越鞠丸合旋覆代赭汤治疗非糜烂性食管炎(气郁痰阻证)的疗效及对胃泌素、胃蛋白酶原和食管动力的影响

Efficacy of Yueju Wan plus the Xuanfu Daizhe decoction on non-erosive esophagitis of(Qi stagnation and phlegm obstruction syndrome)and its effects on gastrin,pepsinogen and esophageal motility

目的:观察越鞠丸合旋覆代赭汤治疗非糜烂性食管炎(气郁痰阻证)的疗效及对胃泌素、胃蛋白酶原和食管动力的影响。方法:选取100例非糜烂性食管炎(气郁痰阻证)患者,采用随机数字表法划分为对照组和观察组,各50例。对照组患者按照西医标准治疗,观察组则在对照组基础上给予越鞠丸合旋覆代赭汤。比较两组治疗前后中医证候(胃脘胀满、呃逆嗳气、吞咽不利、胸胁胀满和苔白腻、脉弦滑)积分、胃泌素-17(Gastrin-17,G-17)、胃蛋白酶原(Pepsinogen,PG)Ⅰ、PGⅡ和PGⅠ/PGⅡ和食管动力指标(下括约肌静息压、下段蠕动波压力、卧位反流时间百分比和立位反流时间百分比),记录情绪和生活质量评分[焦虑自评量表(Self-rating Anxiety Scale,SAS)、纽芬兰纪念大学幸福度量表(Memorial University of Newfoundand Scale of Happiness,MUNSH)和生活质量量表(36-item Short From Health Survey Questionnaire,SF-36)评分],并统计临床治疗总有效率。结果:两组治疗后胃脘胀满、呃逆嗳气、吞咽不利、胸胁胀满和苔白腻、脉弦滑的证候积分均较治疗前显著降低(P<0.05),且观察组治疗后的上述中医证候积分均显著低于对照组(P<0.05)。两组治疗后PGⅠ和PGⅠ/PGⅡ数值均较治疗前显著升高(P<0.05),G-17和PGⅡ显著降低(P<0.05),且观察组治疗后的上述指标均显著优于对照组(P<0.05)。两组治疗后下括约肌静息压和下段蠕动波压力均较治疗前显著升高(P<0.05),卧位和立位反流时间百分比显著降低(P<0.05),且观察组治疗后的上述食管动力指标均显著优于对照组(P<0.05)。两组治疗后SAS评分较治疗前显著降低(P<0.05),MUNSH和SF-36评分显著升高(P<0.05),且观察组治疗后的上述情绪和生活质量评分均显著优于对照组(P<0.05)。观察组的临床治疗总有效率显著高于对照组(P<0.05)。结论:越鞠丸合旋覆代赭汤可有效改善非糜烂性食管炎气郁痰阻证患者的中医证候评分,调节胃泌素、胃蛋白酶原的异常分泌和食管动力失衡状态,并缓解患者的抑郁情绪,提高其生活质量,改善治疗结局。

Objective:To observe the curative effect of Yueju Wan(越鞠丸)plus the Xuanfu Daizhe decoction(旋覆代赭汤)in the treatment of non-erosive esophagitis[Qi(气)stagnation and phlegm obstruction syndrome]and its effect on gastrin,pepsinogen and esophageal motility.Methods:A total of 100 patients with non-erosive esophagitis(Qi stagnation and phlegm obstruction syndrome)were divided into the control group and the observation group by random number table method,with 50 cases in each group.The patients in the control group were treated according to the standard of Western medicine,and the patients in the observation group were given Yueju Wan plus the Xuanfu Daizhe decoction more.The TCM symptom(epigastric fullness,hiccups,belching,dysphagia,fullness of the chest and flanks,white greasy coating and slippery pulse)scores,G-17,PGⅠ,PGⅡand PGⅠ/PGⅡ,and esophageal motility indicators(lower sphincter resting pressure,lower peristaltic wave pressure,percentage of supine regurgitation time and percentage of upright regurgitation time);scores of mood and quality of life(SAS,MUNSH and SF-36 scores)were recorded,and the total effective rate of clinical treatment was calculated.Results:After treatment,the symptom scores of epigastric fullness,hiccups,belching,dysphagia,fullness of chest and flank,white greasy coating,and slippery pulse were significantly lower in the two groups than before treatment(P<0.05).The above TCM syndrome scores in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the values of PGⅠand PGⅠ/PGⅡin the two groups were significantly increased compared with those before treatment(P<0.05),while G-17 and PGⅡwere significantly decreased(P<0.05),and the above indexes in the observation group after treatment were significantly better than those in the control group(P<0.05).After treatment,lower sphincter resting pressure and lower peristaltic wave pressure in both groups were significantly higher than those before treatment(P<0.05),and the percentages of supine and standing reflux time were significantly decreased(P<0.05).The above esophageal motility indexes in the observation group were significantly better than those in the control group(P<0.05).After treatment,the SAS scores in the two groups were significantly lower than those before treatment(P<0.05),and the MUNSH and SF-36 scores were significantly increased(P<0.05),and the above emotional and life quality scores in the observation group after treatment were significantly better than those in the control group(P<0.05).The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Yueju Wan plus the Xuanfu Daizhe decoction can effectively improve the TCM symptoms in patients with non-erosive esophagitis with Qi stagnation and phlegm obstruction syndrome,regulate the abnormal secretion of gastrin and pepsinogen,and esophageal motility imbalance,relieve the depression of patients,and improve quality of life and treatment outcomes.