疏肝和胃汤治疗肝郁脾虚型功能性消化不良的临床研究

A Clinical Study on Treating Functional Dyspepsia with Liver-depression and Spleen-deficiency with Shugan Hewei Decoction

目的:从脑肠轴角度研究全国名中医凌湘力教授运用疏肝和胃汤治疗肝郁脾虚型功能性消化不良(FD)的临床疗效及其可能作用机制。方法:将60例肝郁脾虚型FD患者随机均分为治疗组、对照组,治疗组给予口服疏肝和胃汤,对照组给予口服多潘立酮片,14天为一个疗程,观察一个疗程后两组临床疗效及血清乙酰胆碱酯酶(AChE)、胃动素(MTL)、P物质(SP)、胃泌素(GAS)、胆囊收缩素(CCK)含量。结果:干预后两组均可升高FD患者血清MTL、GAS、AChE、SP水平(P<0.01)。两组组间MTL、GAS比较差异无统计学意义,而AChE、SP比较差异有统计学意义(P<0.01)。治疗后两组CCK水平均较前降低,且治疗组更优,差异有统计学意义(P<0.01)。两组能改善症状总积分(P<0.05),但组间比较差异无统计学意义,两组临床总有效率差异有统计学意义(P<0.05)。结束治疗3个月后的复发率治疗组低于对照组(P<0.05)。结论:疏肝和胃汤治疗肝郁脾虚型FD具有良好的疗效及安全性,其机制可能与升高血清MTL、GAS、AChE、SP,下调血清CCK水平有关。

Objective:To investigate the clinical efficacy and its possible mechanism of the Shugan Hewei Decoction created by national famous TCM master Ling Xiangli on functional dyspepsia(FD) patients with liver-depression and spleen-deficiency syndrome from the angle of brain-gut axis. Methods: 60 FD patients with liver-depression and spleen-deficiency syndrome were randomly divided into a treatment group and a control group. The former was given Shugan Hewei Decoction, while the latter was given Domperidone tablets. One course of treatment(14 days) was carried out for all patients. The clinical efficacy and the contents of serum AChE, MTL, SP, GAS and CCK were compared between the two groups before and after the treatment. Results: After intervention, both of the two methods can enhance the level of serum MTL, GAS, AChE and SP(P<0.01). There was no statistical differences in MTL and GAS between the two groups(P<0.05), but there were significant differences in AChE and SP between the two groups(P<0.01). After treatment, CCK levels in both groups were lower than before, and the treatment group was better. The difference was statistically significant(P <0.01). The two groups could improve the total score of symptoms(P<0.05), but there was no statistical difference between the two groups(P> 0.05), and the total clinical effective rate was statistically significant between the two groups(P<0.05). The recurrence rate was lower in the treatment group than in the control group after 3 months after the treatment(P<0.05). Conclusion: Shugan Hewei Decoction has good effect and safety in the treatment of FD with liver-depression and spleen-deficiency syndrome, and its mechanism maybe related to the increase of serum MTL, GAS, AChE and SP, and the decrease of serum CCK level.