發(fā)布時間：2018-06-14 08:36

  本文選題：紫蘇四香散加味方 + 泮托拉唑鈉腸溶膠囊　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的通過觀察紫蘇四香散加味方聯(lián)合西藥(泮托拉唑鈉腸溶膠囊)治療肝胃郁熱型慢性糜爛性胃炎的臨床療效及其對相關(guān)炎性因子的影響,進(jìn)一步探討該方藥在防治CEG上的作用機(jī)理,客觀的評價其安全性和有效性,為臨床治療CEG提供更廣泛的思路和理論依據(jù)。方法選取從2015年3月至2016年4月于武漢市中心醫(yī)院中醫(yī)科及消化內(nèi)科的門診及住院部的經(jīng)胃鏡確診為慢性糜爛性胃炎,經(jīng)過中醫(yī)辨證后為肝胃郁熱型的患者60例,然后隨機(jī)的分為兩組即治療組和對照組。兩組患者中若有幽門螺旋桿菌(Hp)感染者,先給予根除Hp治療2周。之后對照組的患者給予泮托拉唑鈉腸溶膠囊口服,40mg/次,2次/日;治療組的患者是在對照組的基礎(chǔ)上給予導(dǎo)師的經(jīng)驗方即紫蘇四香散加味方治療,方藥主要由下列藥物組成:紫蘇梗10克,藿香10克,香附20克,降香10克,沉香10克,木香10克,黃芪15克,丹參15克,蒲公英15克,雞內(nèi)金15克,炒二芽各20克,枳殼10克,厚樸10克,海螵蛸15克,炙甘草6克,中藥飲片及中藥煎劑均由湖北天濟(jì)飲片公司提供,每天1劑,口服,200ml-250ml/次,2次/日。60例患者的療程均為8周。治療結(jié)束之后,觀察兩組患者治療前后的中醫(yī)證候的相關(guān)療效、單個中醫(yī)臨床癥狀的療效、中醫(yī)癥狀的總積分、消化內(nèi)鏡下胃黏膜的改善情況、Hp的轉(zhuǎn)陰率、臨床的綜合治療效果及兩組患者治療后的炎性因子水平(包括CRR和IL-6水平)以及患者治療期間的不良反應(yīng)。除此之外,還有停藥2周后對治療有效患者的隨訪觀察,觀察其在隨訪6個月中的復(fù)發(fā)情況。收集數(shù)據(jù)后采用SPSS19.0軟件來進(jìn)行統(tǒng)計學(xué)分析計算,計量資料服從正態(tài)分布的采用t檢驗,非正態(tài)分布的采用非參數(shù)檢驗;無序的計數(shù)資料用卡方檢驗,有序的計數(shù)資料用非參數(shù)檢驗。結(jié)果(1)在改善患者的單個中醫(yī)癥狀的相關(guān)療效方面,比如其胃痛、飽脹感、噯氣、泛酸癥狀的改善,兩組患者比較有統(tǒng)計學(xué)差異(P0.05);(2)在降低患者的中醫(yī)癥狀總積分方面,在治療前,治療組及對照組的總積分分別為15.40±1.19,14.87±1.33,治療后的分別為3.67±0.71,7.30±0.88,治療后兩組患者的總積分均較治療前有所下降,但治療組降低的更為明顯,兩組比較有統(tǒng)計學(xué)意義(P0.05)。(3)在改善患者中醫(yī)證候方面,治療組的有效率為96.67%,對照組的有效率為73.33%,其中治療組差異更為顯著,兩組間比較提示有差異(P0.05)。(4)在消化內(nèi)鏡下胃黏膜改善的方面,治療組的有效率為90.00%,對照組的有效率為66.67%。經(jīng)過統(tǒng)計學(xué)的計算比較,得出兩組之間的數(shù)據(jù)具有統(tǒng)計學(xué)的意義(P0.05)。(5)在兩組患者的炎癥因子的變化方面,治療后,兩組CRP、IL-6水平均降低;且治療組在治療后的CRP、IL-6水平均低于對照組在治療后水平,經(jīng)比較,P0.05,兩組之間有統(tǒng)計學(xué)意義。(6)在根除Hp方面,治療組和對照組的轉(zhuǎn)陰率分別為40.00%、13.33%,經(jīng)過比較得出兩組之間有統(tǒng)計學(xué)意義(P0.05)。(7)在臨床綜合療效方面,治療組與對照組的總有效率分別為93.33%、70.00%,經(jīng)比較,差異具有統(tǒng)計學(xué)意義(P0.05)。(8)治療結(jié)束6個月后,隨訪治療有效患者,治療組及對照組復(fù)發(fā)率分別為7.14%、47.62%,差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論(1)在緩解慢性糜爛性胃炎患者的中醫(yī)臨床癥狀、降低患者的中醫(yī)證候積分、修復(fù)胃鏡下胃黏膜的糜爛程度以及抗Hp上,泮托拉唑鈉腸溶膠囊及紫蘇四香散加味方均能夠達(dá)到治療效果,但紫蘇四香散加味方聯(lián)合泮托拉唑腸溶膠囊其治療效果更為明顯。(2)紫蘇四香散加味方聯(lián)合泮托拉唑鈉腸溶膠囊在治療CEG的同時,能夠有效地改變患者的相關(guān)炎性因子即C反應(yīng)蛋白和白介素-6的水平,為臨床治療CEG提供了新的思路。(3)紫蘇四香散加味方在治療CEG上有一定的療效,具有多靶點作用、副作用少的特點,可與常規(guī)治療方法結(jié)合使用,值得推廣應(yīng)用。本研究方通過中醫(yī)辨證論治有效緩解CEG的臨床癥狀,從而延緩病情的進(jìn)一步惡化,豐富了中醫(yī)藥治療CEG的方法。
[Abstract]:Objective To observe the clinical effect and the influence on the related inflammatory factors of the liver and stomach depressed chronic erosive gastritis by observing the effect of the four fragrant powder of Perilla powder plus the Pantoprazole Sodium Enteric-coated Capsules and the Western Medicine (Pantoprazole Sodium Enteric-coated Capsules) on the chronic erosive gastritis of the liver and stomach depression, and further explore the mechanism of the prescription in the prevention and control of the chronic erosive gastritis, and objectively evaluate the safety and effectiveness of the drug in order to provide a more effective treatment for the clinical treatment of CEG. Methods from March 2015 to April 2016, 60 patients with chronic erosive gastritis diagnosed as chronic erosive gastritis were selected from the outpatient and inpatient department of the Department of traditional Chinese medicine and the digestive department of Wuhan City Center Hospital from March 2015 to April 2016. After the TCM syndrome differentiation, the patients were randomly divided into two groups, the treatment group and the control group. Two groups of patients were affected. The patients with Helicobacter pylori (Hp) infection were given Hp for 2 weeks. Then the patients in the control group were given Pantoprazole Sodium Enteric-coated Capsules orally, 40mg/ times, 2 times. The patients in the treatment group were given the experience of the tutor on the basis of the control group, namely, the Perilla four fragrant powder plus flavour prescription, and the prescription of the medicine was mainly composed of the following drugs: perilla. 