非糜烂性反流病的中医证型分布及与情志因素的相关性研究
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摘要
目的:1.通过对非糜烂性反流病(non-erosive reflux disease,NERD)的证型做小样本调查,初步了解本地区NERD患者中医证型的分布特点,同时根据调查结果,进一步对常见证型进行深入探讨。2.通过对NERD患者焦虑和/或抑郁状态评分调查,探讨精神心理因素与NERD常见证型发病的相关性。3.为NERD的中西医结合治疗开拓新的思路和方法。
方法:自2006年2月～2008年1月,对就诊于福建省人民医院和福建省立医院消化内科门诊、住院和福建省消化内镜中心的具有典型的烧心感和反流症状(如胸骨后疼痛、反酸或反食)患者,予反流性疾病问卷(reflux diagnostic questionnaire,RDQ,又称耐信量表)评定症状总分≥12分,行电子胃镜检查,排除有食管粘膜损害或Barrett食管表现的患者,筛选出非糜烂性反流病(NERD)患者,行证候学调查,并予分析、归纳,应用国际通用的焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)对所有入选患者进行焦虑和/或抑郁状态心理测评,并统计总积分,观察临床非糜烂性反流病患者常见中医证型与焦虑和/或抑郁的关系。
结果:
1.本课题共收集176例NERD患者,主要归纳为4个常见证型,其中肝胃郁热证56例占总例数32.2%,肝胃不和证48例占总例数27.2%,痰气郁阻证37例占总例数20.9%,脾胃虚弱证27例占总例数15.2%,其它证型8例占总例数4.5%。由此可见,NERD患者中肝胃郁热证最多,肝胃不和证其次。
2.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证RDQ积分比较,前2个证型分别明显高于后2个证型RDQ积分,存在显著性差异,P＜0.05;肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证临床症状较严重。
3.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证SAS表和/或SDS表积分比较,前2个证型分别明显高于后2个证型,存在显著性差异,P＜0.05:肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证伴有抑郁和/或焦虑状态较严重。
4.NERD患者RDQ积分与SAS表和/或SDS表积分呈显著正相关性。
5.非糜烂性反流病4个常见证型的患者均有不同程度的精神心理因素,肝胃郁热、肝胃不和的焦虑和/或抑郁状态评分明显高于其他各型。
结论:1.本地区NERD患者中医证型以肝胃郁热证、肝胃不和证、痰气郁阻证和脾胃虚弱证为主,特别是前2个证型。2.精神心理因素在NERD的发病中起重要作用。3.NERD患者症状严重程度与其焦虑和/或抑郁状态严重程度呈正相关性。4.肝之疏泄功能失常在NERD的发病中是十分重要的一环。
Objective:1.Through the sample survey of the NERD's chinese syndromes to understand this area sufferers'distribution feature.according to the investigation result at the same time, further carry on the deep discussion to often chinese syndromes.2.Through grading and investigating to NERD patient's anxious and/or depressed state,To probe the relationship between psychological factor and chinese syndromes types of non-erosive reflux disease 3.Open up new thinking and method for the therapy of combining traditional Chinese and Western medicine of NERD.
Method:Since February,2006 to January,2008,to go to a doctor on hospital,and Endoscope of ministry have typical cooking feeling and reflux symptom digest,Pain,sour instead of behind the brestbone or against food) The patiens mark Reflux diagnostic questionnare(RDQ)scal,the total points of symptom are greater than 12 points,then using gastrocopy,get rid of oesophageal mucous membrane damage or Barrett patient whose esophagus display,We choosed non-erosive reflux diseas(NERD)patients,Basing on Chinese medicine diagnostic standard to evaluate,employing internatioanlly agreed anxiety commenting scales(Self-rating anxiety scale,SAS),the depressed scale(Self-rating depression scale,SDS) commenting.It is until allthe patients more selected for anxiety and Depressed state psychology test and assess,count total scores,to observe the relationship between different chinese syndro-mes and psychological factor.
Results:1.176 cases of non-erosive reflux disease were classified according to svndrome differentiation.Mainly four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach accounted for 32.2%as 56 patiens,disorder of liver stomach accounted for 27.2%as 48 patiens,phlegmqi stagnation accounted for 20.9%as 37 patiens,27 patiens of asthenia spleen and stomach accounted for 15.2%,other syndrome types 8 account for 4.5%. Therefore NERD patients stagnated heat of liver stomach to take the most,disorder of liver stomach secondly.
