吴茱萸槟榔汤加减穴位贴敷治疗慢性非萎缩性胃炎的临床观察
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摘要
目的:观察吴茱萸槟榔汤加减穴位贴敷对慢性非萎缩性胃炎(CNAG)的疗效及作用机制。方法:将217例患者采用SAS软件生成,随机分为对照组(107例)和观察组(110例)。基础治疗,奥美拉唑肠溶片,20 mg/次,2次/d,饭前半小时口服;枸橼酸铋钾片,2片/次,2次/d,饭前半小时口服;阿莫西林胶囊,1. 0 g/次,2次/d,饭后即服,二维呋喃唑酮片,1片/次,2次/d,饭后即服;枸橼酸莫沙必利片,5 mg/次,3次/d,口服;连续服用2周。观察组采用吴茱萸槟榔汤加减贴敷中脘、胃俞、膈俞、神阙、脾俞等穴位,持续6 h/d,每日1次。对照组采用模拟药物贴敷同样穴位。两组连续治疗2周。进行治疗前后胃脘痞满、胃脘疼痛等消化不良症状评分;检测治疗前后胃动素、胃泌素、肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)和前列腺素E2(PGE2)水平;随访1个月后复查胃镜和幽门螺杆菌(Hp)检测;记录两组患者穴位贴敷出现的不良反应。结果:观察组患者胃镜疗效优于对照组(Z=2. 015,P <0. 05),观察组患者中医证候疗效优于对照组(Z=2. 663,P <0. 01);观察组胃脘痞满、胃脘疼痛、食后腹胀、早饱、纳呆、呃逆、泛酸、暖气、恶心呕吐等消化不良症状评分均低于对照组(P <0. 01);观察组Hp阴转率为93. 64%,高于对照组的84. 11%(χ2=5. 002,P <0. 05);观察组患者血清TNF-α,IL-6水平均低于对照组,PGE2水平高于对照组(P <0. 01);观察组患者胃动素和胃泌素水平均高于对照组(P <0. 01);观察组6例患者出现轻度红斑、瘙痒,作对症处理后消失。结论:采用吴茱萸槟榔汤加减穴位贴敷辅助治疗CNAG患者可显著减轻临床症状,促使HP阴转,提高临床疗效,并能调节胃肠激素和抑制炎症因子释放,起到保护胃黏膜,改善胃肠功能的作用,临床使用安全。
Objective: To observe the effect of acupoint application therapy of modified Wuzhuyu Binglang Tang on chronic non-atrophic gastritis( CNAG) and the mechanism of action. Method: Two hundred and seventeen patients were randomly divided into control group( 107 cases) and observation group( 110 cases) by random number table. Both groups 'patients got Omeprazole enteric-coated tablets half an hour before meals,20 mg/time,2 times/day,bismuth potassium citrate tablets half an hour before meals,2 tablets/time,2 times/day,amoxicillin capsules after meals,1. 0 g/time,2 times/day,two dimensional furazolidone tablets after meals,1 tablet/time,2 times/day,mosapride citrate tablets,5 mg/time,3 times/day. The treatment lasted for 2 weeks.Patients in observation group got acupoint application of modified Wuzhuyu Binglang Tang at Zhongwan,Weiyu,Geyu,Shenyu and Piyu for 6 h/day,1 time/day. And the patients in control group got model drug at the same acupoints. Before and after treatment,epigastric fullness and epigastric pain were scored. Levels of motilin,gastrin,tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and prostaglandin E2( PGE2) were detected. In1-month follow-up visit,Hp and adverse reaction were detected under gastroscope. Result: The clinical effect in observation group under gastroscope was better than that in control group( Z = 2. 015,P < 0. 05),and the scores of traditional Chinese medicine symptoms in observation group was better than those in control group( Z = 2. 663,P < 0. 01). And scores of epigastric fullness,epigastric pain,post-food abdominal distention,early satiety,nausea,hiccup,pantothenic acid,heating,nausea and vomiting were lower than those in control group( P <0. 01). The negative conversion rate of Hp in observation group was 93. 64%,which was higher than 84. 11% in control group( χ2= 5. 002,P < 0. 05). And levels of TNF-α and IL-6 were lower than those in control group,PGE2 was higher than that in control group( P < 0. 01). And mild erythema and itching disappeared after symptomatic treatment. Conclusion: The acupoint application therapy of modified Wuzhuyu Binglang Tang can relieve the clinical symptoms,promote the negative conversion rate of Hp,improve the clinical effect,regulate gastrointestinal hormones, inhibiting release of inflammatory factors, protect gastric mucosa, and improve gastrointestinal function,with safety in clinic use.
