中西药联合治疗功能性消化不良临床研究
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摘要
目的观察中西药(气滞胃痛颗粒联合西药)治疗肝胃气滞型功能性消化不良的临床疗效,为进一步认识功能性消化不良的病因病机关键及临证用药提供参考依据。方法选择本院2013年3月—2015年12月收治的肝胃气滞型功能性消化不良患者238例,并随机分为对照1组(口服枸橼酸莫沙必利片,5 mg/次,3次/d)、对照2组(口服气滞胃痛颗粒,5 g/次,3次/d)和联合用药组(对照1组+对照2组)。3组患者均连续用药4周,并在治疗结束后评价各组临床疗效、中医证候积分及血清胃动素(motilin,MTL)、胃泌素(gastrin,GAS)、生长抑素(somatostatin,SS)、胆囊收缩素(cholecystokinin,CCK)的含量。结果联合用药组患者治疗后总有效率明显高于对照1组和对照2组,差异具有统计学意义(P <0. 05);联合用药组患者的随访复发率明显低于对照1组和对照2组,而对照2组复发率低于对照1组,差异具有统计学意义(P <0. 05)。联合用药组显著降低患者中医证候积分,并明显低于对照1组和对照2组,差异具有统计学意义(P <0. 05)。与治疗前相比,各组均能不同程度的上调患者GAS、MTL表达水平,下调SS、CCK、NO水平;联合用药组对GAS、MTL、SS、CCK、NO的调节作用均较为明显,与对照1组和对照2组相比,均有显著性差异(P <0. 05)。在治疗期间,对照1组患者有5例出现轻微的胃肠道反应,对照2组和联合用药组均未发生明显不良反应。患者肝、肾功能及血、尿常规均在正常参考范围内,组间比较差异无统计学意义(P> 0. 05)。结论气滞胃痛颗粒联合枸橼酸莫沙必利片治疗肝胃气滞型功能性消化不良有较好的临床疗效,其作用机制可能是协同增效作用,上调患者血清GAS、MTL表达水平,下调SS、CCK、NO水平。
Objective To discuss the clinical efficacy of Qizhi Weitong granules combined with western medicine on liver and stomach qi stagnation type functional dyspepsia,and so as to provide the evidences for the further correct recognition on the keys of the etiology and pathology of FD and clinical medication. Methods 238 cases with liver and stomach qi stagnation type patients were randomly divided into control group one( oral administration of Mosapride Citrate tablets,5 mg/,3/d),the control group two( oral Qizhi Weitong granule,5 g/times,3 times/d) and combination group( control group one and control group two). Three groups of patients were treated for 4 weeks,and the clinical curative effect,TCM syndrome score and serum motilin level at the end of treatment( motilin,MTL),gastrin( gastrin,GAS),somatostatin( somatostatin,SS),cholecystokinin( cholecystokinin,CCK) content were evaluated. Results The total efficiency of the combination group was significantly higher than the control group one and control group two after treatment,and the difference was statistically significant( P < 0. 05). The relapse rate of the combination group was significantly lower than that of the control group one and control group two and control group 2,and there was statistically significant the difference between( P < 0. 05). The combination group significantly reduced the score of TCM syndrome,and was significantly lower than the control group one and the control group two,and the difference between the groups was statistically significant( P < 0. 05). Compared with before treatment,the treatment groups can upregulate the expression level of MTL in patients with GAS,SS,CCK,NO,lower level; regulation of the combination group of GAS,MTL,SS,CCK and NO are more obvious,and the control group one and control group two,and there were significant differences( P < 0. 05). During the treatment of the three groups,there were 5 mild gastrointestinal reactions in the groups,and no significant adverse reactions were observed between the 2 groups and the combination group. The liver,renal function,blood and urine of the patients were in the normal reference range,and there was no significant difference between the groups( P > 0. 05). Conclusion Qizhi Weitong granule combined with Mosapride Citrate tablets in the treatment of liver qi stagnation type of functional dyspepsia has good clinical curative effect,its mechanism may be synergistic effect,increase the serum GAS,the expression level of MTL,SS,CCK,NO level down.
