【摘要】：目的:本觀察采用“疏肝理氣,燥濕和胃”的治法,應(yīng)用自擬方疏肝和胃顆粒治療幽門螺桿菌感染的慢性非萎縮性胃炎(肝胃郁熱證),通過臨床觀察,客觀評(píng)價(jià)疏肝和胃顆粒治療幽門螺桿菌感染的慢性非萎縮性胃炎(肝胃郁熱證)的有效性及安全性。為中醫(yī)藥治療幽門螺桿菌感染的慢性非萎縮性胃炎提供用藥依據(jù)。方法:將來自長春中醫(yī)藥大學(xué)附屬醫(yī)院肝脾胃病科門診符合幽門螺桿菌感染的慢性非萎縮性胃炎(肝胃郁熱證)診斷的患者共60位,按1:1的比例隨機(jī)分為治療組和對(duì)照組。治療組:疏肝和胃顆粒,每次1袋,每日3次;對(duì)照組:西藥三聯(lián)(奧美拉唑腸溶片20mg,克拉霉素500mg,阿莫西林1000mg),每日2次,上方藥物連續(xù)應(yīng)用2周后,繼續(xù)單獨(dú)服用奧美拉唑腸溶片2周(每日1次)。兩組藥物療程均為4周。并分別記錄治療前后中醫(yī)癥狀、胃黏膜改變、Hp轉(zhuǎn)陰率、不良反應(yīng),并在治療結(jié)束后的第15天隨訪復(fù)發(fā)情況。結(jié)果:(1)兩組患者在治療前年齡、性別、病程、中醫(yī)癥狀積分、胃黏膜積分方面比較,統(tǒng)計(jì)學(xué)無顯著差異(P0.05),具有可比性。(2)治療后單項(xiàng)癥狀的改善:返酸這一癥狀的改善,兩組治療效果未見明顯的統(tǒng)計(jì)學(xué)差異(P0.05)。但是,在胃脘疼痛、脘腹脹滿、納差、惡心、噯氣、小便黃這6個(gè)癥狀改善方面,有統(tǒng)計(jì)學(xué)差異(P0.05),治療組的效果優(yōu)于對(duì)照組。(3)治療后中醫(yī)癥候總積分情況:較治療前均有所降低,但治療組癥狀積分下降幅度更大。在中醫(yī)證候改善方面比較,有顯著統(tǒng)計(jì)學(xué)差異(P0.01),治療組優(yōu)于對(duì)照組。(4)胃黏膜改變比較:治療組30例愈顯率53.33%,總有效率為80.00%;對(duì)照組30例愈顯率40%,總有效率為73.33%。經(jīng)秩和檢驗(yàn),治療組和對(duì)照組在治療后改善胃粘膜情況上無差異。(5)Hp改善比較:治療組30例中,治療后Hp(-)14例,Hp(+)16例,總轉(zhuǎn)陰率為46.67%;對(duì)照組30例中,治療后Hp(-)22例,Hp(+)8例,總轉(zhuǎn)陰率為73.33%;有統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)照組在治療后Hp轉(zhuǎn)陰率優(yōu)于治療組。(6)總體療效比較:治療組30例患者愈顯率70%,總有效率為86.67%;對(duì)照組30例患者愈顯率36.67%,總有效率為73.33%。有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。治療組的總體臨床療效優(yōu)于對(duì)照組。(7)安全性比較:兩組藥物均為出現(xiàn)不良反應(yīng)事件。(8)隨訪:治療結(jié)束2周后隨訪受試者,治療組患者隨訪時(shí)癥狀積分無明顯改變,對(duì)照組隨訪時(shí)較治療后明顯增高。兩組比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05),說明在癥狀改善方面治療組的遠(yuǎn)期療效優(yōu)于對(duì)照組。結(jié)論:由以上得出的數(shù)據(jù)說明疏肝和胃顆粒在治療幽門螺桿菌感染的慢性非萎縮性胃炎(肝胃郁熱證)過程中所有的患者未出現(xiàn)明顯的不良反應(yīng),且總體療效及癥狀改善均優(yōu)于對(duì)照組,由此證明了本方法能夠有效消除或改善患者的臨床癥狀,提高他們的生活質(zhì)量且安全無毒副作用。進(jìn)一步驗(yàn)證并豐富了中醫(yī)理論的科學(xué)性和實(shí)用性,為以后臨床上治療幽門螺桿菌感染的慢性非萎縮性胃炎的患者提供了有意的參考。
[Abstract]:Objective: to observe the method of "soothing the liver and regulating qi, dryness and dampness and stomach" and using self-made prescription Shugan and Wei granule to treat chronic non-atrophic gastritis (hepatogastric stagnation and heat syndrome) with HP infection. Objective evaluation of the efficacy and safety of Shugan Hewei granule in the treatment of chronic non-atrophic gastritis (hepatogastric depression-heat syndrome) infected with HP. It provides drug basis for traditional Chinese medicine in the treatment of chronic non-atrophic gastritis with HP infection. Methods: a total of 60 patients with chronic non-atrophic gastritis (hepatogastric depression and heat syndrome) diagnosed by HP infection were randomly divided into treatment group and control group according to the proportion of 1:1. Treatment group: Shugan and Wei granule, one bag at a time, 3 times a day; Control group: omeprazole enteric-coated tablets (omeprazole enteric-coated tablets 20 mg, clarithromycin 500 mg, amoxicillin 1000mg), twice a day, after 2 weeks of continuous administration of omeprazole enteric-coated tablets, continue to take omeprazole enteric-coated tablets alone for 2 weeks (once a day). The course of treatment of both groups was 4 weeks. The symptoms of traditional Chinese medicine, the changes of gastric mucosa, the negative rate of Hp and the adverse reactions were recorded before and after treatment, and the recurrence was followed up on the 15th day after treatment. Results: (1) there was no significant difference in age, sex, course of disease, TCM symptom score and gastric mucous membrane score between the two groups before