Objective: To observe the effect of acupoint application therapy of modified Wuzhuyu Binglang Tang on chronic non-atrophic gastritis( CNAG) and the mechanism of action. Method: Two hundred and seventeen patients were randomly divided into control group( 107 cases) and observation group( 110 cases) by random number table. Both groups 'patients got Omeprazole enteric-coated tablets half an hour before meals,20 mg/time,2 times/day,bismuth potassium citrate tablets half an hour before meals,2 tablets/time,2 times/day,amoxicillin capsules after meals,1. 0 g/time,2 times/day,two dimensional furazolidone tablets after meals,1 tablet/time,2 times/day,mosapride citrate tablets,5 mg/time,3 times/day. The treatment lasted for 2 weeks.Patients in observation group got acupoint application of modified Wuzhuyu Binglang Tang at Zhongwan,Weiyu,Geyu,Shenyu and Piyu for 6 h/day,1 time/day. And the patients in control group got model drug at the same acupoints. Before and after treatment,epigastric fullness and epigastric pain were scored. Levels of motilin,gastrin,tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and prostaglandin E2( PGE2) were detected. In1-month follow-up visit,Hp and adverse reaction were detected under gastroscope. Result: The clinical effect in observation group under gastroscope was better than that in control group( Z = 2. 015,P < 0. 05),and the scores of traditional Chinese medicine symptoms in observation group was better than those in control group( Z = 2. 663,P < 0. 01). And scores of epigastric fullness,epigastric pain,post-food abdominal distention,early satiety,nausea,hiccup,pantothenic acid,heating,nausea and vomiting were lower than those in control group( P <0. 01). The negative conversion rate of Hp in observation group was 93. 64%,which was higher than 84. 11% in control group( χ2= 5. 002,P < 0. 05). And levels of TNF-α and IL-6 were lower than those in control group,PGE2 was higher than that in control group( P < 0. 01). And mild erythema and itching disappeared after symptomatic treatment. Conclusion: The acupoint application therapy of modified Wuzhuyu Binglang Tang can relieve the clinical symptoms,promote the negative conversion rate of Hp,improve the clinical effect,regulate gastrointestinal hormones, inhibiting release of inflammatory factors, protect gastric mucosa, and improve gastrointestinal function,with safety in clinic use.
引文
[1]中国中西医结合学会消化系统疾病专业委员会.慢性非萎缩性胃炎中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2018,26(1):1-8.
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[3]中华中医药学会脾胃病分会.慢性胃炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(7):3060-3064.
[4]唐艳红,汪莉,周武坚,等.穴位贴敷联合雷火灸治疗脾胃虚寒型慢性胃炎的效果观察[J].广西中医药大学学报,2014,17(2):17-19.
[5]刘东林,王小莹,杨冰,等.槟榔药理毒理研究进展[J].中国中药杂志,2013,38(14):2273-2275.
[6]蒋志,陈其城,曹立幸,等.槟榔及其活性物质的研究进展[J].中国中药杂志,2013,38(11):1684-1687.
[7]杨志欣,孟永海,王秋红,等.吴茱萸药理作用及其物质基础研究概况[J].中华中医药学刊,2011,29(11):2415-2417.
[8]中国中西医结合学会消化系统疾病专业委员会.慢性胃炎中西医结合诊疗共识意见(2011年天津)[J].中国中西医结合杂志,2012,32(6):738-743.
[9]Fallone C A,Chiba N,van Zanten S V,et al. The toronto consensus for the treatment of helicobacter pylori infection in adults[J]. Gastroenterology,2016,151(1):51-69.
[10]中国中西医结合学会消化系统疾病专业委员会.胃肠疾病中医证候评分表[J].世界华人消化杂志,2004,12(11):2701-2703.
[11]陈润花,张厂,苏泽琦,等.非萎缩性胃炎到萎缩性胃炎的中医证候演变研究[J].北京中医药大学学报,2015,38(5):310-314.
[12]中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):321-324.
[13]张北华,高蕊,李振华,等.中医药治疗慢性胃炎的专家经验数据挖掘分析[J].中医杂志,2015,56(8):704-708.
