摘要
[目的]探讨雷贝拉唑、曲美布汀联合氟哌噻吨美利曲辛对常规治疗无效非糜烂性胃食管反流病(NERD)疗效的影响及其作用机制.[方法]将质子泵抑制剂(PPI)常规治疗无效的NERD患者108例随机分为对照组和观察组,各54例.对照组接受雷贝拉唑、曲美布汀治疗,观察组在对照组用药的基础上增加氟哌噻吨美利曲辛.比较2组治疗有效率、GerdQ评分、HAMA评分、HAMD评分、PSQI评分、DeMeester评分、酸反流总次数、酸反流＞5 min次数、最长反流时间、食管下括约肌静息压(LESP)、食管下括约肌腹内长度(LESL)、远端收缩积分(DCI)、胃动素(MOT)、胃泌素(GAS)、血管活性肠肽(VIP)、5-羟色胺(5-HT).记录2组不良反应发生率,对治疗显效和有效患者进行半年复发率随访.[结果]观察组治疗有效率高于对照组、复发率低于对照组(P＜0.05).治疗后,观察组GerdQ评分、HAMA评分、HAMD评分、PSQI评分、DeMeester评分、酸反流次数、反流≥5 min次数、最长反流时间低于对照组(P＜0.05);观察组LESP、LESL、DCI高于对照组(P＜0.05).治疗后,观察组MOT、GAS血清水平高于对照组,VIP、5-HT水平低于对照组(P＜0.05).2组不良反应发生率比较差异无统计学意义(P＞0.05).[结论]与雷贝拉唑联合曲美布汀相比,雷贝拉唑、曲美布汀联合氟哌噻吨美利曲辛治疗能够更有效地改善NERD患者躯体症状和精神症状,调节MOT、GAS、VIP、5-HT血清水平,降低复发率.
Abstract
[Objective]To evaluate the effect of rabeprazole,trimebutine combined with flupentixol and melitracen on non-erosive reflux disease(NERD)failed to conventional treatment.[Methods]One hundred and eight NERD patients who did not respond to routine PPI treatment were randomly divided into control group and observation group,with 54 cases in each group.Control group was treated with rabeprazole and trimebutine,and the observation group was treated with flupentixol and melitracen on the basis of control group.Treatment response,gastroesophageal reflux disease questionnaire(GerdQ)score,Hamilton anxiety scale(HAMA)score,Hamilton depression scale(H AMD)score,Pittsburgh sleep quality index(PSQI)score,DeMeester score,acid reflux times,reflux＞5 min times,maximum reflux time,lower esophageal sphinc-terpressure(LESP),length of lower esophageal sphincter(LESL),distal contraction integral(DCI)and the serum levels of motilin(MOT),gastrin(GAS),vasoactine intrestinal peptide(VIP),5-hydroxytryptamine(5-HT)were compared between the two groups.The incidence of adverse reactions was recorded in the two groups,and the recurrence rate of patients with obvious effect and effective treatment was followed up for half a year.[Results]The effective rate in observation group was higher than that in control group(P＜0.05),and the recurrence rate was lower than that in control group(P＜0.05).After treatment,the GerdQ score,HAMA score,HAMD score,PSQI score,DeMeester score,times of acid reflux,times of reflux ≥5 min,and the longest reflux time in the observation group were lower than those in the control group(P＜0.05).LESP,LESL,DCI in observation group were higher than control group(P＜0.05).After treatment,serum levels of MOT and GAS in the observation group were higher than those in the control group,and levels of VIP and 5-HT in observation group were lower than the control group(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).[Conclusion]Compared with rabeprazole combined with trimebutine,rabeprazole,trimebutine combined with flupentixol and melitracen can more effectively improve the somatic symptoms and mental symptoms in NERD pa-tients,regulate the serum levels of MOT,GAS,VIP and 5-HT,and reduce the recurrence rate.
基金项目
廊坊市科学技术研究与发展计划(2019013117)
NETL
NSTL
万方数据