【摘要】：目的通過觀察芩連生肌愈瘍湯結(jié)合西醫(yī)三聯(lián)療法對于脾胃濕熱型HP陽性、重度糜爛性胃炎患者臨床癥狀的改善、內(nèi)鏡下糜爛愈合效果及HP清除率的改善,以評定芩連生肌愈瘍湯對糜爛性胃炎治療的有效性。方法1.研究對象:收集自2015年2月至2016年2月于筆者導(dǎo)師門診就診的共42例病例,均在1周內(nèi)經(jīng)胃鏡確診為慢性糜爛性胃炎,并經(jīng)碳13呼氣試驗診斷為HP陽性,同時按中醫(yī)標(biāo)準(zhǔn)診斷為慢性胃炎脾胃濕熱型。將受試者隨機分為治療組21例及對照組21例,兩組患者在年齡、性別、病程及臨床證候上均無明顯差異。2.治療方法:治療組與對照組均先予以標(biāo)準(zhǔn)三聯(lián)療法治療:泮托拉唑鈉腸溶膠囊40mg,每日2次;克拉霉素膠囊500mg,每日2次;阿莫西林膠囊1.0g,每日2次;共10天。10天后對照組繼續(xù)服用泮托拉唑鈉腸溶膠囊4周,治療組改服中藥芩連生肌愈瘍湯,每7天為一個療程,共服用4個療程。3.觀察指標(biāo):兩組治療前后的組間及組內(nèi)臨床證候積分的比較;兩組間治療后臨床證候療效的比較;兩組間治療后胃鏡下糜爛性胃炎分級及糜爛愈合療效的比較;兩組間治療后HP轉(zhuǎn)陰率的比較;4.統(tǒng)計學(xué)分析方法:所收集數(shù)據(jù)均應(yīng)用SPSS 20.0統(tǒng)計軟件進行分析,滿足正態(tài)分布的,對于計量資料,治療前后組內(nèi)比較用配對樣本t檢驗,組間比較用獨立樣本t檢驗;計數(shù)資料采用x2檢驗。等級資料用秩和檢驗。所得結(jié)果P0.05為有統(tǒng)計學(xué)差異;P0.01表示有顯著統(tǒng)計學(xué)差異;P0.05表示無統(tǒng)計學(xué)意義。結(jié)果1.治療前對比兩組樣本間的性別、年齡、病程、證候療效積分均提示無統(tǒng)計學(xué)差異,具有可比性。2.對比組間治療后臨床證候療效,治療組21例,臨床痊愈1例,顯效6例,有效10例,無效4例,總有效率81%;對照組21例,臨床痊愈0例,顯效2例,有效11例,無效8例,總有效率62%。經(jīng)獨立樣本秩和檢驗后P0.05,提示其臨床證候療效有統(tǒng)計學(xué)差別。3.對比組間治療后胃鏡下糜爛愈合情況,治療組21例,痊愈2例,顯效4例,有效13例,無效2例,總有效率90.47%;對照組21例,臨床痊愈2例,顯效3例,有效11例,無效5例,總有效率76.19%。經(jīng)獨立樣本的秩和檢驗后,P0.05,提示兩組療法對于胃鏡下糜爛愈合的療效無明顯差異,但治療組有效率高于對照組。4.對比組間治療后HP轉(zhuǎn)陰率,治療組21例,陰性19例,陽性2例,轉(zhuǎn)陰率為90.48%;對照組21例,陰性17例,陽性4例,轉(zhuǎn)陰率為80.95%。經(jīng)c2檢驗,P=0.05,提示兩組療法對HP清除最終效果無明顯差異,但就樣本而言,治療組有效率高于對照組。結(jié)論生肌愈瘍湯是湖北省中醫(yī)大師張介眉教授的經(jīng)驗方,筆者導(dǎo)師在此基礎(chǔ)上加黃連、黃芩用于治療脾胃濕熱型糜爛性胃炎,臨床觀察顯示其可有效改善患者臨床證候,對于HP陽性患者,在三聯(lián)療法基礎(chǔ)上使用,有助于提高HP清除率及促進鏡下糜爛愈合。尤其在改善臨床證候方面,效用優(yōu)于泮托拉唑,是治療糜爛性胃炎的有效方劑。
[Abstract]:Objective to observe the improvement of clinical symptoms of HP positive and severe erosive gastritis, the curative effect of endoscopic erosion healing and the improvement of HP clearance rate in patients with spleen and stomach damp-heat type by the combination of Qinlianshengjiyu decoction and western medicine. To evaluate the effectiveness of Qinlianshengjiyu decoction in the treatment of erosive gastritis. Method 1. Participants: from February 2015 to February 2016, 42 patients with chronic erosive gastritis were diagnosed as chronic erosive gastritis by gastroscopy from February 2015 to February 2016, and HP positive was diagnosed by carbon-13 breath test. At the same time according to the criteria of traditional Chinese medicine diagnosis of chronic gastritis spleen-stomach damp-heat type. The subjects were randomly divided into treatment group (n = 21) and control group (n = 21). There was no significant difference in age, sex, course of disease and clinical syndrome between the two groups. Treatment methods: the treatment group and control group were treated with standard triple therapy: pam Tora sodium enteric capsule 40 mg twice a day, clarithromycin capsule 500 mg twice a day, amoxicillin capsule 1.0 g twice a day; After 10 days and 10 days, the control group continued to take pam Tora sodium enteric-coated capsules for 4 weeks. The treatment group was changed to take Qinlianshengjiyu decoction, a course of treatment every 7 days, a total of 4 courses of treatment. 