摘要
研究背景及目的
慢性胃炎是胃黏膜受到多种因素长期损伤后引起的慢性炎症。最常见原因是幽门螺杆菌感染,发病随年龄而增加,多数以胃窦为主的全胃炎,后期以胃黏膜固有腺体萎缩和肠化为主要病理特点,其症状无特异性,体征多不明显。慢性浅表性胃炎的发病率居各种胃病之首,该病病程较长,病情易反复,对人类健康及生活质量影响较大,西医对该病的病因及发病机制有一定认识,治疗方面也多以对症治疗为主缺乏特异性,因而疗效欠佳。中医在辨证论治基础上采用内服与外用相结合的治疗方法提高临床疗效,减少复发,提高患者依从性。自本世纪末以来,随着人类疾病谱的改变及对化学性药物危害性的认识,人们已逐渐意识到传统医学的重要性,一股回归自然、崇尚自然疗法的热潮正在兴起。灸法是重要的传统医学外治疗法之一,其简、便、廉、验的特点广泛应用于临床各科。艾灸治疗脾胃虚弱(含虚寒)型慢性胃炎临床疗效显著。但是随着医院规模的发展,传统的灸法耗费人力,不能满足日益增多的住院病人的治疗。所以很多新型使用方便、低成本、易推广的灸疗仪器越来越多的研制出来,艾灸箱就是其中的一种,这样在保证临床疗效的情况下又提高了临床工作效率。
本课题主要观察艾箱灸联合加味香砂六君子汤治疗脾胃虚弱(含虚寒)型慢性浅表性胃炎的临床疗效及初步探讨其可能的作用机理。
方法
将128例符合纳入标准的患者随机分为治疗组和对照组。治疗组64例：内服香砂六君子汤加减,水煎服,日一剂；并联合使用艾箱灸灸中脘、气海、双足三里,日一次,时间30min。对照组64例：服用香砂六君子汤加减,水煎服,日一剂。疗程均为2周。参考《中药新药临床研究指导原则》设计调查问卷,对治疗前后临床症状进行评分。试验结束后对所有临床资料进行汇总,建立数据库,进行数据管理,采用SPSS 13.0软件进行统计分析。
结果
临床症状疗效(显效率)比较：治疗组在改善胃脘隐痛、上腹胀、体倦乏力、食少纳呆等症状方面优于对照组(P<0.05),对大便稀烂、排便无力、嗳气、泛酸改善与对照组相比无显著性差异(P>0.05),两组对泛酸症状的改善疗效均欠佳。
总疗效比较：治疗组治愈38例(59.4%),显效22例(34.4%),有效3例(4.6%),无效1例(1.6%),总有效率(98.4%),总显效率(93.8%)；对照组：治愈27例(42.9%),显效15例(23.8%),有效14例(22.2%),无效7例(11.1%),总有效率(88.9%),总显效率(66.7%)。经R×C表X2检验,X2=10.67,P=0.0011<0.05,两组比较差异有统计学意义。
结论
艾箱灸联合香砂六君子汤治疗脾胃虚弱(含虚寒)型慢性浅表性胃炎具有确切疗效,艾灸箱施灸面积大,火力集中,灸后作用明显,其较传统艾灸节省人力,操作方便,易于控制温度,安全性高,可提高临床工作效率,值得临床进一步推广应用。
Background and Objectives
Chronic gastritis is a chronic inflammation of gastric mucosa with a long-term injury by a variety of factors. The most common cause of chronic gastric is Helicobater pylori infection; its incidence increases with age; most of which with antral gastritis basis, late to the inherent glandular atrophy and intestinal mucosa into the main pathological features of nonspecific symptoms and most of the signs were not obvious.
The incidence of chronic superficial gastritisis higher than any other stomach trouble, which has a longer disease course, also, it is easily repeated, thereby, it has greatly influenced on human health and quality of life. Western medicine has a certain understanding on the etiology and pathogenesis of it, however, symptomatic treatment is the main mean which is lack of specificity with poor efficacy. TCM is based on therapy with syndrome differentiation;oral use combining with external use can improve its efficacy and reduce its recurrence, which can improve patient's compliance. Since the end of this century, along with changes in the human disease spectrum and the chemical understanding of the dangers of drugs, people have gradually realized the importance of traditional medicine;and therefore, an return to nature, respect for natural therapies is emerging.
Moxibustion is an important external therapy of traditional medicine, which is simple, convenient, inexpensive and effective. Moxibustion is a highly targeted treatment for spleen deficiency in chronic superficial gastritisis. As the scale of the development of the hospital, the traditional labor-intensive moxibustion can not meet the growing number of inpatients treated.Many easy use,low cost, easy promotion moxibustion instruments are developed, so as to ensure the clinical efficacy, and moxibustion with moxa box is one of them.