2.Four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach of total mark of RDQ form,disorder of liver stomach,asthenia spleen and stomach with card and phlegmqi stagnation,the first 2 card type total mark of RDQ form are obviously higher than the last 2 card type total mark of RDQ form,there are significant differences,P＜0.05,has comparativity,There is no significant difference between stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach,P＞0.05,It is not relatively serious to brief on stagnated heat of liver stomach and disorder of liver stomach with the clinical symptom of the card.
3.Four syndrome types of NERD often stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach form and/or SDS form integration,SAS of card,compare while being strongly fragrant with card,the first 2 card types are obviously higher than the last 2 card types separately,there are significance differences,P＜0.05;stagnated heat of liver stomach,disorder of liver stomach,phlegmqi stagnation have a significance difference compared with asthenia spleen and stomach,while being strongly fragrant,P＞0.05,it is not relatively serious to brief on the stagnated heat of liver stomach and disorder of liver stomach with the depressed and/or anxious state.
4.Total mark of NERD symptom(RDQ) Present prominent positive correlation with SDS, SAS.
5.Four syndrome types of NERD have a psychological factor in various degree often,the stagnated heat of liver stomach,disorder of liver stomach with anxiety / states depressed grade last a other various obviously.
Conelusion:1.The chinese syndromes of this area NERD patient relies mainly on the fact that stagnated heat of liver stomach,disorder of liver stomach and phlegrnqi stagnation,asthenia spleen and stomach,especially the first 2 card types.2,psychological factor plays an important role among morbidity of NERD.3.NERD patient presents relevance in the hope of being improved instead of the state severity of anxious and/or depressed state in symptom severity.4.The stagnation of liver plays important role in the pathogenesis of non-erosive reflux disease.
方法:自2006年2月～2008年1月,对就诊于福建省人民医院和福建省立医院消化内科门诊、住院和福建省消化内镜中心的具有典型的烧心感和反流症状(如胸骨后疼痛、反酸或反食)患者,予反流性疾病问卷(reflux diagnostic questionnaire,RDQ,又称耐信量表)评定症状总分≥12分,行电子胃镜检查,排除有食管粘膜损害或Barrett食管表现的患者,筛选出非糜烂性反流病(NERD)患者,行证候学调查,并予分析、归纳,应用国际通用的焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)对所有入选患者进行焦虑和/或抑郁状态心理测评,并统计总积分,观察临床非糜烂性反流病患者常见中医证型与焦虑和/或抑郁的关系。
结果:
1.本课题共收集176例NERD患者,主要归纳为4个常见证型,其中肝胃郁热证56例占总例数32.2%,肝胃不和证48例占总例数27.2%,痰气郁阻证37例占总例数20.9%,脾胃虚弱证27例占总例数15.2%,其它证型8例占总例数4.5%。由此可见,NERD患者中肝胃郁热证最多,肝胃不和证其次。
2.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证RDQ积分比较,前2个证型分别明显高于后2个证型RDQ积分,存在显著性差异,P＜0.05;肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证临床症状较严重。
3.NERD 4个常见证型肝胃郁热证、肝胃不和证与痰气郁阻证、脾胃虚弱证SAS表和/或SDS表积分比较,前2个证型分别明显高于后2个证型,存在显著性差异,P＜0.05:肝胃郁热证与肝胃不和证比较、痰气郁阻证与脾胃虚弱证比较无显著性差异,P＞0.05,提示肝胃郁热证与肝胃不和证伴有抑郁和/或焦虑状态较严重。
4.NERD患者RDQ积分与SAS表和/或SDS表积分呈显著正相关性。
5.非糜烂性反流病4个常见证型的患者均有不同程度的精神心理因素,肝胃郁热、肝胃不和的焦虑和/或抑郁状态评分明显高于其他各型。
结论:1.本地区NERD患者中医证型以肝胃郁热证、肝胃不和证、痰气郁阻证和脾胃虚弱证为主,特别是前2个证型。2.精神心理因素在NERD的发病中起重要作用。3.NERD患者症状严重程度与其焦虑和/或抑郁状态严重程度呈正相关性。4.肝之疏泄功能失常在NERD的发病中是十分重要的一环。
Objective:1.Through the sample survey of the NERD's chinese syndromes to understand this area sufferers'distribution feature.according to the investigation result at the same time, further carry on the deep discussion to often chinese syndromes.2.Through grading and investigating to NERD patient's anxious and/or depressed state,To probe the relationship between psychological factor and chinese syndromes types of non-erosive reflux disease 3.Open up new thinking and method for the therapy of combining traditional Chinese and Western medicine of NERD.
