Clinical observation of Hezhong Jianpi Formula on the expression of gastrointestinal hormones and inflammatory factors in patients with PPI dependent GERD and the mode of PPI withdrawal
-
摘要: 目的 观察和中健脾方在质子泵抑制剂(PPI)撤减过程中的作用及患者体内胃肠激素和炎症因子的表达水平，为临床治疗对PPI产生依赖性的胃食管反流病(GERD)患者提供新的用药思路及方案。方法 采集63例GERD患者的资料，随机分为两组：治疗组31例、对照组32例。治疗组患者在服用维持剂量PPI的情况下，依照和中健脾法辨证施治后加服以和中健脾方为主方化裁的中药，并根据每两周GERD临床症状观察表的评分进行逐步撤减西药；对照组患者根据原来PPI维持剂量继续服用。两组总观察周期为22周，分别在入组时、治疗4周时测定胃肠激素(VIP、GAS、MOT)及炎症细胞因子(IL-6、IL-8、TNF-α)指标变化。之后进行18周的PPI撤药过程，观察其治疗前后的总体疗效、症状积分表及相关的胃镜变化；统计PPI治疗后的用量与起始治疗时的相差剂量。结果 治疗组总体症状积分的改善明显优于对照组(P < 0.05)。治疗组整个治疗过程中PPI的使用总剂量明显少于对照组(P < 0.05)。对治疗组症状作LSD多重比较显示，在前10周PPI依赖性患者在加服中药和中健脾方后于相邻周数的症状积分比较上差异无统计学意义(P>0.05)，而在周数相差较大的区域中，症状积分均有明显的差异变化(P < 0.05)。对治疗组行撤减完成周数百分比统计，患者完成撤减周数从10周开始，且例数最多，12~18周完成撤减例数的百分比逐渐下降。对治疗组PPI剂量作LSD多重比较显示，后期的PPI剂量变化差异无统计学意义(P>0.05)，而在前10周根据每两周的症状积分评估，患者的PPI剂量差异有统计学意义(P < 0.05)。治疗组能有效改善患者GAS、VIP、MOT的表达水平；对照组能改善患者VIP、MOT的表达水平，而GAS的表达水平治疗前后差异无统计学意义；治疗后组间比较，治疗组能更有效改善VIP、MOT的表达水平，而两组GAS的改善水平差异无统计学意义；治疗组和对照组均能有效改善患者IL-6、IL-8、TNF-α的表达水平；治疗后组间比较差异有统计学意义。临床运用和中健脾方未发现不良反应。结论 在GERD临床症状观察表评分疗效为显效的基础上，和中健脾方能有效促进对PPI产生依赖性患者临床症状的改善及其PPI剂量的逐步减量。和中健脾方能更有效改善患者胃肠激素VIP、MOT的表达及炎症因子的表达，可能是其潜在的作用机制；和中健脾方联合PPI减量治疗期间未发现不良反应，安全性及临床实用价值高。Abstract: Objective To observe the effect of Hezhong Jianpi Formula on proton pump inhibitors(PPI) withdrawal and the expression levels of gastrointestinal hormones and inflammatory factors in patients with gastroesophageal reflux disease(GERD) dependent on PPI, so as to provide new medication ideas and schemes for clinical treatment of patients with GERD dependent on PPI.Methods Sixty-three cases were collected. All cases were confirmed as gastroesophageal reflux disease according to the diagnostic criteria of GERD. These patients have been treated with PPI regularly, and now they rely on PPI to maintain the stability of symptoms. The patients were randomly divided into two groups: 31 cases in the treatment group and 32 cases in the control group. For the patients in the treatment group of integrated Traditional Chinese and Western medicine, that is, under the condition of taking proton pump inhibitor of maintenance dose, the Traditional Chinese Medicine with Hezhong Jianpi Formula as the main prescription was added after treatment according to the syndrome differentiation and treatment of Hezhong Jianpi Formula, and the western medicine was gradually withdrawn according to the score of clinical symptom observation table of gastroesophageal reflux disease every two weeks; for patients in the control group, they continued to take the original PPI maintenance dose. Gastrointestinal hormones(VIP, GAS, MOT) and inflammatory cytokines(IL-6, IL-8, TNF-α) were measured at the time of enrollment and 4 weeks of treatment. After another 18 weeks, PPI withdrawal was started, and the overall efficacy, symptom score table and gastroscopy changes of related patients were observed before and after treatment; the difference between the dosage after PPI treatment and the initial treatment was counted.Results The total symptom score of the treatment group was significantly better than that of the western medicine maintenance control group(P < 0.05). The total dosage of PPI in the treatment group was significantly less than that in the control group(P < 0.05). LSD multiple comparison of symptoms in the treatment group showed that there was no significant difference in the symptom scores of the adjacent weeks after taking Chinese medicine in the first 