【作者】 罗政仁；

【导师】 姒健敏；

【作者基本信息】 浙江大学 ， 内科学， 2002， 硕士

【摘要】 功能性消化不良(Functional Dyspepsia，FD)是近年来新命名的属于功能性胃肠疾病的一种，是指在过去一年中有持续或反复发作的上腹痛、腹胀、早饱、嗳气、恶心等上腹部消化不良症状，病程累计超过12周，而经详尽的检查未能发现引起这些症状的局部或全身器质性病变。FD是一种比较常见的临床征候群，其与慢性胃炎的关系一直存在很大的争议，10多年来大量的研究却一直未能为两者的关系提供明确的证据。但这些研究基本上都从H．Pylori感染方面来研究H．Pylori及其相关性胃炎与FD的关系，而对有消化不良症状、H．Pylori阴性的无特定病因的非糜烂性胃炎(浅表性胃炎)—暂且称之为“自发性非糜烂性胃炎”与FD的关系却几乎无人去探讨。自发性非糜烂性胃炎是一种无特定病因的慢性浅表性胃炎，其症状与消化不良症状雷同，而FD患者内镜下亦很难与轻症慢性胃炎相鉴别。二者在概念上到底有无区别或联系?有何联系? 本研究采用前瞻性队列试验方法，对因消化不良症状就诊，经胃镜检查诊断为自发性非糜烂性胃炎(H．Pylori阴性的慢性浅表性胃炎)患者，采用目前常用的慢性胃炎治疗方案和功能性消化不良治疗方案进行 浙江大学硕士学位论文 交叉试验和病例对照试验，对患者疗效进行分析，从治疗学的角度来研 究二者的关系，探讨二者的疾病概念。 材料与方法 收集自 2000年 6月至 200年吕月，近期有消化不良症状，役有特定病 因如酒精、非凿体类消炎药物、胃、肠、肝、胆等器质性疾病、糖尿病、 及结缔组织疾病等，经诊断明确属自发性非糜烂性胃炎患者，所有病例 均经快速尿素酶试验（RUT）和／或C’‘呼气试验和／或病理Giemsa染色除 外H．Pylon感染；患者被随机分成自身交叉试验组和病例对照试验组。 在自身交叉试验中，病人又随机分成甲、乙两组，甲组先予以甲方案（雷 尼替丁 0．15 PO Bid＋施维舒 50mg PO Tid）治疗二个月，二个月后复查， 分级记录症状、胃镜和病理，然后停药后待复发，分级记录症状（不包 括胃镜和病理），改用乙方案（西沙必利片 10mg PO Tid＋多虑平 25mg PO QN＋多酶片 3’PO Tid）治疗，疗程H个月，H个月后复查，分 级记录症状、胃镜和病理。乙组则相反，先用乙方案，后再给予甲方案， 疗程和观察内容不变。在病例对照组中，甲方案组先予以常用的慢性胃 炎治疗方案即制酸剂＋胃粘膜保护剂（雷尼替丁 0．15 PO Bid＋施维舒 So：g＊O＊饲）治疗：乙方案组予以促动力剂＋抗抑郁药十助消化药（西 沙必利片 10mg PO Tid＋多虑平 25mg PO QN＋多酶片 3‘PO Tid）i 疗，疗程均为二个月。病例对照试验和自身交叉试验结束后观察自发性 非糜烂性胃炎患者对甲、乙两方案的疗效，并作比较。疗效判定标准： 显效：症状完全消失，胃镜或病理炎症好转 ＊个级别以上。有效：症 状积分减少50％，胃镜或病理炎症好转1个级别。无效：达不到前述项 目或恶化。未进行胃镜复查者仅以症状评估。临床症状、胃镜、病理改 善达显效和有效标准者判为有效，并以此计算有效率。 2 浙江大学硕士学位论文 统计学处理：本研究所得到的自身交叉资料梁用计数资料配对卡方 检验，病例对照试验资料则采用RXC列联表卡方检验。以P值小于 0刀5为差异有显著性。应用SPSS10刀统计软件包协助统计。 结 果 共有自发性非糜烂性胃炎214例加入研究，其中自身交叉试验组88 例，病例对照试验组126例。在交叉试验组中，男性39例，女性49例， 平均年龄 42．24士 10．64岁，平均病程 23．84士 27．53月。病例对照试验组 中，慢性胃炎治疗方案组（甲方案组）74例，其中男性37例，女性37 例，平均年龄 40．5士 11人6岁，平均病程 24．37士30．46月。乙方案组 52 例，其中男性 ZI例，女性爿例，平均年龄 41．52土 11＊ 9岁，平均病程 23．87士33．88月。病例对照试验组的甲方案组、乙方案组及交叉治疗组 在进行治疗研究前的临床症状特征及胃镜病理分级上具有可比性 （P＞0刀5）。结果：在126例病例对照试验研究对象中，甲方案组74 例，对甲方案治疗有效的有 66例（89．19o），8例（10．slO）无效， 乙方案组52例，对乙方案治疗有效的有46例（88．46％），无效的有6 例（11．54％），两组间总有效率无显著性更多还原

