香砂平胃散对运动障碍样功能性消化不良疗效的临床研究
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摘要
目的
1．观察香砂平胃散对运动障碍样功能性消化不良(FD)患者的胃肠动力作用，包括用药前后标准餐的胃排空及小肠推进功能变化、症状的改善程度及胃电变化等。
2．开发出一种新型的促胃肠动力中药。
方法
选择来自于中国医科大学附属二院消化内科门诊的符合罗马Ⅱ诊断标准的FD患者37例，经内镜检查无胃、十二指肠糜烂、溃疡、肿瘤及中、重度炎症，并经理化检查排除了消化系统其它疾病。以胃排空时间超过正常对照组+2标准差者为运动障碍样FD，并将其作为入选病例；同时选择无消化不良症状健康志愿者15例作为对照。运动障碍样FD患者一次口服标准餐及20枚不透X线标记物，分别于5小时、72小时后拍摄腹平片，比较用药前后胃排空及小肠排空标准餐的时间；同时做胃电图检查，比较用药前后胃电节律的变化；然后询问各症状，并根据用药前后症状计分的变化评价药物的疗效；应用“综合医院焦虑／抑郁(HAD)情绪测定表”对所有入选患者进行焦虑及抑郁心理测评。
结果
服用香砂平胃散后，运动障碍样FD患者餐前[(38.41±22.69)％ vs(28.67±20.79)％]及餐后[(49.24±14.95)％ vs(32.71±17.80)％]正常胃电节律百分比(≥65％)均有提高，餐前[(56.66±22.68)％ vs(63.20±21.53)％]及餐后[(47.00±17.21)％ vs(64.24±17.19)％]胃动过缓率降低，餐前[(85.47±34.49)％ vs(87.33±29.80)％]及餐后[(65.60±17.35)％ vs(87.13±28.41)％]主频不稳定系数降低，上述差异均于餐后更为显著(P＜0.05)；运动障碍样FD患者钡条排空率较正常人显著降低[5
小时:(15.88士20.36)%vs(94.00士8.06)%;72小时:(74.51土45.57)%
vs(92.00土9.78)%，P<0.01〕，服用香砂平胃散后，运动障碍样FD患者胃
排空率(5小时钡条排空率)明显提高【(60 .23士20 .84)%vs(25 .00士
12.34)%，P<0.05〕，小肠排空率(72小时钡条排空率)无明显提高
[(54 .09土1 5 .10)%vs(50.68士14.08)%，p>0.05〕;服用香砂平胃散后，
患者各自觉症状均有明显改善(P<0.05);37例患者中11人有焦虑症状，
18人有抑郁症状，发病率分别为29.73%和48.65%，其中9人二者皆有，占
24 .32%。
结论
1.香砂平胃散可使运动障碍样FD患者胃电规律性及稳定性增加，能
改善胃排空功能。
2.香砂平胃散对运动障碍样FD患者有促进胃动力作用，无明显促进
小肠动力作用。
3.香砂平胃散能明显改善运动障碍样FD患者的各自觉症状。
4.运动障碍样FD患者焦虑及抑郁的发病率较高。
5.香砂平胃散是一种安全、有效的促胃动力中药。
1. To observe the effect of Chinese herb xiangshapingweisan (XSPWS) on gastrointestinal motility in patient with dyskinesia - like functional dyspepsia (FD) which includes gastric emptying and velocity of small intestinal transit of the standard meal, the ameliorative degree of the symptoms and the electrogastric variety before and after taking medicine.
2. To develop a new kind of gastrointestinal prokinetic Chinese herb.
Methods
37 patients with FD selected from digestive medical outpatient service of the second affiliated hospital of China Medical University were enrolled into the study. The diagnostic standard matched to Rome II's. They hadn' t other diseases of digestive system such as gastroduodenal erosion, ulcer, tumor, moderate and hypergastritis by endoscopy and physicochemical examination. Patients whose gastric emptying time exceeded control group by + 2 standard deviation could be included. At the same time, 15 health volunteers had no dyspeptic symptoms were enrolled in as control group. Each patients with dyskinesia - like FD ingested a capsule containing 20 radiopaque markers together with standard meal and plain abdominal films were made after 5h and 72h respectively. The emptying time of standard meal of stomach and small intestines was compared before and after taking medicine. At the same time electrogastrography ( EGG) was taken to compare the electrogastric rhythm before and after taking medicine. Then inquired e
ach symptom and evaluated the curative effect of the medicine by counting the variety of the cent of the symptom before and after taking medicine. Mental state of the patients enrolled into the study were evaluated by Hospital
Anxiety and Depression Scale (HAD).
