乌梅丸治疗寒热错杂型胃食管反流病临床观察

Efficacy of Wumei Pills in the treatment of gastroesophageal reflux disease of cold and heat miscellaneous type

目的观察乌梅丸治疗寒热错杂型胃食管反流病(GERD)的临床疗效。方法将144例寒热错杂型GERD患者按照随机数字表法分为2组,对照组72例予常规西药治疗,治疗组72例在对照组治疗基础上联合乌梅丸治疗,2组疗程8周。比较2组中医证候疗效;比较2组治疗前后胃食管反流病问卷(GerdQ)评分、中医证候评分、匹兹堡睡眠质量指数量表(PSQI)评分变化;比较2组治疗前后胃镜下黏膜分级变化;比较2组治疗前后食管动力学指标食管收缩幅度、食管蠕动波传导速度变化;比较2组治疗前后血清胃肠激素胃动素(MLT)、胃泌素(GAS)、血管活性肽(VIP)变化;比较2组治疗前后内脏敏感性指标血清降钙素基因相关肽(CGRP)、P物质(SP)、5-羟色胺(5-HT)变化。结果治疗组中医证候总有效率97.2%(70/72),对照组中医证候总有效率87.5%(63/72),治疗组中医证候疗效优于对照组(P<0.05)。2组治疗后GerdQ评分、中医证候评分、PSQI评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后胃镜下黏膜分级均较本组治疗前改善(P<0.05),且治疗组改善更明显(P<0.05)。2组治疗后食管收缩幅度、食管蠕动波传导速度均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后血清GAS、MLT水平均较本组治疗前升高(P<0.05),VIP水平较本组治疗前降低(P<0.05);治疗后治疗组血清GAS、MLT水平均高于对照组(P<0.05),VIP水平低于对照组(P<0.05)。2组治疗后血清CGRP、SP、5-HT水平均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。结论乌梅丸治疗寒热错杂型GERD,可缓解患者症状,改善睡眠质量,降低内脏敏感性,改善胃肠激素水平。

Objective To investigate the clinical efficacy of Wumei Pills in the treatment of gastroesophageal reflux disease(GERD)of cold and heat miscellaneous type.Methods One hundred and forty-four GERD patients with cold and heat miscellaneous type were randomly assigned into the control group(n=72)and the treatment group(n=72).All patients were given Western medicine,and patients in the treatment group were additionally given Wumei Pills,the treatment was performed for 8 weeks.The key observation was the gastroesophageal reflux disease questionnaire(GerdQ)score,traditional Chinese medicine(TCM)syndrome score,endoscopic mucosal grading,and Pittsburgh sleep quality index(PSQI)score.The esophageal kinetic index including esophageal contraction amplitude,peristaltic wave amplitude,as well as serum gastrointestinal hormones melatonin(MLT),gastrin(GAS),vasoactive peptide(VIP),serum calcitonin gene-related peptide(CGRP),substance P(SP),and 5-hydroxytryptamine(5-HT)]were assessed in the two groups before and after treatment.Results The total effective rate in the treatment group was better than that of the control group(97.2%[70/72]vs 87.5%[63/72],P<0.05).After treatment,the scores of GerdQ,TCM syndrome and PSQI score in the two groups were significantly lower(P<0.05),and the decrease in the treatment group was more significant(P<0.05).After treatment,the mucosal grading in the two groups was significantly improved(P<0.05),and the improvement in the treatment group was more obvious(P<0.05).The esophageal contraction amplitude and peristaltic wave amplitude in the two groups were significantly higher(P<0.05),and the increase in the treatment group was more obvious(P<0.05).Significantly increased GAS,MLT(P<0.05)and significantly decreased VIP(P<0.05)were detected in the two groups after treatment.The treatment group was superior to the control group in GAS,MLT,VIP(all P<0.05).CGRP,SP,5-HT in the two groups were significantly lower(P<0.05),and the decrease in the treatment group was more obvious(P<0.05).Conclusion For GERD patients with cold and heat miscellaneous type,Wumei Pills can relieve symptoms,improve sleep quality,reduce visceral sensitivity,and improve gastrointestinal hormone levels.