To explore the clinical effect of moxibustion with moxa box coordinating with Xiangsha Liujunzi Tang for chronic superficial gastritisis of spleen deficiency and discuss its mechanism.
Methods
The 128 cases of patients who met the inclusion criteria were randomly divided into control group and treatment group.There were 64 cases in each group. The control group was treated by decotion solution from Xiangsha Liujunzi Tang quaque die, while treatment group added moxibustion with moxa box for Zhongwan, Qihai, Zusanli (two sides) lasting 30min once a day. The course of treatment was two weeks for both of the two groups.
Before and after treatment, the clinical symptom score was used to evaluate by designing the questionnaire survey with cross-sectional survey method reference to "the guiding principles of Chinese medicine clinical research new drugs". After the treatment we summarized all the clinical datas, and then, we analyzed them with SPSS 13.0 software.
Result
Clinical symptom (significant efficiency) comparison:there were significant changes(P<0.05) compared treatment group with control group for epigastric dull pain, upper abdominal distension, tired body fatigue, poor appetite, although there were not significant changes (P>0.05) for pantothenic acid.
Comparisons of the total effect:there were 38cases (59.4%) curative, 22cases(34.4%) sinificant,3cases (4.6%) effective, lcases (1.6%) invalid in treatment group, and the total effective rate was 98.4% while total sinificant rate was 93.8%. There were 27cases(42.9%) curative,15 cases(23.8%) sinificant,14 cases(22.2%) effective,7cases (11.1%) invalid in control group, and the total effective rate was 88.9% while total significant rate was 66.7%. Analyzed by X2 efficiencyP=0.001＜0.05, significant differences was found between the two group.
Conclusion
There is exact efficacy for chronic superficial gastritis with spleen deficiency for moxibustion with moxa box. Moxibustion with moxa box has many advantages, such as concentrated firepower, obvious effect after moxibustion, more labor-saving, easy operation and temperature control, safe, clinical efficacy improvement compared with traditional moxibustion, which is worthy of further promotion.
引文
[1]Yamada T. Textbook of Gastroenterology. Vol 1,2nd edn. Philadelphia:JB Lippincott,1995; 1461-1489
[2]Field SP, Sachar DB, The ymmunology of pernucuous anemia. In:Shorter RG, Kirsner JB, eds, Gastrointestinal immunity for the clinical, Orlando: Grune&Stratton,1985,61
[3]Wilfred MW. Other types of gastritis and gastropathies, including Menetrier's disease. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Pathphysiology/Diagnosis/Management, Voll,6th end. Philadelphia: WB Saunders company,1998,711-732
[4]Dixon MF, Genta RM, Yardiey JH, et al.Classfication and grading of gastritis, The Updated Sydney System. Am J Surg Pathol,1996; 20:1161 -1181
[5]肖树东,许国铭.中华胃肠病学.北京：人民卫生出版社.2008；332
[6]吴耀南,黄墩煌.厦门地区慢性浅表性胃炎的中医证型与发病季节及Hp感染的关系探讨；光明中医,2009年12月第24卷第12期；2234-2236
[7]刘丽,张映红,黄萍等.湖南省会自然人群幽门螺杆菌感染的流行病学调查.中国现代医学杂志,2000，10(4)：101-102.
[8]马应杰,钟爱莲,李春丽等.郑州地区人群幽门螺杆菌感染血清流行病学调查.河南医科大学学报,1996,31(3)：79-80.
[9]汤军,吕宾,孙洁等.某医院高级知识分子幽门螺杆菌感染情况调查.浙江预防医学,2008年20卷3期,15-17
[10]周汉桥,方向明,武汉地区常住居民幽门螺杆菌感染情况分析,微循环学杂志,2009,4期,36-37
[11]何晋德,于虹,屈汉庭.慢性胃炎病理组织学表现与幽门螺杆菌的关系.北京医科大学学报,1999；31(1)：86-87.
[12]顾友谊,邹勇.田文主任医师治疗慢性胃炎经验精粹.中医药学刊,2004；22(5)：789.