Method:Since February,2006 to January,2008,to go to a doctor on hospital,and Endoscope of ministry have typical cooking feeling and reflux symptom digest,Pain,sour instead of behind the brestbone or against food) The patiens mark Reflux diagnostic questionnare(RDQ)scal,the total points of symptom are greater than 12 points,then using gastrocopy,get rid of oesophageal mucous membrane damage or Barrett patient whose esophagus display,We choosed non-erosive reflux diseas(NERD)patients,Basing on Chinese medicine diagnostic standard to evaluate,employing internatioanlly agreed anxiety commenting scales(Self-rating anxiety scale,SAS),the depressed scale(Self-rating depression scale,SDS) commenting.It is until allthe patients more selected for anxiety and Depressed state psychology test and assess,count total scores,to observe the relationship between different chinese syndro-mes and psychological factor.
Results:1.176 cases of non-erosive reflux disease were classified according to svndrome differentiation.Mainly four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach accounted for 32.2%as 56 patiens,disorder of liver stomach accounted for 27.2%as 48 patiens,phlegmqi stagnation accounted for 20.9%as 37 patiens,27 patiens of asthenia spleen and stomach accounted for 15.2%,other syndrome types 8 account for 4.5%. Therefore NERD patients stagnated heat of liver stomach to take the most,disorder of liver stomach secondly.
2.Four syndrome types of non-erosive reflux disease,stagnated heat of liver stomach of total mark of RDQ form,disorder of liver stomach,asthenia spleen and stomach with card and phlegmqi stagnation,the first 2 card type total mark of RDQ form are obviously higher than the last 2 card type total mark of RDQ form,there are significant differences,P＜0.05,has comparativity,There is no significant difference between stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach,P＞0.05,It is not relatively serious to brief on stagnated heat of liver stomach and disorder of liver stomach with the clinical symptom of the card.
3.Four syndrome types of NERD often stagnated heat of liver stomach,disorder of liver stomach and phlegmqi stagnation,asthenia spleen and stomach form and/or SDS form integration,SAS of card,compare while being strongly fragrant with card,the first 2 card types are obviously higher than the last 2 card types separately,there are significance differences,P＜0.05;stagnated heat of liver stomach,disorder of liver stomach,phlegmqi stagnation have a significance difference compared with asthenia spleen and stomach,while being strongly fragrant,P＞0.05,it is not relatively serious to brief on the stagnated heat of liver stomach and disorder of liver stomach with the depressed and/or anxious state.
4.Total mark of NERD symptom(RDQ) Present prominent positive correlation with SDS, SAS.
5.Four syndrome types of NERD have a psychological factor in various degree often,the stagnated heat of liver stomach,disorder of liver stomach with anxiety / states depressed grade last a other various obviously.
Conelusion:1.The chinese syndromes of this area NERD patient relies mainly on the fact that stagnated heat of liver stomach,disorder of liver stomach and phlegrnqi stagnation,asthenia spleen and stomach,especially the first 2 card types.2,psychological factor plays an important role among morbidity of NERD.3.NERD patient presents relevance in the hope of being improved instead of the state severity of anxious and/or depressed state in symptom severity.4.The stagnation of liver plays important role in the pathogenesis of non-erosive reflux disease.
引文
[1]vakil N,van Zanten SV,Kahrilas P,etal.She Montreal definition and classification of gastroesophageal reflux disease:a global evidence-based consensus.Am J Gastroenterol,2006,101(8):1900-1920.
[2]林三仁,许国铭,胡品津,等.中国胃食管反流病共识意见.胃肠病学,2007,12(4):233-239.
[3]Focd KM,Talley N,Hunt R,etal.Report of Asia-Pacific consensus on the management of GERD[J].J-Gastroenterol Hepatol,2004,19(4):353-356.
[4]Waring JP.Non-erosive reflux disease.Semin Gastrointest Dis,2001,12(1):33-37.
[5]Baker Lit.Lieberman D,Oehlke M.Psychological distress in patients with gastroesophageal reflux disease.Am J Gastroenterol,1995,90:1797-1803.
[6]刘洋,燕均.非糜烂性反流病的临床研究.四川大学报,2005,36(4):552.
