本文選題：鋁碳酸鎂 + 反流性食管炎�。� 參考：《南華大學(xué)》2014年碩士論文

【摘要】：目的：通過觀察反流性食管炎(Reflux Esophagitis,RE)患者經(jīng)鋁碳酸鎂聯(lián)合多潘立酮治療前后的臨床療效、內(nèi)鏡下食管炎愈合情況、藥物不良反應(yīng)及表皮生長因子受體(Epidermal Growth Factor Receptor,EGFR)的表達(dá)變化情況，探討鋁碳酸鎂在反流性食管炎中的臨床療效和EGFR在RE中的表達(dá)及臨床意義。 方法：根據(jù)2005年美國胃腸病學(xué)會最新發(fā)表的反流性食管炎的診治指南[1]及2000年中華醫(yī)學(xué)會消化內(nèi)鏡學(xué)會制定的反流性食管炎的診斷及治療方案（試行）[2]，經(jīng)胃鏡檢查，選取64例我院2012年11月-2013年10月消化內(nèi)科門診及住院確診為反流性食管炎的患者。將入選的反流性食管炎患者按照就診先后順序編號，按隨機(jī)數(shù)字表隨機(jī)分入觀察組和對照組：觀察組（33例）給予鋁碳酸鎂1.0g Tid餐后兩小時溫水泡服，多潘立酮10mg Tid餐前半小時口服，治療周期為8周；對照組（31例）給予泮托拉唑40mg Bid晨起空腹及睡前服用，多潘立酮10mg Tid餐前半小時口服，治療周期為8周。入選觀察組及對照組患者均于開始治療前及治療8周后分別行血、尿、糞常規(guī)、肝腎功能、電子胃鏡檢查及行食管組織活檢，應(yīng)用免疫組化法測定食管黏膜EGFR的表達(dá)水平。 結(jié)果：兩組間治療前患者燒心、反酸及胸痛癥狀積分比較差異無統(tǒng)計學(xué)意義（P＞0.05），按各組方案治療8周后，兩組治療后均可顯著降低RE患者癥狀積分，，差異均有統(tǒng)計學(xué)意義（P＜0.05），兩組間治療后癥狀積分比較差異無統(tǒng)計學(xué)意義（P＞0.05）；兩組間治療前內(nèi)鏡下反流性食管炎表現(xiàn)比較差異無統(tǒng)計學(xué)意義（P＞0.05），兩組患者在第8周時復(fù)查胃鏡，內(nèi)鏡下治愈率和有效率相比差異無統(tǒng)計學(xué)意義（P＞0.05），兩組間治療后內(nèi)鏡下表現(xiàn)比較無統(tǒng)計學(xué)意義（P＞0.05）；按各組方案治療8周后，兩組間治療后不良反應(yīng)比較差異有統(tǒng)計學(xué)意義（P＜0.05）；兩組間治療前EGFR陽性表達(dá)率比較差異無統(tǒng)計學(xué)意義（P＞0.05），按各組治療方案治療8周后，兩組EGFR陽性表達(dá)率均較治療前逐漸升高，差異有統(tǒng)計學(xué)意義（P＜0.05）。 結(jié)論：1.鋁碳酸鎂緩解RE患者臨床癥狀的療效與泮托拉唑相當(dāng)，而鋁碳酸鎂大大減少了藥物不良反應(yīng)，且能迅速中和酸性和堿性的反流物，在治療酸堿混合性反流方面有廣泛的應(yīng)用前景。 2.鋁碳酸鎂可能通過上調(diào)EGFR表達(dá)促進(jìn)反流性食管炎愈合，提示EGFR可能在食管炎的修復(fù)過程中起著重要作用。
[Abstract]:Objective: to observe the clinical efficacy, endoscopic esophagitis healing, adverse drug reactions and the expression of epidermal growth factor receptor epidermal Growth Factor receptor (EGFR) in patients with reflux esophagitis reflux before and after treatment with magnesium bicarbonate and domperidone. To investigate the clinical effect of magnesium bicarbonate in reflux esophagitis and the expression of EGFR in RE and its clinical significance. Methods: according to the guidelines for the diagnosis and treatment of reflux esophagitis published by the American Gastroenterology Society in 2005 [1] and the diagnostic and therapeutic plan for reflux esophagitis developed by the Chinese Medical Association of digestive endoscopy in 2000 (trial), gastroscopy was performed. 64 patients with reflux esophagitis were selected from November 2012 to October 2013. Patients with reflux esophagitis were randomly divided into observation group (n = 33) and control group (n = 33). Domperidone 10mg Tid was taken orally half an hour before meal, the treatment period was 8 weeks, the control group was treated with pantazol 40mg Bid on an empty stomach and before bedtime, and domperidone 10mg Tid was taken half an hour before meal, the treatment period was 8 weeks. The patients in the observation group and the control group were treated with blood, urine, fecal routine, liver and kidney function, electronic gastroscopy and esophageal biopsy before treatment and 8 weeks after treatment, respectively. The expression of EGFR in esophageal mucosa was determined by immunohistochemical method. Results: there was no significant difference in the score of heartburn, acid regurgitation and chest pain between the two groups before treatment (P > 0.05). The difference was statistically significant (P < 0.05), there was no significant difference in symptom score after treatment between the two groups (P > 0.05), and there was no significant difference in the manifestations of endoscopic reflux esophagitis between the two groups before treatment (P > 0.05). There was no significant difference in the cure rate and the effective rate between the two groups (P > 0.05), but there was no significant difference between the two groups (P > 0.05). There was no significant difference in the expression rate of EGFR between the two groups before and after treatment (P > 0.05). After 8 weeks of treatment, the positive expression rate of EGFR in the two groups was gradually higher than that before treatment. The difference was statistically significant (P < 0.05). Conclusion 1. The efficacy of magnesium bicarbonate in relieving clinical symptoms in patients with RE was comparable to that of pam Tora, while magnesium bicarbonate significantly reduced adverse drug reactions and quickly neutralized acid and alkaline reflux. In the treatment of acid-base mixed reflux has a wide range of applications. 2. It is suggested that EGFR may play an important role in the repair of esophagitis by upregulating the expression of EGFR to promote the healing of reflux esophagitis.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R571

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