针药并用治疗胃食管反流病肝胃郁热证的疗效及作用机制

Therapeutic effect and mechanism of combination of acupuncture and Chinese herbal medicine on gastroesophageal reflux disease with syndrome of heat stagnation in liver and stomach

目的观察针药并用治疗胃食管反流病(GERD)肝胃郁热证患者的临床疗效及作用机制。方法将82例GERD肝胃郁热证患者随机分为观察组、对照组各41例。对照组予常规临床治疗方案,观察组加予丹栀逍遥散联合针刺治疗,2组疗程均为8周。比较2组临床疗效、上消化道内镜疗效;比较2组治疗前后中医证候积分,反流性疾病问卷(RDQ)评分,血清胃肠激素[胃泌素(GAS)、胃动素(MTL)、血管活性肠肽(VIP)]、蛋白酶激活受体2(PAR2)以及辣椒素瞬时受体电位阳离子通道亚家族V成员1(TRPV1)水平。结果与对照组比较,治疗后观察组上消化道内镜炎症总有效率、临床总有效率均高于对照组,RDQ评分、中医证候积分降低,血清GAS、MTL水平升高,血清VIP、PAR2、TRPV1水平降低,差异均有统计学意义(P<0.05)。结论针药并用辅助西医治疗GERD肝胃郁热证临床疗效较好,其作用机制与调节胃肠激素水平和降低食管高敏感性有关。

Objective To observe the therapeutic efficacy of combination of Chinese herbal medicine and acupuncture on gastroesophageal reflux disease(GERD)with syndrome of heat stagnation in liver and stomach.Methods 82 patients were randomly divided into observation group(n=41)and control group(n=41).The control group was given routine clinical treatment,and the observation group was given Danzhi Xiaoyao Powder combined with acupuncture on the basis of the control group.The course of treatment of two groups was 8 weeks.The clinical efficacy,upper gastrointestinal endoscopy efficacy,TCM syndrome score,reflux disease questionnaire(RDQ)score,serum gastrointestinal hormone[gastrin(GAS),motilin(MTL),vasoactive intestinal peptide(VIP)],PAR2 and TRPV1 were compared between the two groups.Results Compared with the control group,the total effective rate of upper gastrointestinal endoscopy and the total clinical effective rate in the observation group were significantly increased,TCM score,RDQ score and serum VIP,PAR2,TRPV1 expression levels in the observation group were significantly decreased and all the differences were statistically significant(P<0.05).Conclusion The clinical effect of acupuncture combined with western medicine on GERD with stagnation of heat in liver and stomach is related to the regulation of gastrointestinal hormone level and the reduction of esophageal hypersensitivity.