本文選題：替普瑞酮 + 萎縮性胃炎　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討替普瑞酮對(duì)幽門螺桿菌(Helicobacter pylori,Hp)陰性萎縮性胃炎患者的黏膜保護(hù)作用及臨床療效,為萎縮性胃炎的規(guī)范化治療提供理論依據(jù)。方法:選取2016年1月至2016年12月在中國人民解放軍海軍總醫(yī)院消化內(nèi)科門診及住院部就診,經(jīng)胃鏡及病理檢查診斷為萎縮性胃炎,且13C尿素呼氣試驗(yàn)為Hp(-)的患者120名。將這120名患者隨機(jī)分為替普瑞酮組(替普瑞酮膠囊)、鉍劑組(膠體果膠鉍膠囊)和安慰劑組(海軍總醫(yī)院藥劑科自制淀粉藥丸),每組40人,分別治療12周,同時(shí)給予飲食習(xí)慣調(diào)查及指導(dǎo)。三組患者分別于治療前(0周)及治療后(12周)行胃鏡下觀察、病理組織活檢及胃黏膜組織和微循環(huán)因子檢測(cè),并收集治療前后的癥狀積分。比較三組患者間胃鏡下胃黏膜病變程度積分、胃黏膜病理積分及癥狀積分的統(tǒng)計(jì)學(xué)差異性;比較三組患者分別于治療前后胃黏膜組織因子(三葉因子1、氨基己糖)及微循環(huán)因子(胃泌素、前列腺素E2)變化的統(tǒng)計(jì)學(xué)差異并比較治療后各組間的差異性。結(jié)果:1、治療12周時(shí)評(píng)估胃鏡下療效,替普瑞酮組、鉍劑組、安慰劑組總有效率分別為85%、75%、10%;替普瑞酮組較鉍劑組無顯著差異(χ~2=1.25,P0.05);替普瑞酮組與鉍劑組胃鏡下療效均優(yōu)于安慰劑組(P0.05)。2、治療12周時(shí)評(píng)估胃黏膜病理組織變化情況,替普瑞酮組、鉍劑組、安慰劑組總有效率分別為95.0%、87.5%、7.5%;替普瑞酮組較鉍劑組無顯著統(tǒng)計(jì)學(xué)差異(χ~2=0.63,P0.05);替普瑞酮組與鉍劑組胃黏膜病理組織變化情況均優(yōu)于安慰劑組(P0.05)。3、治療12周時(shí)胃黏膜組織因子(三葉因子1、氨基己糖)及微循環(huán)因子(胃泌素、前列腺素E2)變化情況,替普瑞酮組與鉍劑組均較安慰劑組有顯著統(tǒng)計(jì)學(xué)差異(P0.05),替普瑞酮組較鉍劑組無顯著統(tǒng)計(jì)學(xué)差異(P0.05);替普瑞酮組與鉍劑組治療后較治療前均有顯著統(tǒng)計(jì)學(xué)差異(P0.05),安慰劑組治療后較治療前無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。4、治療12周時(shí)評(píng)估癥狀改善情況,替普瑞酮組、鉍劑組、安慰劑組總有效率分別為80%、75%、7.5%;替普瑞酮組較鉍劑組無顯著統(tǒng)計(jì)學(xué)差異(P0.05);替普瑞酮組與鉍劑組癥狀改善情況情況均優(yōu)于安慰劑組(P0.05)。5、鉍劑組治療過程中發(fā)生3例便秘,2例惡心。替普瑞酮組發(fā)生1例頭痛。替普瑞酮組及鉍劑組不良反應(yīng)發(fā)生率分別為2.5%及12.5%。結(jié)論:(1)胃黏膜出現(xiàn)萎縮時(shí)微循環(huán)因子及萎縮部位的胃黏膜組織因子發(fā)生變化。胃黏膜萎縮部位三葉因子1(Trefoil Factor 1,TFF1)分泌減少。(2)萎縮性胃炎患者經(jīng)治療后TFF1含量顯著增加,表明萎縮較前好轉(zhuǎn);經(jīng)治療后血清胃泌素水平顯著上升,可能與萎縮好轉(zhuǎn)相關(guān)。(3)三組患者經(jīng)治療后,觀察組胃黏膜氨基己糖及血清前列腺素E2(Prostaglandin E2,PGE2)含量均較治療前顯著增加,觀察組較對(duì)照組有顯著統(tǒng)計(jì)學(xué)意義。胃黏膜保護(hù)劑能夠顯著增加氨基己糖及PGE2含量,即增強(qiáng)了胃黏膜保護(hù)因素。(4)替普瑞酮結(jié)合健康飲食宣教能夠明顯改善非Hp感染的萎縮性胃炎患者的上腹飽脹、上腹痛、噯氣、惡心、食欲減退等癥狀,且能調(diào)節(jié)胃黏膜組織因子及微循環(huán)因子至正常水平,修復(fù)胃黏膜,對(duì)Hp陰性的萎縮性胃炎具有良好的治療效果,并且不良反應(yīng)發(fā)生率較低,因此可于臨床實(shí)踐中推廣應(yīng)用。
[Abstract]:Objective: To investigate the protective effect and clinical effect of tipri on Helicobacter pylori (Hp) negative atrophic gastritis, and to provide a theoretical basis for the standardized treatment of atrophic gastritis. Methods: from January 2016 to December 2016, the Department of Gastroenterology and inpatient department of Navy PLA General Hospital were selected. Patients were diagnosed as atrophic gastritis with gastroscopy and pathological examination, and 120 patients with 13C urea breath test were Hp (-). The 120 patients were randomly divided into tepreone group (tepreone capsule), bismuth group (Colloidal Bismuth Pectin Capsules) and placebo group (self-made starch pill) in Navy General Hospital, 40 people in each group for 12 weeks, and at the same time, at the same time. The three groups were observed before the treatment (0 weeks) and after the treatment (12 weeks), the pathological biopsy and gastric mucosa tissue and microcirculation factors were detected, and the symptom scores before and after the treatment were collected. The score of the gastric mucosa lesion degree under the gastroscope, the pathological score of the gastric mucosa and the symptom score were compared between the three groups. Statistical difference in the three groups of patients before and after treatment were compared with the changes of gastric mucosal tissue factor (Trifolium factor 1, amino hexose) and microcirculation factor (gastrin, prostaglandin E2) and the differences after treatment. Results: 1, the therapeutic effect was evaluated