健胃愈疡片联合三联疗法治疗反流性食管炎
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摘要
目的探讨健胃愈疡片联合三联疗法治疗反流性食管炎的临床疗效。方法选择2015年2月～2017年2月我院接诊的90例反流性食管炎患者,通过随机数表法分为观察组和对照组各45例,在基础治疗上,对照组给予三联疗法(奥美拉唑+甲硝唑+阿莫西林)治疗,观察组联合健胃愈疡片治疗,两组均连续治疗4周。比较两组治疗前后血清胃泌素(GAS)、一氧化氮(NO)、生长激素释放多肽(Ghrelin)、瘦素(Leptin)和中医证候积分的变化,并比较治疗后粘膜愈合率及临床疗效。结果治疗后,两组血清GAS、Ghrelin较治疗前均显著升高,血清NO、Leptin显著降低(P<0.05),观察组血清GAS、Ghrelin明显高于对照组,血清NO、Leptin明显比对照组低(P<0.05);治疗后,两组烧心、反酸、胸痛症状积分较治疗前均显著降低(P<0.05),观察组烧心、反酸、胸痛症状积分均明显比对照组低(P<0.05);观察组粘膜愈合率明显高于对照组(P<0.05);观察组临床总有效率明显高于对照组(P<0.05)。结论健胃愈疡片联合三联疗法治疗反流性食管炎效果显著,可有效促进食管粘膜愈合、缓解临床症状,促进临床疗效提高,可在临床推广应用。
Objective To study curative efficacy of Jianwei Yuyang tablets combined with triple therapy in treatment of reflux esophagitis.Methods 90 patients of reflux esophagitis who received therapy from February 2015 to February 2017 in our hospital were selected.According to random number table,those patients were divided into the observation group(n=45)and the control group(n=45).On basic treatment,the control group was treated with triple therapy(Omeprazole+ metronidazole+ amoxicillin),while the observation group was combined with Jianwei Yuyang tablets,They were treated continuously for 4weeks.The changes of serum levels of gastrin(GAS),Nitric oxide(NO),growth hormone releasing polypeptide(Ghrelin),Leptin and clinical symptom scores were compared between the two groups before and after treatment,and the mucosal healed rate and clinical efficacy were compared after treatment.Results After treatment,the levels of serum GAS and Ghrelin in the two groups were significantly higher than those before treatment,and levels of serum NO and Leptin decreased significantly(P<0.05);and the levels of serum GAS and Ghrelin in the observation group were significantly higher than those in the control group,and the levels of serum NO and Leptin were significantly lower than those in the control group(P<0.05);after treatment,the scores of heartburn,acid regurgitation,chest pain symptom in the two groups were significantly lower than those before treatment(P<0.05),and the scores of heartburn,acid regurgitation,chest pain symptom in the observation group were significantly lower than those in the control group(P<0.05);the total mucosal healed rate in the observation group were significantly lower than those in the control group(P<0.05);the total effective rate of clinical efficacyin the observation group were significantly lower than those in the control group(P<0.05).Conclusion Jianwei Yuyang tablets combined with triple therapy is well for reflux esophagitis,which can effectively promote the healing of esophageal mucosa,relieve the clinical symptoms and improve the clinical efficacy,it's internal mechanism may be related to regulating the expression of serum GAS,NO,Ghrelin and Leptin.
