活血通降方对糜烂性食管炎瘀血阻络型食管黏膜、运动功能及LES压力的影响

Influence of Huoxue Tongjiang Decoction on Esophageal Mucosa,Motility and LESP in Treatment of Erosive Esophagitis with Blood Stasis Obstruction

目的通过对比观察不同治疗方法对糜烂性食管炎(EE)瘀血阻络型患者的疗效,以及对食管运动功能的影响,探讨活血通降方的作用机制,为临床寻找有效治疗方案提供理论依据。方法将96例糜烂性食管炎瘀血阻络证患者随机分为西药组、中药组、中西医结合组各32例。西药组予雷贝拉唑肠溶胶囊(每次20 mg,1次/d,早餐前口服)和伊托必利(每次50 mg,3次/d,三餐后口服),中药组予活血通降方(1剂/d,早晚分服,50 mL/次),中西医结合组予雷贝拉唑、伊托必利及活血通降方联合治疗,疗程8周,比较治疗前后3组患者胃镜下黏膜表现、中医证候评分、高分辨率食管测压结果及安全性指标。结果3组患者经治疗后胃镜下LA分类,西药组和中西医结合组较治疗前改善明显(P<0.05),治疗后组间相比无显著差异(P>0.05)。3组治疗后中医证候学评分较治疗前均有明显改善(P<0.05或P<0.01),改善程度为中西医结合组优于中药组优于西药组(P<0.05或P<0.01)。3组治疗后LESP均较治疗前有明显改善(P<0.05或P<0.01);治疗后西药组和中药组对LESP的改善作用无明显差异(P>0.05),而中西医结合组较其他两组更能改善LESP(P<0.05或P<0.01)。治疗后3组DCI均明显升高(P<0.05或P<0.01),西药组和中药组对DCI升高作用差别不明显(P>0.05),而中西医结合组较其他两组升高更显著(P<0.01)。药物治疗对改变LESL、IBP、CFV的作用不明显(P>0.05)。结论活血通降方联合西药治疗瘀血阻络型EE在对食管黏膜、中医证候、食管压力、动力的改善方面优于单纯西药或中药治疗,且安全性较好。

Objective To observe the effects of different treatments on esophageal mucosa,pressure and motility when treating erosive esophagitis(EE)with blood stasis obstruction so as to provide theoretical basis for finding out the most effective treatment.Methods Ninety-six EE patients were randomly divided into western medicine group,TCM group and combined western medicine and TCM group,with 32 patients in each group.The western medicine group was given Rabeprazole Enteric-coated Capsules(20mgeach time,once a day,taken before breakfast)and Itopride(50mgeach time,three times a day,taken after meals).The TCM group was given Huoxue Tongjiang Decoction(1 dose a day,taken before breakfast and dinner,50mL per time).The combined western medicine and TCM group was given Rabeprazole Enteric-coated Capsules,Itopride and Huoxue Tongjiang Decoction.Both groups were treated for 8 weeks.The gastroscopic mucosal manifestations,TCM syndrome scores,high resolution esophageal manometry results and safety indicators were compared among the three groups before and after treatment.Results After treatment,the LA classification of the three groups were significantly improved(P<0.05);but there was no significant difference among the three groups(P>0.05).After treatment,three groups'TCM syndrome scores were significantly improved(P<0.05).The improvement of the combined western medicine and TCM group was better than that of the TCM group and the western medicine group(P<0.05 or P<0.01).After treatment,LESP in the three groups was significantly improved(P<0.05 or P<0.01).There was no significant difference between the western medicine group and the TCM group(P>0.05),while the combined western medicine and TCM group was better than the other two groups(P<0.05 or P<0.01).DCI in the three groups increased significantly after treatment(P<0.05 or P<0.01).There was no significant difference between the western medicine group and the TCM group(P>0.05),but the increase in combined western medicine and TCM group group was more significant than that in the other two groups(P<0.01).Conclusion In the treatment of EE,Huoxue Tongjiang Decoction combined with western medicine can better improve esophageal mucosal injury,TCM syndromes,LESP and esophageal motility,and has good safety.