型NERD相关临床症状有明显改善作用,且对抑制NERD患者弱碱反流更具明显效果,有较好的临床使用价值。

OBJECTIVE To study the clinical effect of Wuhua Qinqian Decoction on non erosive gastroesophageal reflux disease (NERD) due to gallbladder heat invading stomach. METHODS 60 patients performing gastroscopy and monitoring 24 hour esophageal impedance pH (MII-pH) after being diagnosed with NERD caused by gallbladder heat invading stomach in Kunshan TCM Hospital Affiliated to Nanjing University of Chinese Medicine from January 2017 to September 2018 were enrolled,and they were randomly divided into the treatment group and the control group with 30 patients in each. The treatment group was given oral Wuhua Qinqian Decoction and the control group was given oral omeprazole enteric coated capsule. Both of their courses lasted for 8 weeks. The changes of TCM syndrome scores,curative effect and 24 h MII-pH monitoring results before and after treatment in the two groups were compared. RESULTS The TCM syndrome scores and curative effect in the treatment group were better than those in the control group ( P < 0.05 , P < 0.01 ). The treatment group had more advantages in the treatment of dry mouth and throat and insomnia ( P < 0.05 , P < 0.01 ). 24 hour esophageal MII pH monitoring results,the acidity and basicity of reflux content and De Meester score (except for the weak base reflux in the control group) were all improved in both groups after treatment ( P < 0.01 ). The improvement of the acid and the weak acid reflux were similar in the two groups ( P > 0.05 ). In the aspect of the weak base reflux,the improvement of the treatment group was better than that of control group ( P < 0.01 ). The improvement of De-Meester score in the treatment group was better than that in the control group ( P < 0.05 ). CONCLUSION Wuhua Qinqian Decoction can significantly improve the clinical symptoms of NERD caused by gallbladder heat invading stomach and effectively inhibit weak base reflux in NERD patients,which is worthy of clinical application.