Objective To discuss the clinical efficacy of Qizhi Weitong granules combined with western medicine on liver and stomach qi stagnation type functional dyspepsia,and so as to provide the evidences for the further correct recognition on the keys of the etiology and pathology of FD and clinical medication. Methods 238 cases with liver and stomach qi stagnation type patients were randomly divided into control group one( oral administration of Mosapride Citrate tablets,5 mg/,3/d),the control group two( oral Qizhi Weitong granule,5 g/times,3 times/d) and combination group( control group one and control group two). Three groups of patients were treated for 4 weeks,and the clinical curative effect,TCM syndrome score and serum motilin level at the end of treatment( motilin,MTL),gastrin( gastrin,GAS),somatostatin( somatostatin,SS),cholecystokinin( cholecystokinin,CCK) content were evaluated. Results The total efficiency of the combination group was significantly higher than the control group one and control group two after treatment,and the difference was statistically significant( P < 0. 05). The relapse rate of the combination group was significantly lower than that of the control group one and control group two and control group 2,and there was statistically significant the difference between( P < 0. 05). The combination group significantly reduced the score of TCM syndrome,and was significantly lower than the control group one and the control group two,and the difference between the groups was statistically significant( P < 0. 05). Compared with before treatment,the treatment groups can upregulate the expression level of MTL in patients with GAS,SS,CCK,NO,lower level; regulation of the combination group of GAS,MTL,SS,CCK and NO are more obvious,and the control group one and control group two,and there were significant differences( P < 0. 05). During the treatment of the three groups,there were 5 mild gastrointestinal reactions in the groups,and no significant adverse reactions were observed between the 2 groups and the combination group. The liver,renal function,blood and urine of the patients were in the normal reference range,and there was no significant difference between the groups( P > 0. 05). Conclusion Qizhi Weitong granule combined with Mosapride Citrate tablets in the treatment of liver qi stagnation type of functional dyspepsia has good clinical curative effect,its mechanism may be synergistic effect,increase the serum GAS,the expression level of MTL,SS,CCK,NO level down.
引文
[1]李鲜.十味柴赭汤对功能性消化不良大鼠胃排空的影响[J].中医学报,2015,30(11):1642-1643.
[2]黄敏芳,张巧真.疏肝解郁汤加心理疏导治疗肝郁气滞型功能性消化不良的随机对照研究[J].中国生化药物杂志,2017,37(5):182-185.
[3] BRUN R,KUO B. Functional dyspepsia[J]. Therapeutic advances in gastroenterology,2010,3(3):145-164.
[4] KANDULSIK A,VENERITO M,MALFERTHEINER P. Therapeutic approach in function(nonulcer)dyspepsia[M]. Springer New York,2010:561-563.
[5]汪茜雅,钮美娥,陈奕,等.门诊功能性消化不良患者生存质量及影响因素分析[J].中华现代护理杂志,2017,23(9):1240-1245.
[6]中华人民共和国卫生部.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:134.
[7]许卫华,李妮娇,张艳丽,等.不同中医证型功能性消化不良患者核素胃排空特点的研究[J].环球中医药,2013,6(5):321-324.
[8] DROSSMAN DA,The functional gastrointestinal disorders and the RomeⅢprocess[J]. Gastroenterology,2006,130(5):1377-1390.
[9]中华中医学会脾胃病分会.消化不良中医诊疗共识意见(2009)[J].中国中西医结合杂志,2010,30(5):533-537.
[10]梁子钰,丁霞,李俊德,等.调肝和胃方治疗功能性消化不良的临床研究[J].世界中西医结合杂志,2014,9(10):1101-1105.
[11]娄秀生.柴胡疏肝散加减治疗肝胃不和型功能性消化不良的临床疗效[J].临床合理用药,2015,8(11C):116-117.