【Abstract】 Functional dyspepsia(FD) is one of the most common functional gastrointestinal disorders(FGIDs) in recent Rome II diagnostic criteria. The definition includes the following: (l)persistent or recurrent pain or discomfort (fullness, early satiety, bloating, belching, nausea, retching, or vomiting) centered in the upper abdomen more than twelve weeks accumulately within the preceding 12 months; and (2) No evidence that organic diseases is likely to explain the symptoms. In effort to clarify the relationship between FD and chronic gastritis , most researchers focused on helicobacter pylori infection status. But it’s still difficult to draw a definite conclusion based on present studies. However, to date, preceding studies seldomly deal with the relationship between FD and nonerosive gastritis with dyspepsia symptoms but no helicobacter pylori infection and specific causes which we named "primary nonerosive gastritis(PNG)" . It’s very difficult to differentiate PNG from FD in clinic because of their similar symptoms and endoscopic appearances. Is there difference or correlation in these two diseases in concept? What relationship is there? Our aim was todiscriminate the definition of PNG and FD by the way of treated reaction.5Material and MethodsFrom Jun 2000 to Aug 2001,patients who meet the PNG diagnostic criteria were enrolled.Patients who had H.Pylori infection, presence of peptic ulcer, hepato-biliary diseases, alcohol abuse ,use of aspirin or non-steroidal anti-inflammatory drugs(NSAID) were excluded. Finally 214 patients were enrolled in the study. Patients were randomly assigned to two groups. One group was case control trial group, another was cross-treated self-control group. Ordinary treatment to chronic gastritis(plan A: Ranitidine 150mg po Bid +Selbex 50mg po Tid) and functional dyspepsia plan(plan B: Cisapride lOmg po Tid +Doxepin 25mg po qn +Domeipian 3* poTid)were given. In case control trial, plan A and plan B were given in control group(group A) and case group(group B) for two months. In cross-treated self-control trial, All patients were also assigned to group A and group B. The patients in group A were given plan A for two months at begin. After two months, the symptoms, endoscopic and pathologic changes were recorded. When the symptoms recurred, plan B were given for two months .On the contrary, the patients in group B were given plan B and plan A in turn. After case control trial and cross-treated self-control trial, symptoms, endoscopic and pathologic changes were analyzed and compared. Effectiveness analysis:The effectiveness were analyzed with the change of dyspeptic symptoms, endoscopy and histology of the stomach after treatment."complete remission": symptoms disappearance, endoscopic and6histological findings improving more than II grades;"effectiveness": symptom score(SC) decrement -^50%, endoscopic and histological results decreasing I grade;"no effectiveness" rsymptom score decrement <50%, no change or deterioration in histopathology in comparison with baseline. Statistical analysis:We used the Statistical Package for the Social sciences 10.0(SPSS 10.0 for Windows)for data analysis.All statistics analysis were performed with chi-square test. P values were computered, with statistical significance indicated by a value of p<0.05.ResultsOf 214 patients with primary nonerosive gastritis,88 were in cross-treated self-control trial group and 126 in case control trial group. At baseline, there were no difference among group A and group B in sex, age and grade of symptom and histopathology. In case control group ,the total effective rate of plan A and plan B was 89.19%(66/74) and 88.46%(46/52) respectively. In cross-treated self-control group, the total effective rate of plan A and plan B was 81.82% and 89.77% respectively. There was no significant difference on the effective rate of these two different plans(p>0.05).The result showed that primary nonerosive gastritis and FD are similar disease and maybe work as a same one but named different更多还原