Objective To study curative efficacy of Jianwei Yuyang tablets combined with triple therapy in treatment of reflux esophagitis.Methods 90 patients of reflux esophagitis who received therapy from February 2015 to February 2017 in our hospital were selected.According to random number table,those patients were divided into the observation group(n=45)and the control group(n=45).On basic treatment,the control group was treated with triple therapy(Omeprazole+ metronidazole+ amoxicillin),while the observation group was combined with Jianwei Yuyang tablets,They were treated continuously for 4weeks.The changes of serum levels of gastrin(GAS),Nitric oxide(NO),growth hormone releasing polypeptide(Ghrelin),Leptin and clinical symptom scores were compared between the two groups before and after treatment,and the mucosal healed rate and clinical efficacy were compared after treatment.Results After treatment,the levels of serum GAS and Ghrelin in the two groups were significantly higher than those before treatment,and levels of serum NO and Leptin decreased significantly(P<0.05);and the levels of serum GAS and Ghrelin in the observation group were significantly higher than those in the control group,and the levels of serum NO and Leptin were significantly lower than those in the control group(P<0.05);after treatment,the scores of heartburn,acid regurgitation,chest pain symptom in the two groups were significantly lower than those before treatment(P<0.05),and the scores of heartburn,acid regurgitation,chest pain symptom in the observation group were significantly lower than those in the control group(P<0.05);the total mucosal healed rate in the observation group were significantly lower than those in the control group(P<0.05);the total effective rate of clinical efficacyin the observation group were significantly lower than those in the control group(P<0.05).Conclusion Jianwei Yuyang tablets combined with triple therapy is well for reflux esophagitis,which can effectively promote the healing of esophageal mucosa,relieve the clinical symptoms and improve the clinical efficacy,it's internal mechanism may be related to regulating the expression of serum GAS,NO,Ghrelin and Leptin.
引文
[1] Yamashita H,Kanamori A,Kano C,et al.The Effects of Switching to Vonoprazan,a Novel Potassium-Competitive Acid Blocker,on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors[J].Digestion,2017,96(1):52-59.
[2] Song JH,Han YM,Kim WH,et al.Oxidative stress from reflux esophagitis to esophageal cancer:the alleviation with antioxidants[J].Free Radic Res,2016,50(10):1071-1079.
[3] Hirano I.An Overview of Dietary Therapies for the Treatment of Eosinophilic Esophagitis[J].Gastroenterol Hepatol(N Y),2017,13(6):381-383.
[4] Akazawa Y,Fukuda D,Fukuda Y.Vonoprazan-based therapy for Helicobacter pylori eradication:experience and clinical evidence[J].Therap Adv Gastroenterol,2016,9(6):845-852.
[5] Laursen TL,Zak RB,Shute RJ,et al.Leptin,adiponectin,and ghrelin responses to endurance exercise in different ambient conditions[J].Temperature(Austin),2017,4(2):166-175.
[6] Politi E,Angelakopoulou A,Grapsa D,et al.Filaggrin and Periostin Expression Is Altered in Eosinophilic Esophagitis and Normalized With Treatment[J].J Pediatr Gastroenterol Nutr,2017,65(1):47-52.
[7] Shivappa N,Hebert JR,Anderson LA,et al.Dietary inflammatory index and risk of reflux oesophagitis,Barrett's oesophagus and oesophageal adenocarcinoma:apopulation-based casecontrol study[J].Br J Nutr,2017,117(9):1323-1331.
[8] Iwakiri K,Sakurai Y,Shiino M,et al.A randomized,doubleblind study to evaluate the acid-inhibitory effect of vonoprazan(20mg and 40mg)in patients with proton-pump inhibitor-resistant erosive esophagitis[J].Therap Adv Gastroenterol,2017,10(6):439-451.
[9] Shah DK,Jain SS,Mohite A,et al.Effect of H.pylori density by histopathology on its complications and eradication therapy[J].Trop Gastroenterol,2015,36(2):101-106.
[10] Moschos JM,Kouklakis G,Vradelis S,et al.Patients with established gastro-esophageal reflux disease might benefit from Helicobacter pylori eradication[J].Ann Gastroenterol,2014,27(4):352-356.
[11] He LX,Zhang ZF,Sun B,et al.Sea cucumber(Codonopsis pilosula)oligopeptides:immunomodulatory effects based on stimulating Th cells,cytokine secretion and antibody production[J].Food Funct,2016,7(2):1208-1216.
[12] Lin Y,Kuang Y,Li K,et al.Screening for bioactive natural products from a 67-compound library of Glycyrrhiza inflate[J].Bioorg Med Chem,2017,25(14):3706-3713.