at 12 weeks, tepreone group, bismuth group, and placebo. The total effective rate of the group was 85%, 75%, 10%, and there was no significant difference between the tepreone group and the bismuth group (x ~2=1.25, P0.05). The efficacy of the tepreone group and the bismuth group was better than that of the placebo group (P0.05).2, and the pathological changes of the gastric mucosa were evaluated at 12 weeks. The total effective rate of the tepreone group, the bismuth group and the placebo group was 95%, 87.5%, 7.5%, respectively. There was no significant difference between the tepreone group and the bismuth group (x ~2=0.63, P0.05); the pathological changes of gastric mucosa in the tepreone group and the bismuth group were better than those of the placebo group (P0.05).3. The changes of gastric mucosal tissue factor (Trifolium factor 1, amino hexose) and microcirculation factor (gastrin, prostaglandin E2) in the group of tepreone at 12 weeks, and the tepreone group and the group of tepreone There was significant difference between the bismuth group and the placebo group (P0.05). There was no significant difference between the tepreone group and the bismuth group (P0.05). There was significant difference between the tepreone group and the bismuth group before the treatment (P0.05). There was no significant difference between the placebo group and the pre treatment group (P0.05).4. The symptoms were evaluated at 12 weeks. The total effective rate of the tepreone group and the bismuth group was 80%, 75%, 7.5%, respectively, and there was no significant difference between the tepreone group and the bismuth group (P0.05). The improvement of the symptoms of the tepreone group and the bismuth group was better than that of the placebo group (P0.05).5, and 3 cases of constipation, 2 nausea in the bismuth group and 1 of the tepreone group in the bismuth group. Cases of headache. The incidence of adverse reactions in the tepreone group and the bismuth group was 2.5% and 12.5%. respectively: (1) the microcirculation factor and the gastric mucosal tissue factor in the atrophy of gastric mucosa were changed. The decrease of the trifoliate factor 1 (Trefoil Factor 1, TFF1) in the atrophy of the gastric mucosa was reduced. (2) the TFF1 content of the atrophic gastritis patients after treatment. The level of atrophy was better than before, and the level of serum gastrin increased significantly after treatment. (3) after treatment, the contents of amino hexose and serum prostaglandin E2 (Prostaglandin E2, PGE2) in the gastric mucosa of the three groups were significantly higher than those before the treatment. The observation group had significant statistical significance compared with the control group. Mucosal protective agents can significantly increase the content of amino hexose and PGE2, that is, enhancing the protective factors of gastric mucosa. (4) tepridone combined with healthy diet education can obviously improve the upper abdominal distention, upper abdominal pain, belching, nausea, anorexia and other symptoms of non Hp infected atrophic gastritis, and can regulate gastric mucosal tissue factor and microcirculation factor. To the normal level, the repair of gastric mucosa has good therapeutic effect on Hp negative atrophic gastritis, and the incidence of adverse reactions is low, so it can be applied in clinical practice.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R573.32

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