treatment (P 0.05). There was no significant difference in the effect of treatment between the two groups (P 0.05). (2) the improvement of single symptom after treatment: there was no significant difference in the effect of acid regurgitation between the two groups (P 0.05). However, there were significant differences in the improvement of six symptoms: epigastric pain, epigastric distension, anorexia, nausea, belching and urination yellow (P 0.05). The effect of the treatment group was better than that of the control group. (3) the total score of TCM symptoms after treatment: it was lower than that before treatment, but the symptom score of the treatment group decreased more significantly. In the improvement of TCM syndromes, there was significant difference (P01), the treatment group was better than the control group. (4) comparison of gastric mucous membrane changes: the effective rate of 30 cases in the treatment group was 53.33%, and the total effective rate was 80.00%; In the control group, the effective rate was 40% and the total effective rate was 73.33%. There was no difference in the improvement of gastric mucosa between the treatment group and the control group by rank sum test. (5) comparison of Hp improvement: among 30 cases in the treatment group, 14 cases of, Hp () (-) in the treatment group had 16 cases of, Hp () after treatment, the total negative conversion rate was 46.67%; In the control group, there were 22 cases of Hp (-) and 8 cases of, Hp () after treatment, the total negative conversion rate was 73.33%. There was significant difference (P 0.05). The negative rate of Hp in the control group was better than that in the treatment group after treatment. (6) comparison of the overall efficacy: the effective rate of 30 patients in the treatment group was 70%, and the total effective rate was 86.67%. In the control group, the effective rate was 36.67% and the total effective rate was 73.33%. There was significant statistical difference (P 0.01). The overall clinical efficacy of the treatment group was better than that of the control group. (7) Safety comparison: there were adverse events in both groups. (8) follow-up: after 2 weeks of treatment, there was no significant change in the symptom score of the patients in the treatment group. The follow-up period in the control group was significantly higher than that after treatment. There was significant difference between the two groups (P 0.05), indicating that the long-term effect of the treatment group was better than that of the control group in symptom improvement. Conclusion: the data obtained above show that Shugan and Wei granules have no obvious adverse reactions in the treatment of chronic non-atrophic gastritis (hepatogastric depression and heat syndrome) caused by HP infection. The overall curative effect and symptom improvement were better than those in the control group, which proved that this method could effectively eliminate or improve the clinical symptoms of patients, improve their quality of life and have no toxic and side effects. It further verifies and enriches the scientific and practical theory of traditional Chinese medicine, and provides an intentional reference for the clinical treatment of patients with chronic non-atrophic gastritis infected with HP in the future.
【學(xué)位授予單位】：長春中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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