[7]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤.第四军医大学学报,2002,23(7):603.
[8]Johnston BT,McFarland RJ,Collins JS,Love AH.Effect of acute stress on oesophageal motility in patients with gastro-oesophageal reflux disease.Gut,1996,38:492-497.
[9]Trimble KC,Pryde A,Heading RC.Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux:evidence for a spectrum of visceral sensitivity in GORD.Gut,1995,37:7-12.
[10]Bradley LA,Richter JE,Pulliam TJ,Hate JM,Scarinei IC,Schan CA,Dalton CB,Salley AN.The relationship between stress and symptoms of gastroesophageal reflux:the influence of psychological factors.Am J Gastroenterol.1993,88:11-19.
[11]Fass R,Fennerty MB,Vakil N.Nonerosive reflux disease-current concepts and dilemmas.Am J Gastroenterol,2001,96:303-314.
[12]李颖波.心身综合治疗非糜烂性反流病的临床研究.中原医刊,2006,33(19):39-42.
[13]吴伟康,徐志伟.中西医结合病理生理学.北京:科学出版社.2003.
[14]壬兴鹏主编.现代胃肠病学.上海:科学技术文献出版社,2001:201-203.
[15]中国胃食管反流病研究协作组.《反流性疾病问卷在胃食管反流病诊断中的价值》.中华消化杂志,2003,23(11):651-654.
[16]Shaw MJ,Talley NJ,Beebe TJ,etal.Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.Am J Gastroenterol,2001,96:52-57.
[17]Fass R.Epidemiology and pathophysiology of sympotomic gastroesophageal reflux disease.Am J Gastroenterol,2003,98(3 supp Ⅰ ):S2-S7.
[18]Liu Y,Gong J,Dong L,etal.A clinical study of non-erosive reflux disease.Sichuan Da Xue Xue Bao Yi Xue Ban,2005,36:552-554.
[19]Ang TL,Fock KM,Ng TM,etal.A comparison of the clinical,demographic and psychiatric profiles among patientswith erosive and non-erosive reflux disease in a multi-ethnic Asian country.World J Gastroenterol,2005,11:3558-3561.
[20]Quigley EM.Non-erosive reflux disease:part of the spectrum of gastro -esophageal reflux disease,a component of functional dyspepsia,or both?Eur J Gastroenterol Hepatol,2001:13(Supp Ⅱ):S13.
[21]张峻,杨昭徐.酸反流与胆汁反流在胃食管反流病中的作用.胃肠病学,2000,5(4):207.
[22]Boiling-StemevaldE,CarlssonR,AalykkeC etal.Relationship between symptoms,endoscopic diagnoses and health related quality of life in patients presenting with upper abdominal complaints.Journal Gastroenterology Hepatology,2002,17(Suppl.):A385(abstract).
[23]Lee Y C,Wang H P.Patients with functional heartburn are more likely to report retrostern discomfort during wireless pH monitoring[J].2005,62(6):834-841.
[24]Fass R.Epidemiology and pathophysiology of symptomatic gastroesophageal reflux disease.Am J Gastrocnterol,2003,98(3 Supp1):S2-7.
[25]徐志洁,段丽萍,王琨,等.焦虑和抑郁与胃食管反流病症状发生的相关研究[J].中华医学杂志,2005,85(45):3210-3215.
[26]钟英强,许哲,郭佳念.埃索美拉唑和氟哌噻顿美利曲辛治疗伴有抑郁或焦虑的非糜烂性胃食管反流疾病.中华消化杂志,2006,26:444-446.
[27]谷仲平,刘锟,王云杰,等.胃食管返流病食管上皮早期超微结构改变.第四军医大学学报,2000.21:994.
[28]Fass R.Am J Gastroenterol,2003,98:S2-7.
[29]Quigley EM.Am J Gastroenterol,2003,98:S24-30.
[30]余建新.黛力新辅助治疗非糜烂性反流病60例疗效观察.广东药学院学报,2005,21(3):354-359.
[31]刘新光.功能性消化不良与胃肠动力异常.中华消化杂志,2002,22:44-45.
[32]梁小燕,高青.胃食管反流病的食管外表现及其临床进展.世界华人消化杂志,2006,14:3387-3390.
[33]刘韶辉,熊理守,林金坤,等.心理社会因素在非糜烂性反流病发病中作用的研究.胃肠病学,2006,11(2):92-95.