[13]梁晓梅,宗晔,于永征等.幽门螺杆菌不同治疗方案的疗效评估.临床内科杂志,2008,25(4)：254-256
[14]林春秀.胆汁反流性胃炎的治疗体会.赣南医学院学报,2008，28(1)：69-70
[15]王志坚,强刚.慢性胃炎中医治疗体会.陕西中医学院学报,2000,23(3)：26-27
[16]潘相学,刘持年,周继友等.连益胃灵治疗HP相关性慢性浅表性胃炎临床研 究.山东中医杂志,2004。23(9)：522
[17]陈福如.862例慢性胃炎中医病因病机分析.江西中医药,1997，28(1)：51
[18]梅颍.刘永年主任治疗慢性胃炎的经验.南京中医药大学学报,2003，19(5)：311-312
[19]李爱玉,张建文.张自平治疗慢性胃炎三法.中医研究,2001，14(5)： 12-13
[20]虞蔚红.养阴清胃汤治疗慢性胃炎胃阴不足型42例.河南中医药学刊,2000,15(3)：67-68
[21]叶庆莲.肝胃相关与胃痛证治探析.上海中医药杂志,2002，36(4)：30-33
[22]赵进明.从血瘀论治慢性萎缩性胃炎.山东中医杂志,1999，18(3)：107-108
[23]谈文峰.从瘀论治慢性胃炎84例临床观察.江西中医药,2001,32(4)：29
[24]于盈光,钟慎清.慢性胃炎用药机制探析.山东中医杂志,2001，20(5)：329-331
[25]王松坡,窦丹波.慢性胃炎分阶段辨证论治探讨.中医药学报,2002，30(5)：16-17
[26]王小平,慢性胃炎辨证论治体会.南京中医药大学学报(自然科学版),2001,17(2)：121-122
[27]罗云坚,黄穗平,陈慧等.慢性胃炎中医证候与胃窦十二指肠运动及胃炎程度的相关性.广州中医药大学学报,2000,(17)3：241-244
[28]韩子岩,韩松岩,韩松颖等.慢性胃炎中医辨证分型与悉尼内镜胃炎分类及Hp感染相关性研究.中医杂志.2001：42(9)：556
[29]李灿东,高碧珍,兰启防等.慢性胃炎脾胃湿热证患者胃黏膜细胞凋亡以及相关蛋白的研究.中国中西医结合杂志,2002，22(9)：667-669
[30]高树中,马玉侠,王秀英.中医外治学的理论基础研究进展.中医外治杂志,2008,17(4)：3-4
[31]陈闽,程霓,陈演江等.艾灸对大鼠的胃粘膜保护作用及与血清铜锌含量的关系.针刺研究,1995,(20)2：45-47
[32]陈永昌,汪凤维,陈演江等.艾灸对胃粘膜保护作用机制初探.南京中医学院学报,1992,(8)4：234-235
[33]易受乡,彭艳,常小荣等.艾灸对应激性胃溃疡大鼠胃粘膜细胞增殖和凋亡的影响及其与热休克蛋白表达关系的研究.针刺研究,2006,(31)5：259-263
[34]郁洁,易受乡,常小荣等.艾灸足三里、梁门穴对大鼠不同组织器官HSP70表达的影响.湖南中医药大学学报,2009,(29)4：67-69
[35]孙世晓,曹艳.艾灸足三里穴影响空腹猫胃运动的实验研究.针灸临床杂,2000,16(12)：32-33
[36]王志成.艾灸治疗脾胃气虚型胃下垂30例.中国针灸,2006,6(12)：895
[37]皮静萍.艾灸在残胃无力症状引起的顽固性呃逆中的应用.皖南医学院学报,2001,1(3)：224
[38]唐玲.艾灸治疗化疗胃肠道反应65例.中圈民间疗法,2001,9(10)：22
[39]陈敏.艾灸加穴位注射治疗胃脘痛57例.湖北中医杂志,2009，31(7)：55
[40]曾奕.艾灸作用的实验研究进展.山东中医杂志,2005,(24)3：187-189
[41]李冀,李浦媛,刘波等.香砂六君子汤的实验研究进展.中医药信息,2008,25,(2)33-34
[42]张英福,郑天珍,李伟等.香砂六君子汤及其成分对大鼠离体胃平滑肌条运动的影响.兰州医学院学报,1999：25(2)：1-3.
[43]薛西林,王志红.香砂六君子汤治疗慢性胃炎临床分析.安徽医学,1995，16(3)：49-50
[44]秦琦,秦玉存等.香砂六君子汤加减治疗慢性萎缩胃炎的临床体会.中医药研究,1995，6：37
[45]章力勤.香砂六君子汤加味治疗胆汁反流性胃炎.浙江中医学院学报,2001,5(3)：48.
[46]彭国英.香砂六君子汤加减治疗幽门螺旋菌感染性胃部疾患.中国民间疗法,2001,(1)：39-40.
[47]刘连憨,曹凡华,张勤兰.香砂六君子汤治疗浅表性胃炎伴肠上皮化生30例.福建中医药,2004,5(1)：37-38.