针刺配合质子泵抑制剂治疗胃食管反流性咳嗽疗效观察

Efficacy Observation of Acupuncture Combined with Proton Pump Inhibitor Therapy for GastroesophagealReflux Cough

目的观察针刺督脉背段配合口服质子泵抑制剂(PPI)治疗胃食管反流性咳嗽(GERC)的临床疗效。方法将90例GERC患者随机分为治疗组和对照组,每组45例。治疗组采用针刺督脉背段配合口服PPI治疗,对照组采用泮托拉唑肠溶胶囊、枸橼酸莫沙必利胶囊、铝碳酸镁片三联强化治疗。两组治疗前后各项食管功能指标(食管下括约肌压力、肌长度、肌松弛率及食管收缩波幅、蠕动波传导速度、平均收缩持续时间)、咳嗽评分(日间、夜间)、中文版莱切斯特咳嗽问卷(LCQ-MC)评分、中医证候评分及各项生化指标[血清白细胞介素8(IL-8)、P物质(SP)、肥大细胞类胰蛋白酶(MCT)]的变化情况,并比较两组临床疗效及复发率。结果两组治疗后食管功能各项指标(食管下括约肌压力、肌长度及食管收缩波幅、蠕动波传导速度、平均收缩持续时间)、咳嗽评分(日间、夜间)、LCQ-MC评分及中医证候评分及各项生化指标与同组治疗前比较差异均具有统计学意义(P<0.05)。治疗组治疗后食管功能各项指标(食管下括约肌压力、肌长度及食管收缩波幅、蠕动波传导速度、平均收缩持续时间)、咳嗽评分(日间、夜间)、LCQ-MC评分及中医证候评分及各项生化指标与对照组比较差异均具有统计学意义(P<0.05)。治疗组总有效率和复发率分别为88.9%和7.5%,对照组分别为82.2%和27.0%。两组复发率比较差异具有统计学意义(P<0.05)。结论针刺督脉背段配合口服PPI是一种治疗GERC的有效方法。

Objective To observe the clinical efficacy of acupuncture at the dorsal segment of Governor Vessel combined with oral proton pump inhibitor(PPI)in the treatment of gastroesophageal reflux cough.Method Ninety patients with gastroesophageal reflux cough were randomized into a treatment group and a control group,with 45 cases in each group.The treatment group was intervened by acupuncture at the dorsal part of the Governor Vessel plus oral administration of PPI,while the control group was given intensified medication treatment with Pantoprazole sodium enteric-coated capsules,Mosapride citrate capsules and Hydrotalcite tablets.Before and after treatment,the esophageal function parameters(lower esophageal sphincter pressure,length and relaxation rate,esophageal contraction amplitude,conduction velocity of peristaltic wave and average esophageal contraction duration),cough scores(diurnal and nocturnal),Leicester Cough Questionnaire in Mandarin-Chinese(LCQ-MC),symptom score of traditional Chinese medicine(TCM)and biochemical indexes[serum interleukin(IL)-8,substance P(SP)and mast cell tryptase(MCT)]were observed in the two groups.The clinical efficacy and relapse rate were also compared.Result The esophageal function parameters(lower esophageal sphincter pressure and length,esophageal contraction amplitude,conduction velocity of peristaltic wave and average contraction duration),cough scores(diurnal and nocturnal),LCQ-MC score,TCM symptom score and biochemical indexes changes significantly after treatment in both groups(P<0.05).After intervention,the esophageal function parameters(lower esophageal sphincter pressure and length,esophageal contraction amplitude,conduction velocity of peristaltic wave and average contraction duration),cough scores(diurnal and nocturnal),LCQ-MC score,TCM symptom score and biochemical indexes in the treatment group were significantly different from those in the control group(P<0.05).The total effective rate was 88.9%and the relapse rate was 7.5%in the treatment group,versus 82.2%and 27.0%in the control group.There was a significant difference in the relapse rate between the two groups(P<0.05).Conclusion Acupuncture at the dorsal part of the Governor Vessel plus oral administration of PPI is an effective approach for gastroesophageal reflux cough.