双倍剂量艾司奥美拉唑、莫沙必利联合坦度螺酮治疗难治性胃食管反流病的疗效

Efficacy of double-dose esomeprazole,mosapride combined with tandospirone in the treatment of refractory gastroesophageal reflux disease

目的探讨双倍剂量艾司奥美拉唑、莫沙必利联合坦度螺酮治疗难治性胃食管反流病(rGERD)的疗效。方法146例rGERD患者随机分为对照组(双倍剂量艾司奥美拉唑+莫沙必利)和治疗组(双倍剂量艾司奥美拉唑+莫沙必利+坦度螺酮),各73例。比较两组临床症状评分、内镜黏膜分级、治疗总有效率、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、SF-36评分、食管动力学指标及血清学指标的差异。记录两组用药不良反应情况,对治疗有效患者进行复发率半年随访。结果两组治疗前临床症状评分、内镜黏膜分级、SAS评分、SDS评分、SF-36评分、食管括约肌压力、立位反流时间比、卧位反流时间比、总反流时间比及生长激素释放肽(ghrelin)、瘦素、胃蛋白酶原Ⅰ(PGⅠ)血清水平差异无统计学意义(P>0.05),治疗后,两组临床症状评分、内镜黏膜分级、SAS评分、SDS评分、立位反流时间比、卧位反流时间比、总反流时间比及瘦素、PGⅠ水平下降(P<0.05),SF-36评分、食管括约肌压力、ghrelin水平增高(P<0.05),但治疗组的以上指标的改善均优于对照组(P<0.05)。治疗组治疗总有效率高于对照组(91.78%vs.79.45%,P<0.05)。坦度螺酮治疗后的临床症状积分和内镜黏膜分级与治疗后SAS评分、SDS评分呈正相关(P<0.05)。治疗过程中,两组均有个别病例发生头晕、乏力等轻微不良反应,未影响治疗。停药后随访半年,治疗组复发率[43.3%(29/67)]低于对照组[77.6%(45/58),P<0.05]。结论与双倍剂量艾司奥美拉唑联合莫沙比利治疗方案比较,双倍剂量艾司奥美拉唑、莫沙比利联合坦度螺酮治疗rGERD的疗效更佳。

Objective To explore the efficacy of double-dose esomeprazole and mosapride combined with tandospirone in the treatment of refractory gastroesophageal reflux disease(rGERD).Methods One hundred and forty-six patients with rGERD were randomly divided into control group(double-dose esomeprazole+mosapride)and treatment group(double-dose esomeprazole+mosapride+tandospirone),with seventy-three cases each group.The differences in clinical symptom score,endoscopic mucosal grading,total therapeutic response,SAS score,SDS score,SF-36 score,esophageal dynamics indexes and serological indexes were compared between the two groups.The adverse reactions of the two groups were recorded,and the recurrence rate of the patients with effective treatment was followed up for half a year.Results Before treatment,clinical symptom scores,grade of endoscopic mucosa,SAS scores and SDS scores,SF-36 scale,esophageal sphincter pressure,stand reflux time ratio,decubitus reflux time ratio,total reflux ratio and the serum levels of growth hormone releasing peptide(ghrelin),leptin,pepsinogenⅠ(PGⅠ)were no statistical differences(P>0.05)between the two groups,after treatment,clinical symptom scores,grade of endoscopic mucosa,SAS scores,SDS scores,stand reflux time ratio,decubitus reflux time ratio,total reflux ratio and the levels of leptin,PGⅠdecreased(P<0.05),SF-36 scale,esophageal sphincter pressure,ghrelin level increased(P<0.05)in the two groups,but the improvement of the above indexes of treatment group were better than the control group(P<0.05).The total effective rate of treatment in the treatment group was higher than that in the control group(91.78%vs.79.45%,P<0.05).Clinical symptom score and endoscopic mucosal grade after tandospireone treatment were positively correlated with SAS score and SDS score after treatment(P<0.05).In the treatment process,both groups had individual cases of dizziness,fatigue and other minor adverse reactions,which did not affect the treatment.After six months of follow-up,the recurrence rate in the treatment group[43.3%(29/67)]was lower than that in the control group[77.6%(45/58)](P<0.05).Conclusion Compared with the double dose of esomeprazole combined with mosabil,the double dose of esomeprazole combined with mosapride combined with tandospirone was more effective in the treatment of rGERD.