【摘要】 目的 探讨四逆萸连汤对内镜阳性肝胃郁热型胃食管反流病(GERD)的临床疗效。方法 86例内镜阳性肝胃郁热型胃食管反流病患者,采用随机数字表法分为治疗组(42例)与对照组(44例)。两组患者均给予基础治疗,在此基础上,治疗组给予中药四逆萸连汤治疗,对照组给予西药雷贝拉唑治疗。比较两组治疗前后主要临床症状积分,主要临床症状、中医证候、胃镜下食管黏膜炎症疗效。结果 治疗结束后6个月,治疗组烧心、反酸症状积分分别为(1.39±0.98)、(1.29±0.67)分,均低于对照组的(2.78±0.66)、(2.93±0.22)分,差异具有统计学意义(t=7.747、15.394, P<0.05)。治疗结束后6个月,治疗组烧心症状痊愈12例、显效9例、有效13例、无效8例,对照组分别为5、6、10、23例,治疗组烧心症状疗效优于对照组,差异具有统计学意义(Z=3.187, P<0.05)。治疗结束后6个月,治疗组反酸症状痊愈13例、显效10例、有效10例、无效9例,对照组分别为6、7、14、17例,治疗组反酸症状疗效优于对照组,差异具有统计学意义(Z=2.460, P<0.05)。治疗结束后6个月,治疗组中医证候痊愈10例、显效8例、有效14例、无效10例,对照组分别为5、6、11、22例,治疗组中医证候疗效优于对照组,差异具有统计学意义(Z=2.475, P<0.05)。治疗结束后6个月,治疗组胃镜下食管黏膜炎症疗效痊愈15例、显效11例、有效11例、无效5例,对照组分别为10、8、7、19例；治疗结束后12个月,治疗组胃镜下食管黏膜炎症疗效痊愈12例、显效16例、有效8例、无效6例,对照组分别为6、4、10、24例；治疗组胃镜下食管黏膜炎症疗效均优于对照组,差异具有统计学意义(Z=2.557、4.020, P<0.05)。结论 采用四逆萸连汤治疗内镜阳性肝胃郁热型胃食管反流病,其改善主要反流症状及食管黏膜炎症的近期疗效与传统西药相当；改善食管黏膜炎症的远期疗效优于传统西药,改善主要反流症状的远期疗效尚待进一步研究。更多还原

【Abstract】 Objective To discuss the clinical efficacy of Sini Yulian Decoction in the treatment of endoscopy-positive gastroesophageal reflux disease(GERD) with stagnant heat of liver and stomach syndrome.Methods A total of 86 cases of endoscopy-positive gastroesophageal reflux disease with stagnant heat of liver and stomach syndrome were divided into treatment group(42 cases) and control group(44 cases) according to random numerical table. Both groups received basic treatment. On this basis, the treatment group was treated with traditional Chinese medicine Sini Yulian Decoction, and the control group was treated with western medicine rabeprazole. The main clinical symptom score before and after treatment, main clinical symptoms, traditional Chinese medicine syndrome, and efficiency of esophageal mucosal inflammation under gastroscope were compared between the two groups. Results At 6 months after the end of treatment, the symptom scores of heartburn and acid regurgitation in the treatment group were(1.39±0.98) and(1.29±0.67) points, which were lower than(2.78±0.66) and(2.93±0.22) points in the control group, and the differences were statistical significance(t=7.747, 15.394; P<0.05). At 6 months after the treatment, 12 cases of heartburn symptoms were cured in the treatment group, 9 cases were significantly effective, 13 cases were effective and 8 cases were ineffective; 5 cases of heartburn symptoms were cured in the control group, 6 cases were significantly effective, 10 cases were effective and 23 cases were ineffective. The efficacy of heartburn symptoms in the treatment group was better than that in the control group, and the difference was statistically significant(Z=3.187, P<0.05). At 6 months after the treatment, 13 cases of acid reflux symptoms were cured in the treatment group, 10 cases were significantly effective, 10 cases were effective and 9 cases were ineffective; 6 cases of acid reflux symptoms were cured in the control group, 7 cases were significantly effective, 14 cases were effective and 17 cases were ineffective. The efficacy of acid reflux symptoms in the treatment group was better than that in the control group, and the difference was statistically significant(Z=2.460, P<0.05). At 6 months after the treatment, 10 cases of traditional Chinese medicine syndrome were cured in the treatment group, 8 cases were significantly effective, 14 cases were effective and 10 cases were ineffective; 5 cases of traditional Chinese medicine syndrome were cured in the control group, 6 cases were significantly effective, 11 cases were effective and 22 cases were ineffective. The efficacy of traditional Chinese medicine syndrome in the treatment group was better than that in the control group, and the difference was statistically significant(Z=2.475, P<0.05). At 6 months after the treatment, 15 cases of esophageal mucosal inflammation under gastroscope were cured in the treatment group, 11 cases were significantly effective, 11 cases were effective and 5 cases were ineffective; 10 cases of esophageal mucosal inflammation under gastroscope were cured in the control group, 8 cases were significantly effective, 7 cases were effective and 19 cases were ineffective. At 12 months after the treatment, 12 cases of esophageal mucosal inflammation under gastroscope were cured in the treatment group, 16 cases were significantly effective, 8 cases were effective and 6 cases were ineffective; 6 cases of esophageal mucosal inflammation under gastroscope were cured in the control group, 4 cases were significantly effective, 10 cases were effective and 24 cases were ineffective. The efficacy of esophageal mucosal inflammation under gastroscope in the treatment group was better than that of the control group, and the difference was statistically significant(Z=2.557, 4.020; P<0.05). Conclusion The short-term efficacy of Sini Yulian Decoction in treating endoscopy-positive gastroesophageal reflux disease with stagnant heat of liver and stomach syndrome is comparable to that of conventional western medicine in improving the major reflux symptoms and esophageal mucosal inflammation; the long-term efficacy of improving esophageal mucosal inflammation was better than that of conventional western medicine, and the long-term efficacy of improving major reflux symptoms is yet to be further studied.更多还原