[34]朱生梁,李勇,朱晓燕,等.胃食管反流病证型研究.上海中医药杂志2002,(12):12-13.
[35]王唏星,李延茎,肖汉玺.从肝论治反流性食管炎经验.中国中西医结合睥胃杂志,2000,8(1):38.
[36]郝娅宁.胃食营反流病擗治体会.陕西中医,1997,18(2):95.
[37]陈纪藩.金匮要略[M].北京:人民卫生出版社,2000,695-701.
[38]陈泽民,翁行善.反流性食道炎.中医肠病学.中国医药科技技出版社,1993,376.
[39]单兆伟,徐景藩.论冶食管病经验.中国中西医结合睥胃杂志,1994,2(1):41.
[40]段国勋,庞龙,熊天琴,等.胃食管反流病中医辨证分型的研究[J]新中医,2000,32(9):34-36.
[41]俞彩珍.反流性食管炎中医辨证分型.湖北中医杂志,1997,(3):20.
[42]李茹柳,陈蔚文,荣颂芽,等.42例胃食管反流中医证型分析[J].广州中医药大学学 报,1996,13(2):4-6.
[43]高士宗.黄帝素问直解[M].北京:科学技术文献出版社,1982,284,42,40.
[44]胡永年.医学心理学[M].北京:中国医药科技出版社,2000,39.
[45]齐南.《景岳全书》论情志病证管窥.成都中医学院学报,1991,14(2):1-4.
[46]张秀萍.因情致病以情治之一试析《临证指南医案》的心理治疗经验.浙江中医杂志,1996,16(4):38.
[1]Dent J,Brun J,Fendrick AM,Fennerty MB,Janssens J,Kahrilas PJ,Lauritsen K,Reynolds JC,Shaw M,Talley NJ.An evidence-based appraisal of reflux disease management-The Genval Workshop Report.Gut,1999,44(supp12):S1-S16.
[2]Meining A,Driesnack U,Classen M,Rosch T.Managemient of gastroesophageal reflux disease in primary care[J].Z astroenterol,2002,40:15-20.
[3]Focd KM,Talley N,Hunt R,etal.Report of Asia-Pacific consensus on the management of GERD[J].J-Gastroenterol Hepatol,2004,19(4):353-356.
[4]Waring JP.Non-erosive reflux disease.Semin Gastrointest Dis,2001,12(1):33-37.
[5]潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19(4):223-226.
[6]Baker LH,Lieberman D,Oehlke M.Psychological distress in patients with gastroesophageal reflux disease.Am J Gastroenterol,1995,90:1797-1803.
[7]刘洋,燕均.非糜烂性反流病的临床研究.四川大学报,2005,36(4):552.
[8]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤.第四军医大学学报,2002,23(7):603.
[9]Fass R,Fennerty MB,Vakil N.Nonerosive reflux disease-current concepts and dilemmas.Am J Gastroenterol,2001,96:303-314.
[10]Bradley LA,RichterJE,Pulliam TJ,Hate JM,Scarinei IC,Schan CA,Dalton CB,Salley AN.The relationship between stress and symptoms of gastroesophageal reflux:the influence of psychological factors.Am J Gastroenterol.1993,88:11-19.
[11]Johnston BT,McFarland RJ,Collins JS,Lo ve AH.Effect of acute stress on oesophageal motility in patients with gastre-oesophageal reflux disease.Gut,1996,38:492-497.
[12]Trimble KC,Pryde A,Heading RC.Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux:evidence for a spectrum of visceral sensitivity in GORD.Gut,1995,37:7-12.
[13]李颖波.心身综合治疗非糜烂性反流病的临床研究.中原医刊,2006,33(19):39-42.
[14]刘韶辉,熊理守,林金坤,等.心理社会因素在非糜烂性反流病发病中作用的研究.胃肠病学,2006,11(2):92-95.
[15]JohnstonBT,LewisSA,CollinsJS,McFarlandRJ,LoveAH.Acidperception in gastro-oesopha--geal reflux disease is dependent on psyehosocial factors.Scand J Gastroenteml,1995,30:1-5.
[16]Ho KY,Kang JY,Yeo B,Ng WL.Non-cardiac,nonoesophageal chest pain:the relevance of psychological factors.Gut,1998,43:105-110.
[17]Kamolz T,Velanovich V.Psychological and emotional aspects of gastroesophageal reflux disease.Dis Esophagus,2002,15:199-203.
