Efficacy of modified Fuzi Lizhong Decoction and Wuzhuyu Decoction on reflux esophagitis of Spleen and Stomach Deficiency-cold type and its influence on serum related hormones
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摘要: 目的 观察附子理中汤合吴茱萸汤加减联合西药治疗脾胃虚寒型反流性食管炎患者的临床疗效及对血清相关激素、胃肠道生活质量指数(gastrointestinal quality of life index，GIQLI)量表评分的影响。方法 将80例脾胃虚寒型反流性食管炎患者按随机数字表法分为对照组(40例)和观察组(40例)。两组患者均予饮食控制、生活方式调整，并予泮托拉唑钠肠溶片、铝碳酸镁片、枸橼酸莫沙必利胶囊口服治疗，观察组同时予附子理中汤合吴茱萸汤加减口服治疗。两组患者的疗程均为12周。比较两组患者治疗前后的中医症状积分、内镜下食管炎分级、血清胃动素、胃泌素、生长激素释放肽、瘦素水平以及GIQLI评分的变化。结果 观察组的疗效优于对照组(P＜0.05)。治疗后，观察组反酸、反流症状积分低于对照组(P＜0.05)，泛吐清水、胃脘隐痛、胃胀、纳差、乏力、便溏积分及症状总积分亦低于对照组(P＜0.01)；观察组内镜下食管炎分级优于对照组(P＜0.01)；观察组血清胃动素、胃泌素、生长激素释放肽及瘦素水平均优于对照组(P＜0.01)；观察组治疗后躯体生理评分、社会活动评分高于对照组(P＜0.05)，自觉症状评分、心理情绪评分、GIQLI评分亦高于对照组(P＜0.01)。此外，随访发现，观察组的复发率低于对照组(P＜0.01)。结论 附子理中汤合吴茱萸汤加减联合西药治疗能改善脾胃虚寒型反流性食管炎患者的临床症状、促进食管黏膜修复，从而改善内镜下食管炎分级，同时能改善患者的血清相关激素水平，提高患者生活质量、降低停药后复发率，值得临床进一步推广应用。Abstract: Objective To observe the clinical effect of modified Fuzi Lizhong Decoction and Wuzhuyu Decoction combined with western medicine on reflux esophagitis with Spleen and Stomach Deficiency-cold type, as well as its impact on serum related hormones and gastrointestinal quality of life index(GIQLI) scores.Methods Eighty patients were randomly divided into control group(40 cases) and observation group(40 cases). Both groups were given diet control, lifestyle adjustment, and oral treatment of pantoprazole sodium enteric coated tablets, magnesium aluminate tablets and Mosapride citrate capsules. Patients in observation groups were also given modified Fuzi Lizhong Decoction and Wuzhuyu Decoction. The course of treatment of both groups was 12 weeks. The changes of Traditional Chinese Medicine(TCM) symptom score, endoscopic esophagitis grading, serum motilin(MTL), gastrin(GAS), Ghrelin, Leptin levels and GIQLI score were compared between the two groups before and after treatment.Results The effect of the observation group was better than that of the control group(P < 0.05). After treatment, the scores of acid regurgitation and reflux symptoms in the observation group were lower than those in the control group(P < 0.05), as well as the scores of spitting water, epigastralgia, gastric distension, anorexia, fatigue, loose stool and total symptom in the observation group were also lower than those in the control group(P < 0.01). The grade of esophagitis in the observation group was better than that in the control group after treatment(P < 0.01). The levels of serum MTL, GAS, Ghrelin and Leptin in the observation group were better than those in the control group after treatment(P < 0.01). After treatment, the scores of physical physiology and social activities in the observation group were higher than those in the control group(P < 0.05), the scores of conscious symptoms, psychological emotions and GIQLI were also higher than those in the control group(P < 0.01). In addition, follow-up found that the recurrence rate of the observation group was lower than the control group(P < 0.01).Conclusion The combination of modified Fuzi Lizhong Decoction and Wuzhuyu Decoction with Western medicine can improve the clinical symptoms of reflux esophagitis patients with Spleen and Stomach Deficiency-cold type, promote the repair of esophageal mucosa, and thus improve the grading of esophagitis. At the same time, it can improve the level of serum related hormones in patients, improve the quality of life of patients, and reduce the recurrence rate after drug withdrawal, which is worthy of further clinical promotion and application and in-depth research.
