舒郁消瘅汤联合西药治疗难治性反流性食管炎合并焦虑抑郁状态疗效观察
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摘要
目的观察舒郁消瘅汤联合泮托拉唑及莫沙必利治疗难治性反流性食管炎合并焦虑抑郁状态的临床疗效并探讨其机制。方法选择50例符合入选标准的难治性反流性食管炎合并焦虑抑郁状态患者,按就诊先后顺序分为治疗组和对照组各25例。2组均行心理疏导,在此基础上对照组给予泮托拉唑加莫沙必利口服,治疗组在对照组治疗基础上给予舒郁消瘅汤加减口服,2组疗程均为8周。观察2组治疗前后反流性疾病问卷(RDQ)评分、内镜下食管黏膜分级评分、汉密尔顿抑郁量表(HAMD-17)评分、汉密尔顿焦虑量表(HAMA)评分变化情况,停药后3个月及6个月时随访评价2组复发情况。结果 2组患者治疗后RDQ评分、内镜下食管黏膜分级评分、HAMD-17评分及HAMA评分均明显降低(P均<0.05),且治疗组各项评分均明显低于对照组(P均<0.05)。停药后3个月,2组症状及镜下复发率比较差异无统计学意义(P>0.05);停药后6个月,治疗组症状及镜下复发率均明显低于对照组(P均<0.05)。结论舒郁消瘅汤联合泮托拉唑及莫沙必利治疗难治性反流性食管炎可显著改善患者情志,促进黏膜损伤好转,且可明显降低远期复发率,值得推广应用。
Objective It is to observe the clinical efficacy of Shuyu Xiaodan Decoction combined with western medicine on refractory reflux esophagitis with anxiety and depression. Methods 50 patients with refractory reflux esophagitis with anxiety and depression met the inclusion criteria were divided into the treatment and control groups according to their sequence of visiting time, 25 cases in each group. Based on psychological counseling, the control group were treated with pantoprazole and mosapride, the treatment group was treated with Shuyu Xiaodan Decoction additionally, both groups were treated for 8 weeks. The changes of RDQ score, endoscope evaluation score, HAMA-17 and HAMD score were observed before and after treatment, and the recurrence was followed up and assessed in 3, 6 months after treatment. Results After treatment, the scores of RDQ, esophageal mucosa under endoscope, HAMD-17 and HAMA were significantly decreased in the two groups(P<0.05), and the scores of these indexes in the treatment group were lower than that in the control group(P<0.05). There was no significant difference in the recurrent rate by symptom and gastroscopy evaluation between the two groups after following up for 3 months(P>0.05),but the rate in the treatment group was obviously lower than that of control group in six months after treatment stopped(P<0.05). Conclusion Shuyu Xiaodan Decoction combined with western medicine can significantly improve the patient's emotions, promote the improvement of mucosal injury, and can significantly reduce the long-term recurrence rate in the treatment of refractory reflux esophagitis with anxiety and depression, it is worthy of popularization and application.
Objective It is to observe the clinical efficacy of Shuyu Xiaodan Decoction combined with western medicine on refractory reflux esophagitis with anxiety and depression. Methods 50 patients with refractory reflux esophagitis with anxiety and depression met the inclusion criteria were divided into the treatment and control groups according to their sequence of visiting time, 25 cases in each group. Based on psychological counseling, the control group were treated with pantoprazole and mosapride, the treatment group was treated with Shuyu Xiaodan Decoction additionally, both groups were treated for 8 weeks. The changes of RDQ score, endoscope evaluation score, HAMA-17 and HAMD score were observed before and after treatment, and the recurrence was followed up and assessed in 3, 6 months after treatment. Results After treatment, the scores of RDQ, esophageal mucosa under endoscope, HAMD-17 and HAMA were significantly decreased in the two groups(P<0.05), and the scores of these indexes in the treatment group were lower than that in the control group(P<0.05). There was no significant difference in the recurrent rate by symptom and gastroscopy evaluation between the two groups after following up for 3 months(P>0.05),but the rate in the treatment group was obviously lower than that of control group in six months after treatment stopped(P<0.05). Conclusion Shuyu Xiaodan Decoction combined with western medicine can significantly improve the patient's emotions, promote the improvement of mucosal injury, and can significantly reduce the long-term recurrence rate in the treatment of refractory reflux esophagitis with anxiety and depression, it is worthy of popularization and application.