[18]MayerEA.Spinaland supraspinal modulation of visceral sensation.Gut,2000,47(supp1-4):ⅳ69-72.
[19]McDonala-Baile J,Bradley LA,Bailey MA,etal.Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageul reflux disease.Gastroene--rology,1994,107(1):61-69.
[20]Richter JE,Bradley LA.Psychophysiological interactions in esophageal diseases.Semin Gastrointest Dis,1996,7(4):169-184.
[10]Bradley LA,Richter JE,Pulliam TJ,etal.the relationship between stressand symptoms of gastroe sophageal reflux:The izfluenee of physiologicalfactors.Am J Gastroenterol,1993,88(1):11-19.
[21]Johnston BT,Lewis SA,Collins JSA,etal.Acid perception in gastro-oesophageal reflux disease is dependent on psychological factors.Scand J Gastroentesol,1995,30(1):1-5.
[22]朱生梁,李勇,朱晓燕,等.胃食管反流病证型研究.上海中医药杂志,2002(12):12-13.
[23]王唏星,李延茎,肖汉玺.从肝论治反流性食管炎经验.中国中西医结合睥胃杂志,2000,8(1):38.
[24]郝娅宁.胃食营反流病擗治体会.陕西中医,1997,18(2):95.
[25]吴伟康,徐志伟.中西医结合病理生理学.北京:科学出版社,2003.
[26]刘小北.清降汤加减治疗胃食管反流病.中国医药学报,1999,14(16):53.
[27]李乾构,王自力中医胃肠病学.北京:中国医药科技出版社,1993,375-385.
[28]张琼英,徐福音教授治疗反流性食管炎经验.中国中西医结合脾胃杂志,2000,8(1):38.
[29]余建新.黛力新辅助治疗非糜烂性反流病60例疗效观察.广东药学院学报,2005,21(3):354-359.
[2]林三仁,许国铭,胡品津,等.中国胃食管反流病共识意见.胃肠病学,2007,12(4):233-239.
[3]Focd KM,Talley N,Hunt R,etal.Report of Asia-Pacific consensus on the management of GERD[J].J-Gastroenterol Hepatol,2004,19(4):353-356.
[4]Waring JP.Non-erosive reflux disease.Semin Gastrointest Dis,2001,12(1):33-37.
[5]Baker Lit.Lieberman D,Oehlke M.Psychological distress in patients with gastroesophageal reflux disease.Am J Gastroenterol,1995,90:1797-1803.
[6]刘洋,燕均.非糜烂性反流病的临床研究.四川大学报,2005,36(4):552.
[7]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤.第四军医大学学报,2002,23(7):603.
[8]Johnston BT,McFarland RJ,Collins JS,Love AH.Effect of acute stress on oesophageal motility in patients with gastro-oesophageal reflux disease.Gut,1996,38:492-497.
[9]Trimble KC,Pryde A,Heading RC.Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux:evidence for a spectrum of visceral sensitivity in GORD.Gut,1995,37:7-12.
[10]Bradley LA,Richter JE,Pulliam TJ,Hate JM,Scarinei IC,Schan CA,Dalton CB,Salley AN.The relationship between stress and symptoms of gastroesophageal reflux:the influence of psychological factors.Am J Gastroenterol.1993,88:11-19.
[11]Fass R,Fennerty MB,Vakil N.Nonerosive reflux disease-current concepts and dilemmas.Am J Gastroenterol,2001,96:303-314.
[12]李颖波.心身综合治疗非糜烂性反流病的临床研究.中原医刊,2006,33(19):39-42.
[13]吴伟康,徐志伟.中西医结合病理生理学.北京:科学出版社.2003.
[14]壬兴鹏主编.现代胃肠病学.上海:科学技术文献出版社,2001:201-203.
[15]中国胃食管反流病研究协作组.《反流性疾病问卷在胃食管反流病诊断中的价值》.中华消化杂志,2003,23(11):651-654.
[16]Shaw MJ,Talley NJ,Beebe TJ,etal.Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.Am J Gastroenterol,2001,96:52-57.
[17]Fass R.Epidemiology and pathophysiology of sympotomic gastroesophageal reflux disease.Am J Gastroenterol,2003,98(3 supp Ⅰ ):S2-S7.
[18]Liu Y,Gong J,Dong L,etal.A clinical study of non-erosive reflux disease.Sichuan Da Xue Xue Bao Yi Xue Ban,2005,36:552-554.
