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Received:August 19, 2019 Published Online:April 20, 2020
Received:August 19, 2019 Published Online:April 20, 2020
中文摘要: 目的 探讨通降合剂联合质子原抑制剂（PPI）雷贝拉唑肠溶胶囊治疗反流性食管炎的临床价值。
方法 回顾性分析2018年1月至12月门诊诊治的89例反流性食管炎患者的临床资料,按照治疗方式不同,将应用雷贝拉唑肠溶胶囊治疗的48例列为对照组,将雷贝拉唑肠溶胶囊联合通降合剂治疗的41例列为治疗组。两组均连续治疗8周后,比较治疗后两组患者食管下括约肌压力和食管体部压力变化;统计临床症状改善时间及治疗前后中医症状积分,计算整体疗效,并分析两组治疗前后24 h食管pH监测情况及血清胃泌素(GAS)、胃动素(MOT)水平。
结果 治疗后,治疗组食管相关压力中食管下括约肌压力及食管体部压力均显著高于对照组(P均<0.01),反酸、嗳气、胸痛等临床症状缓解显著早于对照组(P均<0.01),中医积分低于治疗前及对照组治疗后(P均<0.05);治疗后,治疗组临床总有效率显著高于对照组（95.1% vs 79.2%,P<0.05),治疗组pH均显著高于治疗前及对照组治疗后（P<0.05）,pH<4总时间百分比、反流持续≥5 min次数、pH<4反流次数及最长反流持续时间均显著低于治疗前及对照组治疗后（P均<0.05）,血清GAS、MOT水平均显著高于治疗前及对照组治疗后,差异均有统计学意义(P均<0.05)。
结论 在PPI治疗基础上联用通降合剂治疗反流性食管炎,能有效提高食管相关括约肌压力,缓解临床症状,提高整体疗效,对患者食管pH及反流、胃肠动力激素也有改善作用。
Abstract:Objective To explore the clinical value of proton pump inhibitor(PPI)-Tongjiang mixture combined with rabeprazole enteric-coated capsule in the treatment of reflux esophagitis.
Methods The clinical data of 89 patients with reflux esophagitis treated in outpatient clinic from January to December 2018 were retrospectively analyzed.According to different treatment methods,the patients were divided into control group in which rabeprazole enteric-coated capsule was given (n=48) and treatment group in which Tongjiang mixture was added on the basis of rabeprazole enteric-coated capsule (n=41).After 8 weeks of continuous treatment,the pressures of lower esophageal sphincter(LES) and esophageal body were compared between two groups.The time of improvement in clinical symptoms and scores for Traditional Chinese Medicine (TCM) symptoms,24 h esophageal pH monitoring and levels of serum gastrin (GAS) and motilin (MOT) were observed before and after treatment and analyzed between two groups.
Results After treatment,the pressures of LES and esophageal body in treatment group were significantly higher than those in control group (all P<0.01),and the relief of clinical symptoms such as acid regurgitation,belching and chest pain were significantly earlier than those in control group (all P<0.01).TCM scores were significantly lower than those before treatment in both groups and were significantly lower in treatment group than those in control group (all P<0.05).The effective rate in treatment group was significantly higher than that in control group (95.1% vs 79.2%,P<0.05).The pH value in treatment group was significantly higher than that before treatment and that in control group after treatment (P<0.05).The percentage of total time with pH<4,frequency of reflux duration≥5 min,frequency of reflux with pH<4 and longest reflux duration were significantly lower than those before treatment and those in control group after treatment,and the levels of serum GAS and MOT were significantly higher than those before treatment and those in control group after treatment (all P<0.05).
ConclusionFor the patients with reflux esophagitis,Tongjiang mixture combined with PPI treatment can effectively increase the esophageal sphincter pressure,relieve clinical symptoms and also improve esophageal pH,reflux and gastrointestinal motility with higher overall efficacy.
keywords: Reflux esophagitis Tongjiang mixture Rabeprazole enteric-coated capsule Lower esophageal sphincter pression Esophageal body pression Gastrin Motilin
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基金项目:江苏省人社厅六大人才高峰项目(C类资助项目)
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