胃食管反流病患者血浆代谢组学研究及临床观察

Plasma metabolomics study and clinical observation in patients with gastroesophageal reflux disease

分析胃食管反流病(GERD)患者血浆代谢物成分,探索潜在的发病机制及评价芪石升降归元饮的临床疗效。选取60例广西中医药大学第一附属医院GERD患者及12例健康志愿者,将GERD患者随机分为中药组和西药组,每组各30例。中药组给予芪石升降归元饮治疗,西药组给予雷贝拉唑钠肠溶胶囊治疗,疗程为28 d。比较两组患者临床疗效、胃食管反流病问卷(GERD-Q)、反流性疾病问卷(RDQ)评分。分析GERD病患者与健康受试者血浆代谢物差异。结果表明:两组基线水平无明显差异(P>0.05);中药组临床疗效优于西药组(P<0.05);两组治疗后GERD-Q评分、RDQ评分均较治疗前降低(P<0.05),其中中药组GERD-Q、RDQ评分降低较西药组明显(P<0.01)。GERD患者与健康受试者血浆样本之间存在86个差异代谢物,共参与了27条代谢通路,通过KEGG数据库进行筛选,发现有23个差异代谢物主要富集在亚油酸代谢通路、D-谷氨酰胺和D-谷氨酸代谢通路、精氨酸生物合成代谢通路等,另外还包括了色氨酸代谢通路以及AMPK通路,从而得知GERD患者血浆代谢产物主要涉及脂类、氨基酸类、多肽类等多种代谢途径。芪石升降归元饮治疗GERD疗效显著。

To analyze the plasma metabolites in patients with gastroesophageal reflux disease(GERD),explore the potential pathogenesis and evaluate the clinical effect of Qishi Shengjiang Guiyuan Decoction.60 cases of GERD patients from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine and 12 healthy volunteers were selected,patients with GERD were randomly divided into Chinese medicine group and western medicine group,30 cases in each group,The Chinese medicine group was treated with Qishi Shengjiang Guiyuan Decoction,the western medicine group was giving with rabeprazole sodium enteric-coated capsules,the course of treatment is 28 days.Compare the clinical outcomes,GERD-Q and RDQ scores between the two groups.Analysis of plasma metabolite differences between patients with GERD and healthy volunteers.The results showed no significant difference between the two groups at baseline level(P>0.05).The therapeutic effect of the traditional herb group was exceed than that of the western medicine group(P<0.05).The GERD-Q scores and RDQ scores decreased in both groups after treatment compared with those before treatment(P<0.05),in which the GERD-Q and RDQ scores decreased significantly in the Chinese medicine group compared with the western medicine group(P<0.01).The plasma samples from GERD patients and healthy volunteers contained 86 different metabolites,participating in a total of 27 metabolic pathways.Screening through the KEGG database revealed that 23 different metabolites were mainly enriched in the linoleic acid metabolic pathway,D-glutamine and D-glutamate metabolic pathway,arginine biosynthetic metabolic pathway,and also in the tryptophan metabolic pathway and AMPK pathway,thus revealing that plasma metabolites from GERD patients are mainly involved in lipid,amino acid and peptide metabolic pathways.Qishi Shengjiang Guiyuan Decoction has significant curative effect on GERD.