[19]Ang TL,Fock KM,Ng TM,etal.A comparison of the clinical,demographic and psychiatric profiles among patientswith erosive and non-erosive reflux disease in a multi-ethnic Asian country.World J Gastroenterol,2005,11:3558-3561.
[20]Quigley EM.Non-erosive reflux disease:part of the spectrum of gastro -esophageal reflux disease,a component of functional dyspepsia,or both?Eur J Gastroenterol Hepatol,2001:13(Supp Ⅱ):S13.
[21]张峻,杨昭徐.酸反流与胆汁反流在胃食管反流病中的作用.胃肠病学,2000,5(4):207.
[22]Boiling-StemevaldE,CarlssonR,AalykkeC etal.Relationship between symptoms,endoscopic diagnoses and health related quality of life in patients presenting with upper abdominal complaints.Journal Gastroenterology Hepatology,2002,17(Suppl.):A385(abstract).
[23]Lee Y C,Wang H P.Patients with functional heartburn are more likely to report retrostern discomfort during wireless pH monitoring[J].2005,62(6):834-841.
[24]Fass R.Epidemiology and pathophysiology of symptomatic gastroesophageal reflux disease.Am J Gastrocnterol,2003,98(3 Supp1):S2-7.
[25]徐志洁,段丽萍,王琨,等.焦虑和抑郁与胃食管反流病症状发生的相关研究[J].中华医学杂志,2005,85(45):3210-3215.
[26]钟英强,许哲,郭佳念.埃索美拉唑和氟哌噻顿美利曲辛治疗伴有抑郁或焦虑的非糜烂性胃食管反流疾病.中华消化杂志,2006,26:444-446.
[27]谷仲平,刘锟,王云杰,等.胃食管返流病食管上皮早期超微结构改变.第四军医大学学报,2000.21:994.
[28]Fass R.Am J Gastroenterol,2003,98:S2-7.
[29]Quigley EM.Am J Gastroenterol,2003,98:S24-30.
[30]余建新.黛力新辅助治疗非糜烂性反流病60例疗效观察.广东药学院学报,2005,21(3):354-359.
[31]刘新光.功能性消化不良与胃肠动力异常.中华消化杂志,2002,22:44-45.
[32]梁小燕,高青.胃食管反流病的食管外表现及其临床进展.世界华人消化杂志,2006,14:3387-3390.
[33]刘韶辉,熊理守,林金坤,等.心理社会因素在非糜烂性反流病发病中作用的研究.胃肠病学,2006,11(2):92-95.
[34]朱生梁,李勇,朱晓燕,等.胃食管反流病证型研究.上海中医药杂志2002,(12):12-13.
[35]王唏星,李延茎,肖汉玺.从肝论治反流性食管炎经验.中国中西医结合睥胃杂志,2000,8(1):38.
[36]郝娅宁.胃食营反流病擗治体会.陕西中医,1997,18(2):95.
[37]陈纪藩.金匮要略[M].北京:人民卫生出版社,2000,695-701.
[38]陈泽民,翁行善.反流性食道炎.中医肠病学.中国医药科技技出版社,1993,376.
[39]单兆伟,徐景藩.论冶食管病经验.中国中西医结合睥胃杂志,1994,2(1):41.
[40]段国勋,庞龙,熊天琴,等.胃食管反流病中医辨证分型的研究[J]新中医,2000,32(9):34-36.
[41]俞彩珍.反流性食管炎中医辨证分型.湖北中医杂志,1997,(3):20.
[42]李茹柳,陈蔚文,荣颂芽,等.42例胃食管反流中医证型分析[J].广州中医药大学学 报,1996,13(2):4-6.
[43]高士宗.黄帝素问直解[M].北京:科学技术文献出版社,1982,284,42,40.
[44]胡永年.医学心理学[M].北京:中国医药科技出版社,2000,39.
[45]齐南.《景岳全书》论情志病证管窥.成都中医学院学报,1991,14(2):1-4.
[46]张秀萍.因情致病以情治之一试析《临证指南医案》的心理治疗经验.浙江中医杂志,1996,16(4):38.
[1]Dent J,Brun J,Fendrick AM,Fennerty MB,Janssens J,Kahrilas PJ,Lauritsen K,Reynolds JC,Shaw M,Talley NJ.An evidence-based appraisal of reflux disease management-The Genval Workshop Report.Gut,1999,44(supp12):S1-S16.