[13] Eluri S,Book WM,Kodroff E,et al.Lack of Knowledge and Low Readiness for Health Care Transition in Eosinophilic Esophagitis and Eosinophilic Gastroenteritis[J].J Pediatr Gastroenterol Nutr,2017,65(1):53-57.
[14] Yamashita H,Kanamori A,Kano C,et al.The Effects of Switching to Vonoprazan,a Novel Potassium-Competitive Acid Blocker,on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors[J].Digestion,2017,96(1):52-59.
[15] Brzozowska I,Strzalka M,Drozdowicz D,et al.Mechanisms of esophageal protection,gastroprotection and ulcer healing by melatonin.implications for the therapeutic use of melatonin in gastroesophageal reflux disease(GERD)and peptic ulcer disease[J].Curr Pharm Des,2014,20(30):4807-4815.
[16] Helgadóttir H,Metz DC,Yang YX,et al.The effects of long-term therapy with proton pump inhibitors on meal stimulated gastrin[J].Dig Liver Dis,2014,46(2):125-130.
[17] Shivappa N,Hebert JR,Anderson LA,et al.Dietary inflammatory index and risk of reflux oesophagitis,Barrett's oesophagus and oesophageal adenocarcinoma:apopulation-based case-control study[J].Br J Nutr,2017,117(9):1323-1331.
[18] Iwakiri K,Sakurai Y,Shiino M,et al.A randomized,double-blind study to evaluate the acid-inhibitory effect of vonoprazan(20mg and 40mg)in patients with proton-pump inhibitor-resistant erosive esophagitis[J].Therap Adv Gastroenterol,2017,10(6):439-451.
[19] Takiguchi S,Hiura Y,Takahashi T,et al.Effect of rikkunshito,a Japanese herbal medicine,on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy[J].Gastric Cancer,2013,16(2):167-174.
[20] Ghomraoui FA,Alotaibi ST,Alharthi MA,et al.Plasma ghrelin and leptin in patients with inflammatory bowel disease and its association with nutritional status[J].Saudi J Gastroenterol,2017,23(3):199-205.
[21] Kavanagh ME,O'Sullivan KE,O'Hanlon C,et al.The esophagitis to adenocarcinoma sequence;the role of inflammation[J].Cancer Lett,2014,345(2):182-189.
[22] Nam SY,Choi IJ,Ryu KH,et al.The effect of abdominal visceral fat,circulating inflammatory cytokines,and leptin levels on reflux esophagitis[J].J Neurogastroenterol Motil,2015,21(2):247-254.
[23] Politi E,Angelakopoulou A,Grapsa D,et al.Filaggrin and Periostin Expression Is Altered in Eosinophilic Esophagitis and Normalized With Treatment[J].J Pediatr Gastroenterol Nutr,2017,65(1):47-52.
[2] Song JH,Han YM,Kim WH,et al.Oxidative stress from reflux esophagitis to esophageal cancer:the alleviation with antioxidants[J].Free Radic Res,2016,50(10):1071-1079.
[3] Hirano I.An Overview of Dietary Therapies for the Treatment of Eosinophilic Esophagitis[J].Gastroenterol Hepatol(N Y),2017,13(6):381-383.
[4] Akazawa Y,Fukuda D,Fukuda Y.Vonoprazan-based therapy for Helicobacter pylori eradication:experience and clinical evidence[J].Therap Adv Gastroenterol,2016,9(6):845-852.
[5] Laursen TL,Zak RB,Shute RJ,et al.Leptin,adiponectin,and ghrelin responses to endurance exercise in different ambient conditions[J].Temperature(Austin),2017,4(2):166-175.
[6] Politi E,Angelakopoulou A,Grapsa D,et al.Filaggrin and Periostin Expression Is Altered in Eosinophilic Esophagitis and Normalized With Treatment[J].J Pediatr Gastroenterol Nutr,2017,65(1):47-52.
[7] Shivappa N,Hebert JR,Anderson LA,et al.Dietary inflammatory index and risk of reflux oesophagitis,Barrett's oesophagus and oesophageal adenocarcinoma:apopulation-based casecontrol study[J].Br J Nutr,2017,117(9):1323-1331.