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表 1 两组患者的临床疗效比较
例(%) 组别 例数 痊愈 显效 有效 无效 总有效 对照组 40 0 3(7.5) 26(65.0) 11(27.5) 29(72.5) 观察组 40 4(10.0) 21(52.5) 12(30.0) 3(7.5) 37(92.5)1) 与对照组比较，1)P＜0.05。 
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表 2 两组患者治疗前后的临床症状积分比较
分，X±S 组别 时间 反酸 泛吐清水 反流 胃脘隐痛 胃胀 纳差 乏力 便溏 总分 对照组 治疗前 2.95± 1.50 1.95± 1.40 2.70± 1.60 1.30± 0.85 1.03± 0.77 0.85± 0.62 1.50± 0.82 1.20± 0.85 13.48± 2.92 治疗后 1.10± 1.011) 1.80± 1.26 1.00± 1.011) 0.68± 0.621) 0.55± 0.601) 0.58± 0.551) 0.83± 0.711) 1.08± 0.73 7.60± 2.751) 观察组 治疗前 3.05± 1.81 2.05± 1.32 2.65± 1.59 1.23± 0.92 0.95± 0.71 0.78± 0.66 1.48± 0.72 1.23± 0.77 13.40± 3.45 治疗后 0.65± 0.951)2) 0.55± 0.901)3) 0.50± 0.881)2) 0.33± 0.471)3) 0.18± 0.381)3) 0.25± 0.441)3) 0.33± 0.531)3) 0.35± 0.481)3) 3.13± 2.471)3) 与本组治疗前比较，1)P＜0.01；与对照组治疗后比较，2)P＜0.05，3)P＜0.01。
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表 3 两组患者治疗前后内镜分级(洛杉矶分级)的比较
例 组别 时间 正常 A级 B级 C级 D级 对照组 治疗前 0 2 14 19 5 治疗后 10 6 14 9 1 观察组 治疗前 0 2 13 19 6 治疗后 17 12 9 2 0
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表 4 两组患者治疗前后血清相关激素水平的比较
X±S 组别 时间 MTL/(ng/mL) GAS/(ng/mL) Ghrelin/(ng/mL) Leptin/(pg/mL) 对照组 治疗前 205.07±23.28 55.60±6.80 11.24±2.38 15.39±3.56 治疗后 253.15±44.851) 64.41±8.691) 12.93±2.931) 13.37±2.841) 观察组 治疗前 205.36±20.02 55.48±6.61 11.31±1.92 15.98±3.16 治疗后 290.24±35.701)2) 77.16±11.921)2) 14.68±3.041)2) 10.76±1.791)2) 与本组治疗前比较, 1)P＜0.01；与对照组治疗后比较, 2)P＜0.01。
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表 5 两组患者治疗前后GIQLI评分的比较
分，X±S 组别 时间 自觉症状 躯体生理 心理情绪 社会活动 总分 对照组 治疗前 51.45±6.83 19.18±3.73 13.03±3.19 13.08±3.08 96.73±15.88 治疗后 60.15±5.841) 19.95±2.991) 15.03±3.191) 14.08±3.081) 109.20±13.831) 观察组 治疗前 51.75±5.43 19.13±3.21 13.08±3.02 12.93±2.75 96.88±13.56 治疗后 67.03±6.631)3) 21.65±3.471)2) 16.60±1.611)3) 15.33±2.131)2) 120.60±10.971)3) 与本组治疗前比较, 1)P＜0.01；与对照组治疗后比较, 2)P＜0.05，3)P＜0.01。
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