Results
The percentage of normal preprandial [ ( 38. 41 ± 22. 69) % vs (28. 67 ± 20.79) % ] and postprandial [ (49. 24 ± 14. 95 ) % vs (32. 71 ± 17. 80) % ] eleclrogaslric rhythm in most of ihe patients with dyskinesia - like FD increased after XSPWS was taken. Preprandial [(56. 66 ± 22. 68)% vs (63. 20 ± 21.53)%] and postprandial[ (47. 00 ± 17. 21)% vs(64. 24 ± 17. 19)% ] rate of bradygastria decreased after XSPWS was taken. Preprandial [ ( 85. 47 ± 34.49) % vs ( 87. 33 ± 29. 80) % ] and postprandial [ (65. 60 ± 17. 35 ) % vs (87. 13 ±28.41)%] dominant frequency instability coefficient (DFIC) decreased after XSPWS was taken. Difference as indicated above was notable after meal(P <0. 05). The exhaustion rate of barium strips in patients[5h; (15. 88 ± 20. 36) % ;72h: (74. 51 ±45. 57) ] obviously declined as compared with the normal human [ 5h: (94. 00 ± 8. 06) % ;72h: (92. 00 ± 9. 78) % , P < 0. 01 ]. Gastric exhaustion rate( exhaustion rate of barium strips of 5h)in patients obviously increased[ (60. 23 ± 20. 84) %
vs ( 25. 00 ± 12. 34) % , P < 0. 05 ] while small intestinal exhaustion rate (exhaustion rate of barium strips of 72h) had no obvious increase[ ( 84. 09 ± 18. 10) % vs ( 80. 68 ± 14. 08) % , P > 0. 05 ] after XSPWS was taken. Each of the patients' subjective symptom obviously improved after XSPWS was taken(P <0. 05). 11 patients had symptoms of anxiety while 9 had depression. The incidence was 29.73% and 48.65% respectively. 9 patients had both of the two symptoms whose incidence was 24. 32%.
Conclusions
1. XSPWS can increase regulation and stability of EGG in patients with dyskinesia - like FD. It can also improve the function of gastric motility.
2. XSPWS can promote gastric motility to the patients with dyskinesia - like: FD. It has no obvious effect on motor function of small intestines.
3. XSPWS can obviously improve the patients' subjective symptom with
dyskinesia - like FD.
4. Incidence of anxiety and depression was higher in patients with dyskinesia - like FD.
5. XSPWS is a kind of safe and efifective gastric prokinetic Chinese herb.
1．观察香砂平胃散对运动障碍样功能性消化不良(FD)患者的胃肠动力作用，包括用药前后标准餐的胃排空及小肠推进功能变化、症状的改善程度及胃电变化等。
2．开发出一种新型的促胃肠动力中药。
方法
选择来自于中国医科大学附属二院消化内科门诊的符合罗马Ⅱ诊断标准的FD患者37例，经内镜检查无胃、十二指肠糜烂、溃疡、肿瘤及中、重度炎症，并经理化检查排除了消化系统其它疾病。以胃排空时间超过正常对照组+2标准差者为运动障碍样FD，并将其作为入选病例；同时选择无消化不良症状健康志愿者15例作为对照。运动障碍样FD患者一次口服标准餐及20枚不透X线标记物，分别于5小时、72小时后拍摄腹平片，比较用药前后胃排空及小肠排空标准餐的时间；同时做胃电图检查，比较用药前后胃电节律的变化；然后询问各症状，并根据用药前后症状计分的变化评价药物的疗效；应用“综合医院焦虑／抑郁(HAD)情绪测定表”对所有入选患者进行焦虑及抑郁心理测评。
结果
服用香砂平胃散后，运动障碍样FD患者餐前[(38.41±22.69)％ vs(28.67±20.79)％]及餐后[(49.24±14.95)％ vs(32.71±17.80)％]正常胃电节律百分比(≥65％)均有提高，餐前[(56.66±22.68)％ vs(63.20±21.53)％]及餐后[(47.00±17.21)％ vs(64.24±17.19)％]胃动过缓率降低，餐前[(85.47±34.49)％ vs(87.33±29.80)％]及餐后[(65.60±17.35)％ vs(87.13±28.41)％]主频不稳定系数降低，上述差异均于餐后更为显著(P＜0.05)；运动障碍样FD患者钡条排空率较正常人显著降低[5
小时:(15.88士20.36)%vs(94.00士8.06)%;72小时:(74.51土45.57)%
vs(92.00土9.78)%，P<0.01〕，服用香砂平胃散后，运动障碍样FD患者胃
排空率(5小时钡条排空率)明显提高【(60 .23士20 .84)%vs(25 .00士
12.34)%，P<0.05〕，小肠排空率(72小时钡条排空率)无明显提高
[(54 .09土1 5 .10)%vs(50.68士14.08)%，p>0.05〕;服用香砂平胃散后，
患者各自觉症状均有明显改善(P<0.05);37例患者中11人有焦虑症状，
18人有抑郁症状，发病率分别为29.73%和48.65%，其中9人二者皆有，占
24 .32%。
结论
1.香砂平胃散可使运动障碍样FD患者胃电规律性及稳定性增加，能
改善胃排空功能。
2.香砂平胃散对运动障碍样FD患者有促进胃动力作用，无明显促进
小肠动力作用。
3.香砂平胃散能明显改善运动障碍样FD患者的各自觉症状。
4.运动障碍样FD患者焦虑及抑郁的发病率较高。
5.香砂平胃散是一种安全、有效的促胃动力中药。
1. To observe the effect of Chinese herb xiangshapingweisan (XSPWS) on gastrointestinal motility in patient with dyskinesia - like functional dyspepsia (FD) which includes gastric emptying and velocity of small intestinal transit of the standard meal, the ameliorative degree of the symptoms and the electrogastric variety before and after taking medicine.
