藿朴夏苓汤加减治疗慢性浅表性胃炎（脾胃湿热证）的临床研究

【作者】 刘敏；

【导师】 胡运莲；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2008， 硕士

【摘要】 目的本研究旨在从临床方面观察藿朴夏苓汤加减治疗慢性浅表性胃炎(脾胃湿热证)的疗效并探讨其可能的作用机理,为临床新药研究提供理论依据。方法选取湖北省中医院消化内科门诊就诊及住院病人100份(经胃镜及病理检查后确诊为慢性浅表性胃炎,中医辨证为脾胃湿热证),随机将其分为治疗组(中西药结合组)及对照组(单纯西药组)各50例。两组患者在治疗前性别、年龄、病程、主要中医症候、中医症候积分、胃镜检查情况、病理检查情况、幽门螺杆菌(HP)感染情况方面的比较均无显著性差异(P＞0.05),具有可比性。对照组给予单纯西药治疗,治疗组在同种西药的基础上再给予藿朴夏苓汤加减方治疗。两组病例中有反酸者给予奥美拉唑肠溶胶囊(奥克,口服,20mg/次,2次/日)抑酸,有胃排空障碍及十二指肠液反流者给予吗丁啉片(口服,10mg/次,3次/日)促胃动力,有胃黏膜充血、糜烂严重者给予硫糖铝混悬液(舒可捷,口服,5ml/次,3次/日)保护胃粘膜,HP阳性病例同时给予克拉霉素缓释片(康婷,口服,250mg/次,2次/日),阿莫西林胶囊(抗之霸,口服,1.0g/次,2次/日)等药物治疗。治疗组同时给予藿朴夏苓汤加减(由藿香15g、厚朴10g、半夏10g、赤茯苓10g、白蔻仁6g、陈皮10g、玄胡10g、黄连6g、苍术15g、白术10g、蒲公英20g、炙甘草6g等组成)治疗,水煎温服日一剂,一剂分两次服用,200ml/次。两组病例均以四周为一疗程,服药一疗程后进行疗效判定。观察两组患者治疗后临床总疗效、主要中医症候及积分改善情况、胃镜检查情况、病理检查情况及Hp阴转情况。结果治疗后治疗组临床总疗效为92.0%,对照组为78.0%,经统计学分析,P＜0.05,具有显著性差异;治疗组在中医症候疗效的总有效率为96.0%,对照组为78.0%,经统计学分析P＜0.05,具有显著性差异;治疗组中医症候积分、中医主、次症积分改善方面均优于对照组(P＜0.05);治疗组在胃镜像、病理变化方面的有效率分别为:76.0%、82.0%,对照组分别为:58.0%、62.0%,治疗组在这两方面的改善均优于对照组(P＜0.05);但治疗组HP阴转率为45.4%,对照组为25.8%,组间比较经统计学分析,P＞0.05,两组对Hp感染情况改善方面没有明显差异。结论本研究在清热燥湿、健脾益胃、理气止痛治则基础上,结合现代医学Hp感染、胃肠功能失调、胃粘膜防御机制失常等理论,选药组方藿朴夏苓汤加减结合常规西药治疗该疾病,结果显示:中西药结合治疗慢性浅表性胃炎(脾胃湿热证)有良好的临床疗效,其效果优于单纯西药组。从现代医药理论观察藿朴夏苓汤加减方可能具有抗炎止痛、提高机体免疫力、保护胃粘膜、促胃肠运动、抗Hp感染、抗肿瘤等作用,结合相关西药治疗该病时,具有协同增强的效果。说明藿朴夏苓汤加减方的组方切合临床实际,在治疗慢性浅表性胃炎(脾胃湿热证)方面确有一定疗效,值得进一步研究及推广。更多还原

