归脾汤联合艾司奥美拉唑镁肠溶片治疗非糜烂性反流病伴情绪障碍患者的临床研究

Effect of Guipi Decoction Combined with Esomeprazole Magnesium Enteric-coated Tablets on Non-erosive Reflux Disease with Emotional Disorder

[目的]探讨归脾汤联合艾司奥美拉唑镁肠溶片治疗非糜烂性反流病(non-erosive reflux disease,NERD)伴情绪障碍(心脾两虚证)患者的临床疗效,以及对血清5-羟色胺(5-hydroxytryptamine,5-HT)、血管活性肽(vasoactive intestinal peptide,VIP)水平及肠道菌群数量的影响。[方法]采用随机对照的方法将172例NERD伴情绪障碍(心脾两虚证)患者按1∶1比例随机分为实验组86例(采用归脾汤联合艾司奥美拉唑镁肠溶片治疗)和对照组86例(采用氟哌噻吨美利曲辛片联合艾司奥美拉唑镁肠溶片治疗)。治疗8周后,比较两组治疗前后胃食管反流病量表(gastroesophageal reflux disease questionnaire,GerdQ)评分、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)-24评分变化及临床改善率,同时监测两组治疗前后肠道乳酸杆菌、双歧杆菌、类杆菌、粪肠球菌、大肠杆菌数量变化及血清5-HT、VIP水平改变。[结果]两组患者治疗后的GerdQ评分、HAMA评分、HAMD-24评分均明显下降,治疗前后差异有统计学意义(P<0.001)。两组治疗前后HAMA评分及HAMD-24评分的差值比较,实验组较对照组下降更明显(P<0.001,P<0.05);两组治疗前后GerdQ评分差值比较,差异无统计学意义(P=0.134)。实验组总有效率79.27%,高于对照组62.19%,差异有统计学意义(P<0.05)。治疗后实验组双歧杆菌、乳酸杆菌、类杆菌数量明显增加(P<0.001),粪肠球、大肠杆菌数量下降(P<0.001);而对照组治疗前后菌种数量改变并不明显,差异无统计学意义(P>0.05)。治疗后两组血清5-HT水平较治疗前升高(P<0.001);且实验组5-HT水平升高明显高于对照组,组间差异有统计学意义(P<0.001)。血清VIP水平两组治疗后较治疗前均降低(P<0.01),组间差异有统计学意义(P<0.001)。[结论]归脾汤联合艾司奥美拉唑镁肠溶片治疗NERD伴情志障碍(心脾两虚证)患者的疗效确切,有助于改善胃肠动力及食道高敏感,增加肠道有益菌的数量。

[Objective]To explore the clinical efficacy of Guipi Decoction combined with Esomeprazole Magnesium Enteric-coated tablets in the treatment of patients with non-erosive reflux disease(NERD)and emotional disorders(deficiency of the heart and spleen)and its effect on serum 5-hydroxytryptamine(5-HT),vasoactive intestinal peptide(VIP)levels and intestinal flora.[Methods]One hundred and seventy-two patients with NERD who met the inclusion exclusion criteria were randomly divided into experimental group(86 cases)and control group(86 cases).Patients in experimental group were treated with Guipi Decoction combined with Esomeprazole Magnesium Enteric-coated tablets,and control group were treated with Flupentixol and Melitroxine tablets combined with Esomeprazole Magnesium Enteric-coated tablets.Both groups were treated for 8 weeks.The gastroesophageal reflux disease questionnaire(GerdQ)score,Hamilton anxiety scale(HAMA)score,and Hamilton depression scale(HAMD)-24 score changes and clinical improvement rate were compared between the two groups before and after treatment,while the changes in the number of intestinal Lactobacillus,Bifidobacterium,Bacteroides,Enterococcus faecalis,Escherichia coli and serum 5-HT,VIP levels were monitored before and after treatment in both groups.[Results]After treatment,the GerdQ score,HAMA score,and HAMD-24 score of the two groups were significantly decreased,and the difference before and after treatment was statistically significant(P<0.001);the difference of HAMA score and HAMD-24 score before and after treatment was more obvious in experimental group than in control group(P<0.001,P<0.05),while the difference of GerdQ score between the two groups before and after treatment showed no statistical significance(P=0.134).The overall response rate in experimental group was 79.27%higher than that in control group(62.19%),and the difference had statistical significance(P<0.05).After treatment,the number of Lactobacillus,Bifidobacterium,Bacteroides in experimental group was significantly increased(P<0.001),the number of Enterococcus faecalis and Escherichia coli decreased(P<0.001);while the strains in control group did not change significantly before and after treatment(P>0.05).After treatment,the serum 5-HT level in both groups increased compared with that before treatment(P<0.001),and the 5-HT level increase in experimental group was significantly higher than that in control group,and the difference had statistical significance(P<0.001);the serum VIP levels in both groups decreased after treatment compared with those before treatment(P<0.01),and there was also significantly difference(P<0.001).[Conclusion]Guipi Decoction combined with Esomeprazole Magnesium Entericcoated tablets has definite efficacy in treating NERD patients with emotional disorders(deficiency of the heart and spleen).It also helps to improve gastrointestinal motility and hypersensitivity of the esophagus and increase the number of beneficial bacteria in the intestine.