The evaluation of the therapeutic effect of "spleen ascending and stomach descending coordination" acupuncture and medicine combined therapy in the treatment of non-erosive reflux disease with the cold-heat complex syndrome
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摘要: 目的 评价“脾胃升降协调”针药结合法治疗非糜烂性反流病(non-erosive reflux disease，NERD)寒热错杂证的临床疗效。方法 选择80例2020年9月—2021年12月武汉市中西医结合医院消化内科门诊及住院的NERD寒热错杂证患者，随机分为试验组与对照组，每组各40例。试验组予以半夏调中颗粒10 g/次，3次/d，并配合背俞针刺，30 min/次，每2 d治疗1次，3次/周；对照组予以泮托拉唑钠肠溶胶囊，40 mg/次，1次/d；疗程均为4周。比较两组治疗后反流性疾病问卷(reflux diagnostic questionnaire，RDQ)积分、胃食管反流病健康相关生活质量量表(gastroesophageal reflux disease-health-related quality of life，GERD-HRQL)评分、焦虑自评量表(self-rating anxiety scale，SAS)/抑郁自评量表(self-raring depression scale，SDS)评分、穴位皮温以及血清P物质(substance P，SP)与降钙素基因相关肽(calcitonin gene-related peptide，CGRP)水平。结果 与治疗前相比，试验组治疗后的RDQ积分、GERD-HRQL评分、SAS/SDS评分、血清SP与CGRP均下降，差异有统计学意义(P < 0.05)，穴位皮温升高(P < 0.01)，且试验组均优于对照组，均差异有统计学意义(均P < 0.01)。与治疗前相比，对照组的RDQ积分、GERD-HRQL评分、SAS/SDS评分、血清CGRP水平均下降，差异有统计学意义(P < 0.05)，SP水平下降及穴位皮温升高，但与治疗前比较均差异无统计学意义(P>0.05)。结论 “脾胃升降协调”针药结合疗法治疗NERD寒热错杂证具有补益脾胃、协调气机之功，不仅能缓解患者的临床症状，并且在改善患者的精神心理状态、提高生活质量方面具有独特优势，其机制可能与缓解内脏高敏感、调节食管运动功能相关。Abstract: Objective To evaluate the clinical effect of "spleen ascending and stomach descending coordination" acupuncture and medicine combined therapy in the treatment of non-erosive reflux disease(NERD) with the cold-heat complex syndrome.Methods Eighty patients with NERD of cold-heat complex syndrome were selected from the gastroenterology outpatients and inpatients in Wuhan Hospital of Integrated Traditional and Western Medicine from September 2020 to December 2021, and were randomly divided into the experimental group and the control group with 40 patients in each group. The experimental group was given Banxia Tiaozhong granules 10 g/time, three times/day, combined with Back-Shu acupuncture, 30 min each time, once every two days, three times a week; the control group was given Pantoprazole enteric-coated capsules, 40 mg/time, once a day; the treatment course was four weeks. Reflux diagnostic questionnaire(RDQ) score, gastroesophageal reflux disease-health-related quality of life(GERD-HRQL) score, self-rating anxiety scale(SAS)/self-raring depression scale(SDS) score, acupoint skin temperature and serum substance P(SP), calcitonin gene-related peptide(CGRP) levels were compared between the two groups after treatment.Results RDQ score, GERD-HRQL score, SAS/SDS scale score, SP, and CGRP decreased after treatment(P < 0.05), while acupoint skin temperature increased(P < 0.01), compared with those before treatment, the experimental group was better than the control group(P < 0.01). In the control group, CGRP was decreased compared with that before treatment(P < 0.01), and SP and acupoint skin temperature had no significant difference(P>0.05).Conclusion "Spleen ascending and stomach descending coordination" acupuncture and medicine combined therapy in the treatment of NERD with the cold-heat complex syndrome has the functions of tonifying spleen and stomach and coordinating Qi, which can alleviate clinical symptoms, improving mental state and life quality, and its mechanism may be related to relieving visceral hypersensitivity and regulating esophageal motor function.
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表 1 两组患者的临床资料比较
例，X±S 组别 例数 性别 年龄/岁 病程/月 BMI 男 女 试验组 40 19 21 42.63±11.85 38.28±22.48 23.21±1.76 对照组 40 17 23 41.95±11.85 42.15±24.89 23.52±1.61 P 0.653 0.800 0.467 0.424 
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表 2 两组患者治疗前后RDQ积分比较
分，X±S 组别 例数 治疗前 治疗后 t P 试验组 40 18.85±2.76 8.75±3.51 22.176 < 0.001 对照组 40 19.23±2.29 10.08±3.32 17.912 < 0.001 t -0.661 -3.964 P 0.511 < 0.001
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表 3 两组患者的GERD-HRQL量表评分比较
分，X±S 组别 例数 治疗前 治疗后 t P 试验组 40 21.03±6.75 8.28±4.16 16.961 < 0.001 对照组 40 22.95±7.09 14.23±6.16 10.676 < 0.001 t -1.243 -5.065 P 0.217 < 0.001
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表 4 两组患者的SAS和SDS量表评分比较
分，X±S 组别 例数 SAS t P SDS t P 治疗前 治疗后 治疗前 治疗后 试验组 40 53.43±6.15 38.45±5.97 16.348 < 0.001 57.20±4.20 43.53±4.26 16.062 < 0.001 对照组 40 53.90±6.08 52.10±5.72 2.479 0.018 56.53±5.45 53.80±5.58 5.018 < 0.001 t -0.339 -10.443 0.621 -9.256 P 0.736 < 0.001 0.537 < 0.001
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表 5 两组患者的俞穴相对温度比较
℃，X±S 组别 例数 脾俞 t P 胃俞 t P 治疗前 治疗后 治疗前 治疗后 试验组 40 1.09±0.54 1.43±0.52 -6.601 < 0.001 1.11±0.51 1.67±0.41 -7.12 < 0.001 对照组 40 1.03±0.43 1.07±0.46 -1.766 0.085 1.13±0.46 1.17±0.47 -1.766 0.085 t 0.523 3.248 -0.232 5.066 P 0.602 < 0.001 0.817 < 0.001
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表 6 两组患者治疗前后的血清SP水平与CGRP水平比较
pg/mL, X±S 组别 例数 SP t P CGRP t P 治疗前 治疗后 治疗前 治疗后 试验组 40 8.09±4.08 6.03±3.83 4.608 < 0.001 3.46±1.11 1.83±0.82 10.866 < 0.001 对照组 40 8.12±3.30 7.67±2.67 1.069 0.292 3.66±1.01 3.04±1.02 4.875 < 0.001 t -0.034 -2.223 2.747 7.438 P 0.973 0.029 0.007 < 0.001
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