10 grams of terrier, 10 gram of patchouli, 10 grams of incense, 10 grams of incense, 10 grams of wood incense, 15 grams of Astragalus, 15 g of Danshen, 15 grams of dandelion, 15 grams of dandelion, 15 grams of chicken inside and 15 grams, two buds and 20 grams of stir fry, Fructus aurantii bark, cortex magnolia, fried licorice, herbal decoction and decoctions of traditional Chinese medicine are provided by Hubei Tianji beverage company, daily, oral, oral, times, and times Daily.60 patients were treated for 8 weeks. After the treatment, the therapeutic effects of TCM syndromes before and after treatment were observed, the clinical symptoms of single Chinese medicine, the total score of TCM symptoms, the improvement of gastric mucosa under digestive endoscopy, the negative rate of Hp, the effect of clinical combined therapy and the inflammatory factor water after the treatment of the two groups of patients. Level (including CRR and IL-6 levels) and adverse reactions during the treatment of patients. Besides, there were 2 weeks of follow-up observation on the effective patients after stopping drugs, and observed the recurrence of the patients during the follow-up period of 6 months. The data were collected by SPSS19.0 software for statistical analysis, and the measurement data were subject to normal distribution by t test. The nonparametric test was used in the state distribution; the disordered count data were checked with chi square, and the ordered counting data were tested by nonparametric tests. Results (1) the two groups had statistical differences (P0.05) in the improvement of the patient's single TCM symptoms, such as stomachache, satiety, belching, and Pantothenic symptoms (P0.05); (2) in reducing the patient The total integral of TCM symptoms was 15.40 + 1.19,14.87 + 1.33 before treatment and 3.67 + 0.71,7.30 + 0.88 after treatment. The total integral of the two groups after treatment was lower than before the treatment, but the treatment group decreased more obviously, the two groups were statistically significant (P0.05). (3) the improvement of the patients was improved. In TCM syndrome, the effective rate was 96.67% in the treatment group and 73.33% in the control group. The difference in the treatment group was more significant, and the difference between the two groups was different (P0.05). (4) the effective rate of the treatment group was 90% in the digestive endoscopy, and the effective rate of the control group was compared with the statistical calculation of 66.67%.. The data between the two groups had statistical significance (P0.05). (5) in the two groups of patients with the changes in inflammatory factors, after treatment, the two groups of CRP, IL-6 water decreased, and the treatment group after the treatment of CRP, IL-6 water was lower than the control group after the treatment level, P0.05, two groups have statistical significance. (6) in the eradication of Hp, treatment, treatment. The negative rate of the group and the control group was 40%, 13.33%, and the difference between the two groups was statistically significant (P0.05). (7) in the clinical comprehensive efficacy, the total effective rate of the treatment group and the control group was 93.33%, 70%, the difference was statistically significant (P0.05). (8) after the end of the treatment for 6 months, the treatment of effective patients, treatment, treatment, treatment, treatment, treatment, treatment, treatment, and treatment The recurrence rate of the group and the control group was 7.14%, 47.62%, and the difference was statistically significant (P0.05). Conclusion (1) in alleviating the clinical symptoms of chronic erosive gastritis, reducing the score of TCM syndrome, repairing the erosion degree of gastric mucosa under the gastroscope and anti Hp, the Pantoprazole Sodium Enteric-coated Capsules and the four flavour of perilla and perilla were all able to be used. The treatment effect was achieved, but the effect of the combination of Perilla four fragrant powder plus pantoprazole enteric coated capsules was more obvious. (2) the combination of Perilla four fragrant powder and Pantoprazole Sodium Enteric-coated Capsules combined with the treatment of CEG could effectively change the related inflammatory factors of the patient, namely, the level of C reaction to egg white and interleukin -6, and provide a clinical treatment for the treatment of CEG. 3. (3) the decoction of four fragrant powder and flavour of Perilla has a certain effect on the treatment of CEG. It has the characteristics of multiple targets and less side effects. It can be used in combination with the conventional treatment method, which is worth popularizing. This study can effectively alleviate the clinical symptoms of CEG through TCM syndrome differentiation, thus postpone the further deterioration of the condition and enrich the traditional Chinese medicine. The treatment of CEG.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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