瑶药膏药联合扶正化瘀胶囊治疗门脉高压性胃病的临床研究

Clinical study on Yao medicine plaster combined with Fuzheng Huayu capsule in the treatment of portal hypertensive gastropathy

目的观察瑶药膏药联合扶正化瘀胶囊治疗门脉高压性胃病(PHG)的临床疗效。方法选择2018年1月—2020年1月贺州市中医医院收治的72例PHG患者,随机分为2组各36例,对照组采用奥美拉唑、莫沙必利、普萘洛尔治疗,并配合维生素、保肝降酶等辅助治疗,观察组在此基础上采用瑶药膏药联合扶正化瘀胶囊治疗。2组均以4周为1个疗程,连续治疗2个疗程。观察2组症状积分、门静脉血流动力学[门静脉主干内径(DPV)、血流速度(VPV)、血流量(QPV)]、肝纤维化指标[血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)]、胃肠激素[血清胃泌素(GAS)、胃动素(MTL)、胰高血糖素(GLU)]水平变化,比较2组内镜下胃黏膜改善情况及总体治疗效果。结果治疗后2组症状积分均显著降低(P均<0.05),且观察组显著低于同期对照组(P<0.05);治疗后2组DPV、QPV均显著降低(P均<0.05),VPV显著加快(P均<0.05),且观察组各指标改善情况均显著优于同期对照组(P均<0.05);治疗后2组HA、PCⅢ、LN、Ⅳ-C、GAS、MTL水平均显著降低(P均<0.05),且观察组均显著低于同期对照组(P均<0.05);治疗后2组GLU水平均显著降低(P均<0.05),但2组间比较差异无统计学意义(P>0.05);观察组和对照组胃黏膜病变改善总有效率分别为86.11%(31/36)、63.89%(23/36),总有效率分别为88.89%(32/36)、72.22%(26/36),观察组均显著高于对照组(P均<0.05)。结论瑶药膏药联合扶正化瘀胶囊辅助治疗PHG有助于改善临床症状、门脉血流动力学和胃黏膜病变,减轻肝纤维化,且可调节胃肠激素分泌。

Objective It is to observe the clinical efficacy of Yao medicine plaster combined with Fuzheng Huayu capsule in the treatment of portal hypertensive gastropathy(PHG).Methods A total of 72 PHG patients admitted to Hezhou Hospital of Traditional Chinese Medicine from January 2018 to January 2020 were selected and randomly divided into 2 groups with 36 cases in each group.The control group was treated with omeprazole,mosapride and propranolol combined with adjuvant therapy such as vitamins,liver protection and enzyme reduction,the observation group was treated with Yao medicine plaster combined with Fuzheng Huayu capsule.4 weeks as a course of treatment,and both groups were continuously treated for 2 treatment courses.The changes in symptom scores,portal vein hemodynamics[diameter of portal vein(DPV),velocity of portal vein(VPV),quantity of portal vein(QPV)],and the levels of liver fibrosis indexes[serum hyaluronic acid(HA),typeⅢprocollagen(PCⅢ),laminin(LN),typeⅣcollagen(Ⅳ-C)],gastrointestinal hormones[serum gastrin(GAS),motilin(MTL),glucagon(GLU)]were observed in the two groups,The improvement of gastric mucosa under endoscopy and the overall treatment effect were compared between the two groups.Results After treatment,the symptom scores of the two groups were significantly decreased(all P<0.05),and the observation group was significantly lower than the control group(P<0.05);DPV and QPV were significantly decreased(all P<0.05),VPV was significantly accelerated in the two groups(all P<0.05),and the improvement of each index in the observation group was significantly better than that in the control group(P<0.05);the levels of HA,PCⅢ,LN,Ⅳ-C,GAS,and MTL were significantly decreased in the two groups(all P<0.05),and the observation group was significantly lower than the control group(P<0.05);the levels of GLU in both groups were significantly decreased(P<0.05),but there was no significant difference between the two groups(P>0.05).The total effective rates of gastric mucosal lesions in the observation group and control group were 86.11%(31/36)and 63.89%(23/36),respectively,and the total effective rates were 88.89%(32/36)and 72.22%(26/36),respectively,the observation group was significantly higher than the control group(P<0.05).Conclusion Yao medicine plaster combined with Fuzheng Huayu capsule can improve clinical symptoms,portal hemodynamics and gastric mucosal lesions,alleviate liver fibrosis,and can regulate the secretion of gastrointestinal hormones in the adjuvant treatment of PHG.