柴胡桂枝干姜汤加味治疗胆热脾寒型慢性胆囊炎疗效及对炎症因子、胆囊功能及胃肠功能的影响

Effect of Modified Chaihu Guizhi Ganjiang Tang in Treating Chronic Cholecystitis of Gallbladder Heat

目的:观察柴胡桂枝干姜汤加味治疗慢性胆囊炎胆热脾寒证的临床效果,探讨其对炎症因子、胆囊功能及胃肠功能的影响。方法:选择2017年3月至2018年7月江苏省中医院门诊收治的129例慢性胆囊炎患者,采取随机数字表法将其随机分成观察组(65例)与对照组(64例),剔除遗失与脱落病例,观察组和对照组均实际完成61例。对照组给予常规治疗,观察组在此基础上内服柴胡桂枝干姜汤加味治疗,所有患者均治疗3周。对比两组临床疗效,治疗前后中医证候积分、炎症因子[白细胞介素(IL)-6,肿瘤坏死因子(TNF)-α]血清水平、胆囊功能及胃肠功能指标[胃动素(MTL),血管活性肠肽(VIP)]水平变化,毒副反应发生情况。结果:研究期间遗失与脱落7例,观察组总有效率为95.08%(58/61),与对照组的80.33%(49/61)相比明显升高(P<0.05)。两组治疗后各项症状(右上腹胀痛不适、纳呆嗳气、大便溏泄等)积分及血清IL-6,TNF-α水平均较本组治疗前明显降低(P<0.05),且观察组减少更明显(P<0.05)。两组治疗后胆囊壁厚度和血清VIP水平均较本组治疗前明显减少(P<0.05),胆囊收缩功能和血清MTL含量均明显提高(P<0.05);且观察组改善更明显(P<0.05)。两组均无明显副作用发生。结论:柴胡桂枝干姜汤加味治疗胆热脾寒型慢性胆囊炎能有效促进患者机体炎症反应的缓解,加速胃肠功能及胆囊收缩功能的恢复,疗效确切,患者耐受性较好。

Objective:To explore the clinical effect of modified Chaihu Guizhi Ganjiang Tang in the treatment of chronic cholecystitis with gallbladder heat and spleen cold syndrome.Method:Totally 129 cases with chronic cholecystitis treated in our hospital from March 2017 to July 2018 were selected as study objectives and randomly divided into observation group(65 cases)and control group(64 cases).After the shedding and exclusion cases were subtracted,61 patients in observation group and 61 patients in control group actually completed this study.The routine treatment was provided to both groups,and modified Chaihu Guizhi Ganjiang Tang was additionally given to observation group.All of the cases received treatments for 3 weeks.The two groups’clinical effect,traditional Chinese medicine(TCM)syndrome scores,inflammatory factors[interleukin(IL)-6,tumor necrosis factor(TNF)-α]levels in serum,gallbladder function,gastrointestinal function indicators[motilin(MTL),vasoactive intestinal peptide(VIP)]before and after treatments,as well as toxic side reaction were compared.Result:Totally 7 cases were lost during the study period.The overall effective rate of the observation group was 95.08%(58/61),which was significantly higher than 80.33%(49/61)of the control group(P<0.05).The scores of two groups(the right upper quadrant pain and discomfort,belch,diarrhea,et al)and serum IL-6,TNF-αconcentrations after treatment were significantly lower than those before treatment(P<0.05),gallbladder contractile function and serum MTL content were improved significantly(P<0.05),which was more significant in observation group(P<0.05).There was no significant side effect in both groups.Conclusion:Modified Chaihu Guizhi Ganjiang Tang treats patients with chronic cholecystitis with bile heat and spleen cold syndrome by effectively relieving inflammatory response and accelerating the recovery of gastrointestinal function and gallbladder systolic function,with an exact curative effect and high patient tolerance.