10 weeks(P>0.05), but there were significant differences in the symptom scores in the regions with large difference in weeks(P < 0.05). In the treatment group, the percentage of complete withdrawal weeks was counted. It was found that the number of patients completed the withdrawal weeks started from the 10 weeks, and the number of patients was the largest. The percentage of patients who completed the withdrawal from the 12 weeks to the 18 weeks decreased gradually. LSD multiple comparison of PPI dose in the treatment group showed that the late PPI dose change was not statistically significant(P>0.05), but in the first 10 weeks, according to the symptom score every two weeks, the PPI dose of patients had significant statistical difference(P < 0.05). By comparing the expression of gastrointestinal hormones before and after treatment, the treatment group can effectively improve the expression levels of GAS, VIP and MOT in GERD patients. The expression of VIP and mot in GERD patients was improved in the control group, but the expression level of gas was not statistically significant before and after treatment. After treatment, the treatment group could improve the secretion level of VIP and mot more effectively, but the improvement level of gas in the two groups was not statistically significant. By comparing the expression of inflammatory factors before and after treatment, the treatment group and the control group can effectively improve IL-6, IL-8, TNF -α in GERD patients; after treatment, the difference between the two groups was statistically significant. No side effects and adverse reactions were found in clinical application of Hezhong Jianpi Formula.Conclusion Based on the clinical symptom observation table of gastroesophageal reflux disease, Hezhong Jianpi Formula can effectively improve the clinical symptoms of patients with dependence on proton pump inhibitors, and gradually reduce the dose of proton pump inhibitors. Hezhong Jianpi Formula can effectively improve the expression of gastrointestinal hormones VIP, MOT and inflammatory factors, which may be its potential mechanism, which is worthy of further exploration. No side effects and adverse reactions were found during the reduction treatment of Hezhong Jianpi Formula combined with proton pump inhibitor, so it has high safety and clinical practical value.
-
-
表 1 治疗前后胃肠激素及炎症因子指标比较
pg/mL，X±S 指标 治疗组(n=31) 对照组(n=32) 治疗前 治疗后 P 治疗前 治疗后 P VIP 120.48±21.74 96.27±31.33 0.001 125.63±31.67 111.75±22.88 0.001 MOT 1 681.69±257.68 1 920.48±260.91 0.001 1 644.83±399.86 1 706.59±416.95 0.023 GAS 329.21±40.67 345.58±39.05 0.001 321.28±102.82 327.83±95.93 0.348 IL-6 140.45±32.37 94.15±30.94 0.001 147.12±69.90 131.39±72.15 0.001 IL-8 434.00±53.22 378.02±39.65 0.001 428.37±73.96 416.56±81.97 0.020 TNF-α 584.18±99.01 433.23±108.05 0.001 594.58±294.70 528.81±192.82 0.043 
下载: 导出CSV
表 2 两组患者各治疗时间点PPI剂量比较
mg, X±S 组别 例数 治疗时间/周 2 4 6 8 10 12 14 16 18 治疗组 31 352.26±107.66 264.19±80.75 197.58±86.47 126.45±79.13 51.94±79.75 20.32±57.71 13.55±55.47 9.03±50.29 9.03±50.29 对照组 32 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35 328.13±76.35
下载: 导出CSV
-
[1] 中华医学会消化病学分会. 2020年中国胃食管反流病专家共识[J]. 中华消化杂志, 2020, 40(10): 649-662. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202108002.htm
[2] Chait MM. Gastroesophageal reflux disease: Important considerations for the older patients[J]. World J Gastrointest Endosc, 2010, 2(12): 388-396. doi: 10.4253/wjge.v2.i12.388
