疏肝和胃汤联合雷贝拉唑治疗肝胃不和型反流性食管炎临床研究

Clinical Study on Shugan Hewei Decoction(疏肝和胃汤)Combined with Rabeprazole in Treatment of Reflux Esophagitis with Liver and Stomach Disharmony

目的探究疏肝和胃汤联合雷贝拉唑治疗肝胃不和型反流性食管炎的临床疗效及对肠道菌群的影响。方法选取医院2021年1月—2022年12月收治的115例肝胃不和型反流性食管炎患者,随机分为西药组(55例)和疏肝和胃组(60例),西药组予口服雷贝拉唑钠肠溶胶囊,疏肝和胃组在西药组基础上加用疏肝和胃汤加减治疗,均治疗8周。分别于治疗前后评价两组患者中医症状积分(反酸、胃胀、胸骨后灼痛、倦怠乏力、大便黏腻),胃镜下观察患者的胃液反流情况(24 h反流次数、最长反流时间、胃液反流分级),采集粪便检测肠道菌群种属和数量,并评价临床疗效,观察治疗期间出现的不良反应情况。结果(1)中医症状评分:治疗后两组较治疗前均降低(P<0.05),疏肝和胃组患者在胃胀、胸骨后灼痛、倦怠乏力、大便黏腻方面较西药组低(P<0.05),差异均有统计学意义。反酸方面两组治疗后差异无统计学意义(P>0.05)。(2)胃液反流情况:治疗后两组24 h食管内胃液反流次数、最长反流时间及胃镜下食管内胃液反流程度分级均较治疗前改善(P<0.05),且疏肝和胃组优于西药组(P<0.05),差异均有统计学意义。(3)临床疗效:疏肝和胃组临床总有效率为95.00%(57/60),高于西药组的78.18%(43/55)(Z=2.542,P=0.011),差异有统计学意义。(4)肠道菌群:治疗后疏肝和胃组乳酸菌、双歧杆菌数量较治疗前升高(P<0.05),肠球菌、肠杆菌数量减少(P<0.05);西药组治疗后乳酸菌、双歧杆菌数量减少(P<0.05),肠杆菌、肠球菌较治疗前差异无统计学意义(P>0.05)。与西药组比较,疏肝和胃组治疗后乳酸菌、双歧杆菌数量升高(P<0.05),肠球菌、肠杆菌数量减少(P<0.05),差异均有统计学意义。(5)不良反应:两组治疗过程中均未发生严重的不良反应事件,主要不良反应为腹胀腹泻、恶心呕吐、大便次数增多、口干、头痛,西药组不良反应总发生率为21.82%(12/55),疏肝和胃组为16.67%(10/60),两组比较差异无统计学意义(χ^(2)=3.379,P=0.066)。结论疏肝和胃汤联合西药治疗肝胃不和型反流性食管炎,能够改善患者反酸、胃胀等症状,抑制胃液反流,调节肠道菌群,效果均优于单纯西药治疗,且安全性较好。

Objective To explore the clinical efficacy of Shugan Hewei Decoction(疏肝和胃汤)combined with rabeprazole in the treatment of reflux esophagitis with disharmony between liver and stomach and its effect on intestinal flora.Methods A total of 115 patients with reflux esophagitis with disharmony between liver and stomach were randomly divided into western medicine group(55 cases)and Shugan Hewei Decoction group(60 cases).The western medicine group was given rabeprazole sodium enteric-coated capsule orally.The Shugan Hewei Decoction group was treated with Shugan Hewei Decoction on the basis of the western medicine group for 8 weeks.Before and after treatment,the TCM symptom scores(acid regurgitation,bloating,burning pain after sternum,fatigue and greasy stool)of the two groups were evaluated,and the gastric reflux(the number of reflux in 24 hours,the longest reflux time and the grade of gastric reflux)of the patients were observed under gastroscope,and the feces were collected to detect the species and quantity of intestinal flora,and the clinical efficacy was evaluated,and the adverse reactions occurred during treatment were observed.Results(1)Traditional Chinese medicine symptom scores:After treatment,the scores of both groups were lower than those before treatment(P<0.05).The scores of stomach bloating,poststernal burning pain,fatigue and sticky stool in the Shugan Hewei Decoction group were lower than those in the western medicine group(P<0.05),and the difference was statistically significant.There was no significant difference in acid reflux between the two groups after treatment(P>0.05).(2)Gastric reflux:The number of reflux,the longest reflux time and the grade of reflux in the esophagus under gastroscope in the two groups at 24 hours after treatment were improved compared with those before treatment(P>0.05).(3)Clinical efficacy:The total clinical effective rate of the Shugan Hewei Decoction group was 95.00%(57/60),higher than 78.18%(43/55)of the western medicine group(Z=2.542,P=0.011),with a statistically significant difference.(4)Intestinal flora:After treatment,the number of lactic acid bacteria and bifidobacteria in the Shugan Hewei Decoction group significantly increased compared with that before treatment(P<0.05),while the number of enterococcus and enterobacteria decreased(P<0.05).After treatment,the number of lactic acid bacteria and bifidobacteria in the western medicine group decreased(P<0.05),while the number of enterobacteria and enterococcus had no significant difference(P>0.05).Compared with that of the western medicine group,the number of lactic acid bacteria and bifidobacteria in the Shugan Hewei Decoction group increased after treatment(P<0.05),while the number of enterococcus and enterobacter decreased(P<0.05).The difference was statistically significant.(5)Adverse reactions:There were no serious adverse reactions during the treatment in the two groups.The main adverse reactions were abdominal distension,diarrhea,nausea and vomiting,increased stool frequency,dry mouth and headache.The total incidence of adverse reactions in the western medicine group was 21.82%(12/55),and that in the Shugan Hewei Decoction group was 16.67%(10/60).There was no statistically significant difference between the two groups(χ^(2)=3.379,P=0.066).Conclusions Shugan Hewei Decoction combined with western medicine can improve the symptoms of reflux esophagitis of disharmony between liver and stomach,inhibit gastric reflux and regulate intestinal flora.The effect is better than that of western medicine alone,and the safety is better.