[2]Meining A,Driesnack U,Classen M,Rosch T.Managemient of gastroesophageal reflux disease in primary care[J].Z astroenterol,2002,40:15-20.
[3]Focd KM,Talley N,Hunt R,etal.Report of Asia-Pacific consensus on the management of GERD[J].J-Gastroenterol Hepatol,2004,19(4):353-356.
[4]Waring JP.Non-erosive reflux disease.Semin Gastrointest Dis,2001,12(1):33-37.
[5]潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19(4):223-226.
[6]Baker LH,Lieberman D,Oehlke M.Psychological distress in patients with gastroesophageal reflux disease.Am J Gastroenterol,1995,90:1797-1803.
[7]刘洋,燕均.非糜烂性反流病的临床研究.四川大学报,2005,36(4):552.
[8]郝悦,黄裕新,王景杰.心理性应激对大鼠胃排空的影响及胃粘膜的损伤.第四军医大学学报,2002,23(7):603.
[9]Fass R,Fennerty MB,Vakil N.Nonerosive reflux disease-current concepts and dilemmas.Am J Gastroenterol,2001,96:303-314.
[10]Bradley LA,RichterJE,Pulliam TJ,Hate JM,Scarinei IC,Schan CA,Dalton CB,Salley AN.The relationship between stress and symptoms of gastroesophageal reflux:the influence of psychological factors.Am J Gastroenterol.1993,88:11-19.
[11]Johnston BT,McFarland RJ,Collins JS,Lo ve AH.Effect of acute stress on oesophageal motility in patients with gastre-oesophageal reflux disease.Gut,1996,38:492-497.
[12]Trimble KC,Pryde A,Heading RC.Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux:evidence for a spectrum of visceral sensitivity in GORD.Gut,1995,37:7-12.
[13]李颖波.心身综合治疗非糜烂性反流病的临床研究.中原医刊,2006,33(19):39-42.
[14]刘韶辉,熊理守,林金坤,等.心理社会因素在非糜烂性反流病发病中作用的研究.胃肠病学,2006,11(2):92-95.
[15]JohnstonBT,LewisSA,CollinsJS,McFarlandRJ,LoveAH.Acidperception in gastro-oesopha--geal reflux disease is dependent on psyehosocial factors.Scand J Gastroenteml,1995,30:1-5.
[16]Ho KY,Kang JY,Yeo B,Ng WL.Non-cardiac,nonoesophageal chest pain:the relevance of psychological factors.Gut,1998,43:105-110.
[17]Kamolz T,Velanovich V.Psychological and emotional aspects of gastroesophageal reflux disease.Dis Esophagus,2002,15:199-203.
[18]MayerEA.Spinaland supraspinal modulation of visceral sensation.Gut,2000,47(supp1-4):ⅳ69-72.
[19]McDonala-Baile J,Bradley LA,Bailey MA,etal.Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageul reflux disease.Gastroene--rology,1994,107(1):61-69.
[20]Richter JE,Bradley LA.Psychophysiological interactions in esophageal diseases.Semin Gastrointest Dis,1996,7(4):169-184.
[10]Bradley LA,Richter JE,Pulliam TJ,etal.the relationship between stressand symptoms of gastroe sophageal reflux:The izfluenee of physiologicalfactors.Am J Gastroenterol,1993,88(1):11-19.
[21]Johnston BT,Lewis SA,Collins JSA,etal.Acid perception in gastro-oesophageal reflux disease is dependent on psychological factors.Scand J Gastroentesol,1995,30(1):1-5.
[22]朱生梁,李勇,朱晓燕,等.胃食管反流病证型研究.上海中医药杂志,2002(12):12-13.
[23]王唏星,李延茎,肖汉玺.从肝论治反流性食管炎经验.中国中西医结合睥胃杂志,2000,8(1):38.
[24]郝娅宁.胃食营反流病擗治体会.陕西中医,1997,18(2):95.
[25]吴伟康,徐志伟.中西医结合病理生理学.北京:科学出版社,2003.
[26]刘小北.清降汤加减治疗胃食管反流病.中国医药学报,1999,14(16):53.
[27]李乾构,王自力中医胃肠病学.北京:中国医药科技出版社,1993,375-385.
[28]张琼英,徐福音教授治疗反流性食管炎经验.中国中西医结合脾胃杂志,2000,8(1):38.
[29]余建新.黛力新辅助治疗非糜烂性反流病60例疗效观察.广东药学院学报,2005,21(3):354-359.