3. Observation measures: comparison of clinical syndromes between and within groups before and after treatment, comparison of clinical syndromes efficacy after treatment between two groups, comparison of grade of erosive gastritis and curative effect of erosive gastritis under gastroscopy between two groups after treatment, and comparison of curative effect of erosive gastritis and erosive healing between two groups after treatment. The comparison of HP negative conversion rate between the two groups was 4. 5%. Statistical analysis method: all the collected data were analyzed by SPSS 20.0 statistical software to satisfy the normal distribution. For the metrological data, the matched sample t test was used before and after treatment, and the independent sample t test was used to compare the data between groups. The count data were examined by x 2 test. Rank data are tested by rank sum. The results showed that there was significant statistical difference between P0.01 and P0.01. P05 indicated that there was no statistical significance. Result 1. Before treatment, the gender, age, course of disease, syndromes of the two groups of samples showed no statistical difference, comparable. 2. There were 21 cases of clinical cure, 6 cases of remarkable effect, 10 cases of effective, 4 cases of ineffective, total effective rate of 81 cases in the treatment group, 21 cases in the control group, 0 cases in clinical cure, 2 cases in remarkable effect, 11 cases in effective, 8 cases in invalidation. The total effective rate is 62. After the independent sample rank sum test, P0.05, it indicated that its clinical syndromes curative effect has the statistical difference. 3. In the treatment group, 21 cases were cured, 4 cases were effective, 13 cases were effective, 2 cases were ineffective, the total effective rate was 90.477.21 cases in the control group were clinically cured, 3 cases were effective, 11 cases were effective, 5 cases were ineffective. The total effective rate is 76.19. The results showed that there was no significant difference between the two groups in the healing of erosion under gastroscope, but the effective rate in the treatment group was higher than that in the control group. 4. There were 21 cases in the treatment group, 19 cases in the negative group, 2 cases in the positive group, and 90.48% in the control group, while in the control group, 17 cases were negative, 4 cases were positive, and the negative rate was 80.95%. The results of c2 test showed that there was no significant difference between the two groups in the final effect of HP removal, but the effective rate in the treatment group was higher than that in the control group. Conclusion Shengjiyu Yang decoction is an experiential prescription of Professor Zhang Jiemei, a master of traditional Chinese medicine in Hubei Province. On this basis, the author's tutor added Coptis chinensis and Scutellaria baicalensis to treat erosive gastritis of damp-heat type of spleen and stomach. The clinical observation shows that it can effectively improve the clinical symptoms of the patients. For HP positive patients, it is helpful to improve HP clearance rate and promote the healing of erosion under microscope. Especially in improving clinical syndromes, the effect is better than pam Tora, it is an effective prescription for erosive gastritis.
【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】：2016
【分類號】：R259

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