引文
[1] El-Serag HB,Sweet S,Winchester CC,et al. Update on the epidemiology of gastro-esophageal reflux disease:a systematic review[J]. Gut,2014,63(6):871-880
[2] 中华医学会消化病学分会胃肠动力学组. 胃食管返流病治疗共识意见[J]. 现代消化及介入诊疗,2008,13(1):71-72
[3] Cicala M,Emerenziani S,Guarino MP,et al. Proton pump inhibitor resistance,the real challenge in gastro-esophageal reflux disease[J]. World J Gastroenterol,2013,19(39):6529-6535
[4] 王高峰,朱生樑. 难治性胃食管反流病的诊断及治疗进展[J]. 实用医学杂志,2011,27(9):1517-1520
[5] Lee SP,Lee KN,Lee OY,et al. The relationship between existence of typical symptoms and psychological factors in patients with erosive esophagitis[J]. J Neurogastroenterol Motil,2012,18(3):284-290
[6] 中华医学会消化病学分会. 2014年中国胃食管反流病专家共识意见[J]. 胃肠病学,2015,20(3):155-168
[7] Bavishi C,Dupont HL. Systematic review:the use of proton pump inhibitors and increased susceptibility to enteric infection[J]. Aliment Pharmacol Ther,2011,34(11/12):1269-1281
[8] Sibbing D,Morath T,Stegherr J,et al. Impact of proton pump inhitors on the antiplatetet effects of clopidorgrel[J]. Haemost,2009,101(4):714-719
[9] 中华中医药学会脾胃病分会. 胃食管反流病中医诊疗共识意见(2009,深圳)[J]. 中医杂志,2010,51(9):844-847
[10] 中国中西医结合学会消化系统疾病专业委员会. 胃食管反流病中西医结合诊疗共识意见(2010)[J]. 中国中西医结合杂志,2011,31(11):1550-1553
[11] 中国胃食管反流病研究写作组. 反流性疾病问卷在胃食管反流病诊断中的价值[J]. 中华消化杂志,2003,23(11):651-654
[12] 刘安民,王世喜,韩玉娟,等. 胃食管反流病患者临床症状、心理因素和自主神经功能间关系研究[J]. 山东医药,2007,47(13):60-61
[13] 李军,李芳,张丽娟,等. 老年胃食管反流病患者心理健康状况调查[J]. 人民军医,2007,50(6):334-335
[14] 陈剑. 辛开苦降方干预反流性食管炎患者精神心理状态的临床评价研究[D]. 北京:北京中医药大学,2014
[15] 周晓艳,褚传莲. 重视难治性胃食管反流病精神心理因素的诊治[J]. 世界华人消化杂志,2017,25(1):1-6
[16] 高亚楠,费素娟. 精神心理障碍与胃食管反流疾病共病的研究进展[J]. 医学综述,2017,23(15):3036-3040
[17] Kahrilas PJ,Jonsson A,Denison H,et al. Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy[J]. Gut,2014,63(5):720-726
[18] Yu YY,Fang DC,Fan LL,et al. Efficacy and safety of esomeprazole with flupentixol/melitracen in treating gastroesophageal reflux disease patients with emotional disorders[J]. J Gastroenterol Hepatol,2014,29(6):1200-1206
[19] 张颖,陈宇霞,黄世敬. 柴胡及柴胡类复方的抗抑郁研究现状[J]. 世界中西医结合杂志,2014,9(9):985-988
[20] 张卫卫. 半夏厚朴汤及厚朴主要成分促胃肠动力、抗焦虑和抗抑郁作用的研究[D]. 沈阳:中国医科大学,2004
[21] 谢英. 中药促胃肠动力抗抑郁假说的提出与验证[D]. 长沙:中南大学,2012
[22] Yi LT,Zhang L,Ding AW,et al. Orthogonal array design for antidepressant compatibility of polysaccharides from Banxia Houpo Decoction,a traditional Chinese herb prescription in the mouse models of depression[J]. Arch Pharm Res,2009,32(10):1417-1423
[23] 徐欢,陈海芳,介磊,等. 枳实、枳壳的化学成分及胃肠动力研究概述[J]. 江西中医学院学报,2009,21(1):42-44
[24] 韩珍,贺弋,杨艳,等. 郁金抗抑郁作用的实验研究[J]. 宁夏医学院学报,2008,30(3):275-276
[25] 张建军,胡春玲. 中药党参研究的现代进展[J]. 甘肃高师学报,2017,22(3):39-43
[26] 杨子谊,吴红彦. 旋覆代赭汤临床应用研究概述[J]. 实用中医药杂志,2013,29(3):231-232
[27] 姜雪,孙森凤,王悦,等. 甘草药理作用研究进展[J]. 化工时刊,2017,31(7):25-28
[28] 陈熹,李玉洁,杨庆,等. 大枣现代研究开发进展与展望[J]. 世界科学技术-中医药现代化,2015,17(3):687-691
