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
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摘要
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-α concentrations 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.
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-α concentrations 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.
引文
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[3]中华消化杂志编辑委员会.中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].中华消化杂志,2014,34(12):292-296.
[4]吴伟,张光银,翟宏军.消炎利胆胶囊联合头孢唑林钠治疗慢性胆囊炎的临床研究[J].现代药物与临床,2017,32(12):2446-2450.
[5]赵润元,杜朋丽,李博林,等.柴金化瘀方对慢性胆囊炎患者血清炎性因子及胆囊收缩功能的影响[J].中国中西医结合消化杂志,2018,26(10):874-877.
[6]张洁靖,李汉智.利胆排石汤保守治疗慢性胆囊炎的临床分析[J].中国实验方剂学杂志,2016,22(7):187-190.
[7]张声生,赵文霞.胆囊炎中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(4):241-246
[8]刘南阳,史彬,杨迪,等.李振华运用柴胡桂枝干姜汤验案举隅[J].辽宁中医杂志,2018,45(8):1602-1604.
[9]袁嘉嘉,孙志广,肖君,等.柴胡桂枝干姜汤在治疗消化系统疾病中的应用[J].辽宁中医杂志,2016,43(8):1777-1780.
[10]陈灏珠,林果为.实用内科学[M].13版.北京:人民卫生出社,2009:2152-2153.
[11]李曰庆.中医外科学[M].2版.北京:中国中医药出版社,2007:127.
[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:281-285.
[13]Poddubnaya O A.Chronorehabilitation of the patients suffering from chronic cholecystitis with concomitant gallbladder dysfunction and opisthorchiasis[J].Vopr Kurortol Fizioter Lech Fiz Kult,2017,94(2):29-35.
[14]Van Dijk A H,De Reuver P R,Tasma T N,et al.Systematic review of antibiotic treatment for acute calculous cholecystitis[J].British J Surg,2016,103(7):797-811.
[15]中华中医药学会脾胃病分会.胆囊炎中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(4):241-246.
[16]王付,谢新年.四逆散合方辨治肝胆病证[J].中国实验方剂学杂志,2011,17(19):300-301.
[17]于李.柴胡桂枝干姜汤的应用研究[J].长春中医药大学学报,2016,32(6):1177-1179.
[18]徐维浓,陈明.柴胡桂枝干姜汤证之解读与运用[J].中华中医药杂志,2015,30(9):3142-3144.
[19]郭丽萍.柴胡疏肝散治疗慢性胆囊炎及对患者胆囊功能、炎症因子水平的影响[J].陕西中医,2018,39(7):882-884.
[20]Kasprzak A,Szmyt M,Malkowski W,et al.Analysis of immunohistochemical expression of proinflammatory cytokines(IL-1α,IL-6,and TNF-α)in gallbladder mucosa:comparative study in acute and chronic calculous cholecystitis[J].Folia Morphol Warsz,2015,74(1):65-72.
[21]王清华,姚旭,魏新智,等.黄芩苷对肺纤维化大鼠肺组织氧化应激的反应及炎症细胞的影响[J].中华中医药学刊,2017,35(6):1382-1384.
[22]韩伟民.柴芩舒胆汤联合针刺治疗慢性胆囊炎疗效及对胆囊收缩功能的影响[J].现代中西医结合杂志,2018,27(4):403-406.
[23]Sanger G J,Furness J B.Ghrelin and motilin receptors as drug targets for gastrointestinal disorders[J].Nat Rev Gastroenterol Hepatol,2016,13(1):38-48.
[2]中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].临床肝胆病杂志,2015,31(1):7-11.
[3]中华消化杂志编辑委员会.中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].中华消化杂志,2014,34(12):292-296.
[4]吴伟,张光银,翟宏军.消炎利胆胶囊联合头孢唑林钠治疗慢性胆囊炎的临床研究[J].现代药物与临床,2017,32(12):2446-2450.
[5]赵润元,杜朋丽,李博林,等.柴金化瘀方对慢性胆囊炎患者血清炎性因子及胆囊收缩功能的影响[J].中国中西医结合消化杂志,2018,26(10):874-877.
[6]张洁靖,李汉智.利胆排石汤保守治疗慢性胆囊炎的临床分析[J].中国实验方剂学杂志,2016,22(7):187-190.
[7]张声生,赵文霞.胆囊炎中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(4):241-246
[8]刘南阳,史彬,杨迪,等.李振华运用柴胡桂枝干姜汤验案举隅[J].辽宁中医杂志,2018,45(8):1602-1604.
[9]袁嘉嘉,孙志广,肖君,等.柴胡桂枝干姜汤在治疗消化系统疾病中的应用[J].辽宁中医杂志,2016,43(8):1777-1780.
[10]陈灏珠,林果为.实用内科学[M].13版.北京:人民卫生出社,2009:2152-2153.
[11]李曰庆.中医外科学[M].2版.北京:中国中医药出版社,2007:127.
[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:281-285.
[13]Poddubnaya O A.Chronorehabilitation of the patients suffering from chronic cholecystitis with concomitant gallbladder dysfunction and opisthorchiasis[J].Vopr Kurortol Fizioter Lech Fiz Kult,2017,94(2):29-35.
[14]Van Dijk A H,De Reuver P R,Tasma T N,et al.Systematic review of antibiotic treatment for acute calculous cholecystitis[J].British J Surg,2016,103(7):797-811.
[15]中华中医药学会脾胃病分会.胆囊炎中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(4):241-246.
[16]王付,谢新年.四逆散合方辨治肝胆病证[J].中国实验方剂学杂志,2011,17(19):300-301.
[17]于李.柴胡桂枝干姜汤的应用研究[J].长春中医药大学学报,2016,32(6):1177-1179.
[18]徐维浓,陈明.柴胡桂枝干姜汤证之解读与运用[J].中华中医药杂志,2015,30(9):3142-3144.
[19]郭丽萍.柴胡疏肝散治疗慢性胆囊炎及对患者胆囊功能、炎症因子水平的影响[J].陕西中医,2018,39(7):882-884.
[20]Kasprzak A,Szmyt M,Malkowski W,et al.Analysis of immunohistochemical expression of proinflammatory cytokines(IL-1α,IL-6,and TNF-α)in gallbladder mucosa:comparative study in acute and chronic calculous cholecystitis[J].Folia Morphol Warsz,2015,74(1):65-72.
[21]王清华,姚旭,魏新智,等.黄芩苷对肺纤维化大鼠肺组织氧化应激的反应及炎症细胞的影响[J].中华中医药学刊,2017,35(6):1382-1384.
[22]韩伟民.柴芩舒胆汤联合针刺治疗慢性胆囊炎疗效及对胆囊收缩功能的影响[J].现代中西医结合杂志,2018,27(4):403-406.
[23]Sanger G J,Furness J B.Ghrelin and motilin receptors as drug targets for gastrointestinal disorders[J].Nat Rev Gastroenterol Hepatol,2016,13(1):38-48.