[12]弭艳红,弭艳旭,王印宝,等.舒胃方对功能性消化不良患者胃动力的影响[J].湖北中医药大学学报,2015,17(6):23-25.
[13] SOHN W,LEE OY,LEE SP,et al. Mast cell number,substance P and vasoactive intestinal peptide in irritable bowel syndrome with diarrhea[J]. Scand J Gastroenterol,2014,49(1):43-51.
[14] ZHANG LY,DONG X,LIU ZL,et al. Luminal serotonin timedependently modulates vagal afferent driven antinociception in response to coiorectal distention in rats[J]. Neurogastroenterol Motil,2011,23(1):62-69.
[15]孙静,贾秋颖.理气和胃止痛汤治疗肝胃气滞型胃痛疗效观察[J].亚太传统医药,2016,12(9):129-130.
[16]周赛男,蔡光先,万胜.四磨汤治疗功能性消化不良(肝脾气滞证)的临床疗效及对血清NO、AchE、CCK、SP的影响[J].中国中医急症,2014,23(10):1791.
[17]郭晓鹤,张彩凤,朱艳丽,等.枳术宽中胶囊联合莫沙必利治疗功能性消化不良临床研究[J].中医学报,2015,30(4):595-597.
[2]黄敏芳,张巧真.疏肝解郁汤加心理疏导治疗肝郁气滞型功能性消化不良的随机对照研究[J].中国生化药物杂志,2017,37(5):182-185.
[3] BRUN R,KUO B. Functional dyspepsia[J]. Therapeutic advances in gastroenterology,2010,3(3):145-164.
[4] KANDULSIK A,VENERITO M,MALFERTHEINER P. Therapeutic approach in function(nonulcer)dyspepsia[M]. Springer New York,2010:561-563.
[5]汪茜雅,钮美娥,陈奕,等.门诊功能性消化不良患者生存质量及影响因素分析[J].中华现代护理杂志,2017,23(9):1240-1245.
[6]中华人民共和国卫生部.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:134.
[7]许卫华,李妮娇,张艳丽,等.不同中医证型功能性消化不良患者核素胃排空特点的研究[J].环球中医药,2013,6(5):321-324.
[8] DROSSMAN DA,The functional gastrointestinal disorders and the RomeⅢprocess[J]. Gastroenterology,2006,130(5):1377-1390.
[9]中华中医学会脾胃病分会.消化不良中医诊疗共识意见(2009)[J].中国中西医结合杂志,2010,30(5):533-537.
[10]梁子钰,丁霞,李俊德,等.调肝和胃方治疗功能性消化不良的临床研究[J].世界中西医结合杂志,2014,9(10):1101-1105.
[11]娄秀生.柴胡疏肝散加减治疗肝胃不和型功能性消化不良的临床疗效[J].临床合理用药,2015,8(11C):116-117.
[12]弭艳红,弭艳旭,王印宝,等.舒胃方对功能性消化不良患者胃动力的影响[J].湖北中医药大学学报,2015,17(6):23-25.
[13] SOHN W,LEE OY,LEE SP,et al. Mast cell number,substance P and vasoactive intestinal peptide in irritable bowel syndrome with diarrhea[J]. Scand J Gastroenterol,2014,49(1):43-51.
[14] ZHANG LY,DONG X,LIU ZL,et al. Luminal serotonin timedependently modulates vagal afferent driven antinociception in response to coiorectal distention in rats[J]. Neurogastroenterol Motil,2011,23(1):62-69.
[15]孙静,贾秋颖.理气和胃止痛汤治疗肝胃气滞型胃痛疗效观察[J].亚太传统医药,2016,12(9):129-130.
[16]周赛男,蔡光先,万胜.四磨汤治疗功能性消化不良(肝脾气滞证)的临床疗效及对血清NO、AchE、CCK、SP的影响[J].中国中医急症,2014,23(10):1791.
[17]郭晓鹤,张彩凤,朱艳丽,等.枳术宽中胶囊联合莫沙必利治疗功能性消化不良临床研究[J].中医学报,2015,30(4):595-597.