[2] 中华医学会消化病学分会胃肠动力学组. 胃食管返流病治疗共识意见[J]. 现代消化及介入诊疗,2008,13(1):71-72
[3] Cicala M,Emerenziani S,Guarino MP,et al. Proton pump inhibitor resistance,the real challenge in gastro-esophageal reflux disease[J]. World J Gastroenterol,2013,19(39):6529-6535
[4] 王高峰,朱生樑. 难治性胃食管反流病的诊断及治疗进展[J]. 实用医学杂志,2011,27(9):1517-1520
[5] Lee SP,Lee KN,Lee OY,et al. The relationship between existence of typical symptoms and psychological factors in patients with erosive esophagitis[J]. J Neurogastroenterol Motil,2012,18(3):284-290
[6] 中华医学会消化病学分会. 2014年中国胃食管反流病专家共识意见[J]. 胃肠病学,2015,20(3):155-168
[7] Bavishi C,Dupont HL. Systematic review:the use of proton pump inhibitors and increased susceptibility to enteric infection[J]. Aliment Pharmacol Ther,2011,34(11/12):1269-1281
[8] Sibbing D,Morath T,Stegherr J,et al. Impact of proton pump inhitors on the antiplatetet effects of clopidorgrel[J]. Haemost,2009,101(4):714-719
[9] 中华中医药学会脾胃病分会. 胃食管反流病中医诊疗共识意见(2009,深圳)[J]. 中医杂志,2010,51(9):844-847
[10] 中国中西医结合学会消化系统疾病专业委员会. 胃食管反流病中西医结合诊疗共识意见(2010)[J]. 中国中西医结合杂志,2011,31(11):1550-1553
[11] 中国胃食管反流病研究写作组. 反流性疾病问卷在胃食管反流病诊断中的价值[J]. 中华消化杂志,2003,23(11):651-654
[12] 刘安民,王世喜,韩玉娟,等. 胃食管反流病患者临床症状、心理因素和自主神经功能间关系研究[J]. 山东医药,2007,47(13):60-61
[13] 李军,李芳,张丽娟,等. 老年胃食管反流病患者心理健康状况调查[J]. 人民军医,2007,50(6):334-335
[14] 陈剑. 辛开苦降方干预反流性食管炎患者精神心理状态的临床评价研究[D]. 北京:北京中医药大学,2014
[15] 周晓艳,褚传莲. 重视难治性胃食管反流病精神心理因素的诊治[J]. 世界华人消化杂志,2017,25(1):1-6
[16] 高亚楠,费素娟. 精神心理障碍与胃食管反流疾病共病的研究进展[J]. 医学综述,2017,23(15):3036-3040
[17] Kahrilas PJ,Jonsson A,Denison H,et al. Impact of regurgitation on health-related quality of life in gastro-oesophageal reflux disease before and after short-term potent acid suppression therapy[J]. Gut,2014,63(5):720-726
[18] Yu YY,Fang DC,Fan LL,et al. Efficacy and safety of esomeprazole with flupentixol/melitracen in treating gastroesophageal reflux disease patients with emotional disorders[J]. J Gastroenterol Hepatol,2014,29(6):1200-1206
[19] 张颖,陈宇霞,黄世敬. 柴胡及柴胡类复方的抗抑郁研究现状[J]. 世界中西医结合杂志,2014,9(9):985-988
[20] 张卫卫. 半夏厚朴汤及厚朴主要成分促胃肠动力、抗焦虑和抗抑郁作用的研究[D]. 沈阳:中国医科大学,2004
[21] 谢英. 中药促胃肠动力抗抑郁假说的提出与验证[D]. 长沙:中南大学,2012
[22] Yi LT,Zhang L,Ding AW,et al. Orthogonal array design for antidepressant compatibility of polysaccharides from Banxia Houpo Decoction,a traditional Chinese herb prescription in the mouse models of depression[J]. Arch Pharm Res,2009,32(10):1417-1423
[23] 徐欢,陈海芳,介磊,等. 枳实、枳壳的化学成分及胃肠动力研究概述[J]. 江西中医学院学报,2009,21(1):42-44
[24] 韩珍,贺弋,杨艳,等. 郁金抗抑郁作用的实验研究[J]. 宁夏医学院学报,2008,30(3):275-276
[25] 张建军,胡春玲. 中药党参研究的现代进展[J]. 甘肃高师学报,2017,22(3):39-43
[26] 杨子谊,吴红彦. 旋覆代赭汤临床应用研究概述[J]. 实用中医药杂志,2013,29(3):231-232
[27] 姜雪,孙森凤,王悦,等. 甘草药理作用研究进展[J]. 化工时刊,2017,31(7):25-28
[28] 陈熹,李玉洁,杨庆,等. 大枣现代研究开发进展与展望[J]. 世界科学技术-中医药现代化,2015,17(3):687-691
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