【Abstract】 OBJIECTThis thesis aims to provide theoretical basis for the study of the new clinical medicine by observing the curative effects of the Addition and Subtraction Treatment of chronic superficial gastritis (CSG) by decoction HUO PU XIA LING TANG and discussing its possible functional mechanism.METHODS100 patients whose diseases are diagnosed as CSG (damp-heat in spleen and stomach) after gastroscopic and pathological examinations in the digestive medical department of Hubei Traditional Chinese Medical Hospital are selected as subjects and randomly divided into two equal groups: the treatment group of CCTWM and the control group of simple western medicine. The two groups of patients are comparable since they have no significant differences before treatments in aspects of sex, age, course of disease, main traditional Chinese medical symptom, gastroscopic examination, pathological test, and Hp infection (P>0. 05 )..In the two groups, those who show acrid regurgitation are treated by omeprazole enteric-coated tablets (swallow, 20mg every time and twice a day) . Those who have acid suppression, delayed gastric emptying and duodenal reflux are treated by Motilium tablets to promote gastric dynamics (swallow, 10mg every time and three times a day ) . Those who have hyperemia gastric mucosa and severe erosion are treated by sucralfate suspension to protect gastric mucosa (Sucralfate, swallow, 5ml every time and three times a day) . Those with severe erosion of gastric mucosa in the control group are treated by omeprazole enteric-coated tablets (swallow, 20mg every time and twice a day), clarithromycin tablets (swallow, 250mg every time and twice a day) and amoxicillin tablets (swallow, 1.0g every time and twice a day ). The treatment group is treated with decoction HUO PU XIA LING TANG, the composition of which includes agastache rugosa, magnolia officianlis, pinellia ternate, poria cocos, Amoni compacti, coix seed, almond, coptis chinensis, atractylodes lancea, atractylodes, eupatorium fortune and taraxacum herb. Take these herbal decoctions with luke warm water, 200ml every time and twice a day.One treatment period is 4 weeks for each groups. The curative effects will be judged after the patients have taken the medicine for one period. What need observing include the total effective rate of patients in the two groups, main CTM symptoms and the improvements of the integrals and the results of gastroscopic and pathological examinations and Hp negative-conversion.RESULTSAfter the treatment, the total curative effect of the treatment group is 92.0% and the control group 78.0%. The statistic analysis reveals that when P<0. 05, it has significant differences. The total effective rate of the treament group in the Chinese medical symptom is 96. 0% and the control group 78.0%. Statistics reveals that when P< 0. 05, it has significant differences. Traditional Chinese medicine syndrome integrals of the treatment group and the improvement of the main and minor syndrome integrals are better than that of the control group ( P < 0. 05 ) . The effective rate of the treatment group in gastroscopic examinations and pathological changes are 76.0% and 82.0% respectively while the control group 58.0% and 62.0%. The improvement of the treatment group is obviously better than that of the control group (P<0. 05 ) , but the rate of Hp negative-conversion is 45.4% while the control group 25.8%. The statistic analysis shows that when P > 0. 05, the two groups have no significant differences in avoiding Hp infection.CONCLUSIONBased on the traditional methods of heat-clearing and damp-drying, invigorating spleen and stomach and regulating Qi and analgesia with a combination of the theories of modern medical science such as Hp inflection, gastrointestinal dysfunction and maladjustment of the mechanisms of gastric mucosal protection, this thesis decoction HUO PU XIA LING TANG usually uses western medicine to treat the disease. The result reveals that CCTWM is very effective in treating CSG, and the effect is better than that of the control group which uses western medicine only. decoction HUO PU XIA LING TANG possibly have such functions as antiinflammation and analgesia, increase body’s immunity, protect gastric mucosa, enhance gastrointestinal impetus, anti Hp infection and antitumor. In treating the disease with western medicine, it has a synergetic enchanting effect. It shows that the composing prescriptions of decoction HUO PU XIA LING TANG is suitable for the clinical reality. They do have some curative effects in treating CSG (damp-heat in spleen and stomach)and are worth further study and recommending.更多还原