2. To develop a new kind of gastrointestinal prokinetic Chinese herb.
Methods
37 patients with FD selected from digestive medical outpatient service of the second affiliated hospital of China Medical University were enrolled into the study. The diagnostic standard matched to Rome II's. They hadn' t other diseases of digestive system such as gastroduodenal erosion, ulcer, tumor, moderate and hypergastritis by endoscopy and physicochemical examination. Patients whose gastric emptying time exceeded control group by + 2 standard deviation could be included. At the same time, 15 health volunteers had no dyspeptic symptoms were enrolled in as control group. Each patients with dyskinesia - like FD ingested a capsule containing 20 radiopaque markers together with standard meal and plain abdominal films were made after 5h and 72h respectively. The emptying time of standard meal of stomach and small intestines was compared before and after taking medicine. At the same time electrogastrography ( EGG) was taken to compare the electrogastric rhythm before and after taking medicine. Then inquired e
ach symptom and evaluated the curative effect of the medicine by counting the variety of the cent of the symptom before and after taking medicine. Mental state of the patients enrolled into the study were evaluated by Hospital
Anxiety and Depression Scale (HAD).
Results
The percentage of normal preprandial [ ( 38. 41 ± 22. 69) % vs (28. 67 ± 20.79) % ] and postprandial [ (49. 24 ± 14. 95 ) % vs (32. 71 ± 17. 80) % ] eleclrogaslric rhythm in most of ihe patients with dyskinesia - like FD increased after XSPWS was taken. Preprandial [(56. 66 ± 22. 68)% vs (63. 20 ± 21.53)%] and postprandial[ (47. 00 ± 17. 21)% vs(64. 24 ± 17. 19)% ] rate of bradygastria decreased after XSPWS was taken. Preprandial [ ( 85. 47 ± 34.49) % vs ( 87. 33 ± 29. 80) % ] and postprandial [ (65. 60 ± 17. 35 ) % vs (87. 13 ±28.41)%] dominant frequency instability coefficient (DFIC) decreased after XSPWS was taken. Difference as indicated above was notable after meal(P <0. 05). The exhaustion rate of barium strips in patients[5h; (15. 88 ± 20. 36) % ;72h: (74. 51 ±45. 57) ] obviously declined as compared with the normal human [ 5h: (94. 00 ± 8. 06) % ;72h: (92. 00 ± 9. 78) % , P < 0. 01 ]. Gastric exhaustion rate( exhaustion rate of barium strips of 5h)in patients obviously increased[ (60. 23 ± 20. 84) %
vs ( 25. 00 ± 12. 34) % , P < 0. 05 ] while small intestinal exhaustion rate (exhaustion rate of barium strips of 72h) had no obvious increase[ ( 84. 09 ± 18. 10) % vs ( 80. 68 ± 14. 08) % , P > 0. 05 ] after XSPWS was taken. Each of the patients' subjective symptom obviously improved after XSPWS was taken(P <0. 05). 11 patients had symptoms of anxiety while 9 had depression. The incidence was 29.73% and 48.65% respectively. 9 patients had both of the two symptoms whose incidence was 24. 32%.
Conclusions
1. XSPWS can increase regulation and stability of EGG in patients with dyskinesia - like FD. It can also improve the function of gastric motility.
2. XSPWS can promote gastric motility to the patients with dyskinesia - like: FD. It has no obvious effect on motor function of small intestines.
3. XSPWS can obviously improve the patients' subjective symptom with
dyskinesia - like FD.
4. Incidence of anxiety and depression was higher in patients with dyskinesia - like FD.
5. XSPWS is a kind of safe and efifective gastric prokinetic Chinese herb.
引文
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