[3] Herbella FA, Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment[J]. World J Gastroenterol, 2010, 16(30): 3745-3749. doi: 10.3748/wjg.v16.i30.3745
[4] 魏秀秀, 张北华, 尹晓岚, 等. 胃食管反流病的中西医治疗现状述评[J]. 世界中医药, 2022, 17(15): 2101-2107. doi: 10.3969/j.issn.1673-7202.2022.15.001
[5] 张競云, 田旭东, 雒佳, 等. 中医药治疗胃食管反流病的研究现状[J]. 中外医学研究, 2022, 20(31): 177-181. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202231045.htm
[6] 李紫梦, 康艳楠, 罗如珍, 等. 胃食管反流病症状管理指南/共识的质量评价[J]. 中国全科医学, 2020, 23(33): 4151-4159. doi: 10.12114/j.issn.1007-9572.2020.00.505
[7] 梁笑楠, 战蓉蓉, 张晓岚. 《2020年中国胃食管反流病专家共识》解读[J]. 河北医科大学学报, 2021, 42(8): 869-925. doi: 10.3969/j.issn.1007-3205.2021.08.001
[8] 王轶, 朱生樑, 方盛泉, 等. 从NMDA信号通路探析疏肝和胃法在难治性胃食管反流病中的应用[J]. 中医药学报, 2022, 50(12): 111-115. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXB202212021.htm
[9] 刘凡, 张书, 郭洁, 等. 中医药治疗胃食管反流病特色与优势探讨[J]. 辽宁中医药大学学报, 2021, 23(6): 157-160. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202106034.htm
[10] 中华中医药学会脾胃病分会. 胃食管反流病中医诊疗专家共识意见(2017)[J]. 中国中西医结合消化杂志, 2017, 25(5): 321-326. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=4f45188a-40fa-4b79-ac0a-4c2e0e91a783
[11] 白兴华. 对《胃食管反流病中医诊疗专家共识意见(2017)》的思考[J]. 上海中医药杂志, 2019, 53(11): 5-10. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ201911003.htm
[12] 王维, 郭志玲, 曹云, 等. 胃食管反流病中医诊疗共识对比分析[J]. 北京中医药, 2019, 38(7): 716-718. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO201907028.htm
[13] 黄龙记, 班莹, 林浩, 等. 胃食管反流病的中医诊疗研究进展[J]. 湖南中医杂志, 2019, 35(12): 117-119. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZO201912030.htm
[14] 王洪双, 王石红, 李喆, 等. 左金丸加减治疗肝胃郁热型胃食管反流病的系统评价[J]. 云南中医学院学报, 2020, 43(6): 18-25. https://www.cnki.com.cn/Article/CJFDTOTAL-YNZY202006004.htm
[15] 王三强, 许敏光, 魏会珍, 等. 反流性食管炎中医学研究进展[J]. 陕西中医, 2020, 41(2): 266-268. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZY202002035.htm
[16] 石芳, 张乃霖, 郑晓佳, 等. 从"火热论"探讨胃食管反流病证治思路[J]. 中医杂志, 2020, 61(3): 213-216. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202003013.htm
[17] 刘慧敏, 刘绍能, 姚乃礼, 等. 姚乃礼基于气机升降理论治疗胃食管反流病经验[J]. 北京中医药, 2020, 39(4): 335-336. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO202004012.htm
[18] 孙刚, 刘万里, 杨璐, 等. 疏通降逆贴穴位敷贴联合口服奥美拉唑肠溶胶囊治疗胃食管反流病的疗效观察[J]. 世界中西医结合杂志, 2022, 17(11): 2269-2277. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202211028.htm
[19] 宋杰林, 周正华, 王威. 以"土虚木贼"为核心病机论治胃食管反流病[J]. 湖南中医药大学学报, 2022, 42(8): 1356-1359. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202208020.htm
[20] 严安, 喻斌. 喻斌教授应用柴胡疏肝散辨治胃食管反流病临证经验[J]. 中国民族民间医药, 2022, 31(21): 78-84. https://www.cnki.com.cn/Article/CJFDTOTAL-MZMJ202221026.htm
[21] 杨帅, 郝永彪, 谢妲, 等. 通降消积方联合西药常规治疗对脾虚气逆型胃食管反流病患者食管动力及胃肠激素的影响[J]. 广州中医药大学学报, 2022, 39(12): 2768-2775. https://www.cnki.com.cn/Article/CJFDTOTAL-REST202212006.htm
[22] 中国医疗保健国际交流促进会胃食管反流多学科分会. 中国胃食管反流病多学科诊疗共识[J]. 中华胃食管反流病电子杂志, 2020, 7(1): 1-28. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201909007.htm
[23] 陈虎林, 刘杰, 吴德卫, 等. 经皮穴位电刺激治疗胃癌术后胃食管反流疗效及对血清MTL、VIP的影响[J]. 山东中医杂志, 2022, 41(11): 1196-1200. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY202211010.htm
[24] 魏小丽, 王宇航, 李成, 等. 针刺天枢穴联合莫沙必利治疗习惯性便秘及对血清VIP、MTL、5-HT的影响[J]. 中华中医药学刊, 2021, 39(7): 95-98. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202107026.htm
[25] 周丽, 王丹, 潘小丽, 等. 电针治疗肝胃不和型功能性消化不良的临床疗效及对血清胃泌素、胃动素水平的影响[J]. 实用医学杂志, 2020, 36(4): 538-542. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202004026.htm
[26] 曹珊, 张湘燕, 张程, 等. 丹参酮ⅡA磺酸钠对ARDS患者IL-6、IL-8、TNF-α及是ICAM-1炎症因子的干预作用研究[J]. 现代医药卫生, 2020, 36(5): 644-650. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202005002.htm
-
图(2)
表(2)
计量
- 文章访问数: 470
- PDF下载数: 85
- 施引文献: 0