[8] Iwakiri K,Sakurai Y,Shiino M,et al.A randomized,doubleblind study to evaluate the acid-inhibitory effect of vonoprazan(20mg and 40mg)in patients with proton-pump inhibitor-resistant erosive esophagitis[J].Therap Adv Gastroenterol,2017,10(6):439-451.
[9] Shah DK,Jain SS,Mohite A,et al.Effect of H.pylori density by histopathology on its complications and eradication therapy[J].Trop Gastroenterol,2015,36(2):101-106.
[10] Moschos JM,Kouklakis G,Vradelis S,et al.Patients with established gastro-esophageal reflux disease might benefit from Helicobacter pylori eradication[J].Ann Gastroenterol,2014,27(4):352-356.
[11] He LX,Zhang ZF,Sun B,et al.Sea cucumber(Codonopsis pilosula)oligopeptides:immunomodulatory effects based on stimulating Th cells,cytokine secretion and antibody production[J].Food Funct,2016,7(2):1208-1216.
[12] Lin Y,Kuang Y,Li K,et al.Screening for bioactive natural products from a 67-compound library of Glycyrrhiza inflate[J].Bioorg Med Chem,2017,25(14):3706-3713.
[13] Eluri S,Book WM,Kodroff E,et al.Lack of Knowledge and Low Readiness for Health Care Transition in Eosinophilic Esophagitis and Eosinophilic Gastroenteritis[J].J Pediatr Gastroenterol Nutr,2017,65(1):53-57.
[14] Yamashita H,Kanamori A,Kano C,et al.The Effects of Switching to Vonoprazan,a Novel Potassium-Competitive Acid Blocker,on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors[J].Digestion,2017,96(1):52-59.
[15] Brzozowska I,Strzalka M,Drozdowicz D,et al.Mechanisms of esophageal protection,gastroprotection and ulcer healing by melatonin.implications for the therapeutic use of melatonin in gastroesophageal reflux disease(GERD)and peptic ulcer disease[J].Curr Pharm Des,2014,20(30):4807-4815.
[16] Helgadóttir H,Metz DC,Yang YX,et al.The effects of long-term therapy with proton pump inhibitors on meal stimulated gastrin[J].Dig Liver Dis,2014,46(2):125-130.
[17] Shivappa N,Hebert JR,Anderson LA,et al.Dietary inflammatory index and risk of reflux oesophagitis,Barrett's oesophagus and oesophageal adenocarcinoma:apopulation-based case-control study[J].Br J Nutr,2017,117(9):1323-1331.
[18] Iwakiri K,Sakurai Y,Shiino M,et al.A randomized,double-blind study to evaluate the acid-inhibitory effect of vonoprazan(20mg and 40mg)in patients with proton-pump inhibitor-resistant erosive esophagitis[J].Therap Adv Gastroenterol,2017,10(6):439-451.
[19] Takiguchi S,Hiura Y,Takahashi T,et al.Effect of rikkunshito,a Japanese herbal medicine,on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy[J].Gastric Cancer,2013,16(2):167-174.
[20] Ghomraoui FA,Alotaibi ST,Alharthi MA,et al.Plasma ghrelin and leptin in patients with inflammatory bowel disease and its association with nutritional status[J].Saudi J Gastroenterol,2017,23(3):199-205.
[21] Kavanagh ME,O'Sullivan KE,O'Hanlon C,et al.The esophagitis to adenocarcinoma sequence;the role of inflammation[J].Cancer Lett,2014,345(2):182-189.
[22] Nam SY,Choi IJ,Ryu KH,et al.The effect of abdominal visceral fat,circulating inflammatory cytokines,and leptin levels on reflux esophagitis[J].J Neurogastroenterol Motil,2015,21(2):247-254.
[23] Politi E,Angelakopoulou A,Grapsa D,et al.Filaggrin and Periostin Expression Is Altered in Eosinophilic Esophagitis and Normalized With Treatment[J].J Pediatr Gastroenterol Nutr,2017,65(1):47-52.