吐酸病患者中医情志辨证疗效的单中心回顾性研究

A single center retrospective study on the efficacy of Traditional Chinese Medicine syndrome differentiation on emotion in patients with acid regurgitation

目的回顾性研究21010例吐酸病患者的基本资料,包括病因、心理评估、中医辨证分型,重点分析中医情志辨证施治的功效,为临床加强心身治疗提供依据。方法收集2016年1月-2018年12月就诊于消化科的吐酸病患者的病历资料,按照病因分为反流性食管炎(reflux esophagitis,RE)、非糜烂性反流病(non-erosive reflux disease,NERD)、反流高敏感(reflux hypersensitivity,RH)、功能性烧心(functional heartburn,FH)4个组,统计各组患者的一般资料、情志因素、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)和汉密尔顿抑郁量表(Hamilton depression Scale,HAMD)评分,重点分析中医情志辨证治疗对于吐酸病患者症状缓解的有效率。结果筛选吐酸病患者21010例,男8864例,女12146例,发病年龄40~60岁。病因:RE患者6284例(29.9%),NERD患者10426例(49.6%),RH患者2430例(11.6%),FH患者1870例(8.9%)。该类症状患者中合并情志障碍者约占38%(7901/21010),主要表现为焦虑、抑郁及睡眠障碍。其中RE患者1131例(18%),NERD患者3649例(35%),RH患者1531例(63%),FH患者1590例(85%),结果FH>RH>NERD>RE,差异有统计学意义(P<0.05),8周质子泵抑制剂治疗后有效率分别为89%、72%、54%、0;部分予以中医情志辨证施治2周,各组有效率均有提升,总有效率为76%,其中FH组有效率提升52%,差异有统计学意义(P<0.05)。结论吐酸病主要病因包括NERD、RE、RH及FH。患者多合并焦虑、抑郁情绪,该类患者加强心身治疗至关重要,中医情志调节可提高质子泵抑制剂治疗的疗效。

Objective To retrospectively study the basic data of 21010 patients with acid regurgitation,including etiology,psychological assessment,Traditional Chinese Medicine(TCM)syndrome differentiation,and focus on the analysis of the efficacy of emotional regulation by TCM,so as to provide a basis for clinical strengthening psychosomatic treatment.Methods Patients with acid regurgitation in the digestive department from January 2016 to December 2018 were collected and divided into four groups according to the etiology:reflux esophagitis(RE),non-erosive reflux disease(NERD),reflux hypersensitivity(RH)and functional heartburn(FH).The general information,emotional factors and Hamilton anxiety scale(HAMA)/Hamilton depression Scale(HAMD)scores in each group were statistically analyzed,and the effective rate of symptom relief by TCM treatment were analyzed emphatically.Results 21010 patients with acid regurgitation were screened,including 8864 males and 12146 females,with onset ages ranging from 40 to 60 years old.Etiology was as follows:6284(29.9%)cases with RE,10426(49.6%)cases with NERD,2430(11.6%)cases with RH,and 1870(8.9%)cases with FH.About 38%(7901/21010)of these patients were associated with emotional disorders,which were mainly manifested as anxiety,depression and sleep disorder,with 1131 cases of RE(18%),3649 cases of NERD(35%),1531 cases of RH(63%),and 1590 cases of FH(85%).The ranking in these four groups was FH>RH>NERD>RE(P<0.05),and the eight-week PPI treatment efficacy rates were 89%,72%,54%,and 0,respectively.Part of the patients were treated with TCM based on emotion and syndrome differentiation for two weeks,the effective rates of each group were improved,with a total effective rate of 76%,moreover,the FH group increased by 52%,which was statistically significant(P<0.05).Conclusion The mainly etiology of acid regurgitation includes NERD,RE,RH and FH.These patients often have anxiety and depression disorders,so it is crucial to strengthen psychosomatic treatment.In addition,emotional regulation by TCM could improve the efficacy of PPI effectively.