[14]XIE D P,CHEN L B,LIU C Y,et al. Arecoline excites the colonic smooth muscle motility via M3receptor in rabbits[J]. Chin J Physiol,2004,47(2):89-94.
[15]邹百仓,董蕾,魏睦新,等.槟榔对胃运动和胃肠激素的影响[J].陕西中医,2007,28(3):370-372.
[16]张莘,张选平,贾春生,等.基于数据挖掘的穴位贴敷疗法运用特点研究[J].针刺研究,2012,37(5):416-421.
[17]陈海山,龚锦容,黄朝忠,等.功能性消化不良与胃黏膜肥大细胞、血浆胃动素的关系[J].胃肠病学,2015,20(9):533-537.
[18]胡丽波,谢津璧,万坚,等.血清胃蛋白酶原及胃泌素在胃部疾病中的表达及意义[J].胃肠病学和肝病学杂志,2015,24(3):281-283.
[19]邓智武,黄健虹,梁晓海.益气养阴化癖汤对慢性胃炎胃黏膜COX-2值、血清PGE2值水平变化影响及临床治疗效果分析[J].环球中医药,2018,11(6):949-952.
[20]胡恒.康复新液对幽门螺杆菌阳性胃炎患者胃黏膜改善情况、症状改善情况及临床疗效分析[J].中国中西医结合消化杂志,2017,25(10):775-778.
[2]中华医学会消化病学分会.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-37.
[3]中华中医药学会脾胃病分会.慢性胃炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(7):3060-3064.
[4]唐艳红,汪莉,周武坚,等.穴位贴敷联合雷火灸治疗脾胃虚寒型慢性胃炎的效果观察[J].广西中医药大学学报,2014,17(2):17-19.
[5]刘东林,王小莹,杨冰,等.槟榔药理毒理研究进展[J].中国中药杂志,2013,38(14):2273-2275.
[6]蒋志,陈其城,曹立幸,等.槟榔及其活性物质的研究进展[J].中国中药杂志,2013,38(11):1684-1687.
[7]杨志欣,孟永海,王秋红,等.吴茱萸药理作用及其物质基础研究概况[J].中华中医药学刊,2011,29(11):2415-2417.
[8]中国中西医结合学会消化系统疾病专业委员会.慢性胃炎中西医结合诊疗共识意见(2011年天津)[J].中国中西医结合杂志,2012,32(6):738-743.
[9]Fallone C A,Chiba N,van Zanten S V,et al. The toronto consensus for the treatment of helicobacter pylori infection in adults[J]. Gastroenterology,2016,151(1):51-69.
[10]中国中西医结合学会消化系统疾病专业委员会.胃肠疾病中医证候评分表[J].世界华人消化杂志,2004,12(11):2701-2703.
[11]陈润花,张厂,苏泽琦,等.非萎缩性胃炎到萎缩性胃炎的中医证候演变研究[J].北京中医药大学学报,2015,38(5):310-314.
[12]中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):321-324.
[13]张北华,高蕊,李振华,等.中医药治疗慢性胃炎的专家经验数据挖掘分析[J].中医杂志,2015,56(8):704-708.
[14]XIE D P,CHEN L B,LIU C Y,et al. Arecoline excites the colonic smooth muscle motility via M3receptor in rabbits[J]. Chin J Physiol,2004,47(2):89-94.
[15]邹百仓,董蕾,魏睦新,等.槟榔对胃运动和胃肠激素的影响[J].陕西中医,2007,28(3):370-372.
[16]张莘,张选平,贾春生,等.基于数据挖掘的穴位贴敷疗法运用特点研究[J].针刺研究,2012,37(5):416-421.
[17]陈海山,龚锦容,黄朝忠,等.功能性消化不良与胃黏膜肥大细胞、血浆胃动素的关系[J].胃肠病学,2015,20(9):533-537.
[18]胡丽波,谢津璧,万坚,等.血清胃蛋白酶原及胃泌素在胃部疾病中的表达及意义[J].胃肠病学和肝病学杂志,2015,24(3):281-283.
[19]邓智武,黄健虹,梁晓海.益气养阴化癖汤对慢性胃炎胃黏膜COX-2值、血清PGE2值水平变化影响及临床治疗效果分析[J].环球中医药,2018,11(6):949-952.
[20]胡恒.康复新液对幽门螺杆菌阳性胃炎患者胃黏膜改善情况、症状改善情况及临床疗效分析[J].中国中西医结合消化杂志,2017,25(10):775-778.