歸脾湯聯合質子泵抑制劑治療非糜爛性反流病伴抑郁患者的臨床觀察及對血清腦腸肽水平的影響

何若瑜　曹燕飛

[摘要] 目的 探討歸脾湯聯合質子泵抑制劑治療非糜爛性反流病伴抑郁患者的臨床療效及對血清腦腸肽5-HT、VIP水平的影響。 方法 將符合納入排除標準的94例非糜爛性反流病患者隨機分為對照組（n=47）和實驗組（n=47），對照組采用氟哌噻噸美利曲辛片聯合蘭索拉唑膠囊治療，實驗組采用歸脾湯聯合蘭索拉唑膠囊進行治療，兩組均治療8周，比較兩組治療前后RDQ積分、GERDQ評分、HAMA量表評分、HAMD-24量表評分變化，同時監測兩組治療前后血清5-HT、VIP水平變化，統計兩組有效率。 結果 治療后，實驗組總有效率80.85%優于對照組59.57%（P<0.05）；兩組治療后RDQ積分、GERDQ評分、HAMD-24量表評分均較前降低（P<0.01），且實驗組各量表評分顯著低于對照組（P<0.05）；兩組治療后血清5-HT均較前升高，實驗組5-HT水平顯著高于對照組（P<0.05），血清VIP水平兩組均較前降低，但組間無統計學差異（P>0.05）。 結論 歸脾湯聯合蘭索拉唑膠囊可在一定程度改善非糜爛性反流病伴抑郁患者的臨床癥狀，提高血清5-HT水平，降低血清VIP，效果較黛力新聯合蘭索拉唑更優，有較好的臨床療效。

[關鍵詞] 非糜爛性胃食管反流病；抑郁狀態；歸脾湯；腦腸肽；質子泵抑制劑

[中圖分類號] R571 [文獻標識碼] B [文章編號] 1673-9701（2018）19-0097-04

Effect of Guipi decoction combined with proton pump inhibitor on patients with non-erosive reflux disease complicated with depression and its effect on serum brain-gut peptide levels

HE Ruoyu CAO Yanfei

The Third Affiliated Hospital of Zhejiang University of Chinese Medicine， Hangzhou 310000，China

[Abstract] Objective To investigate the clinical efficacy of Guipi decoction combined with proton pump inhibitor in the treatment of patients with non-erosive reflux disease and depression and its effect on the levels of serum brain-gut peptide 5-HT and VIP. Methods 94 non-erosive reflux disease patients who met the exclusion criteria were randomly divided into control group（n=47） and experimental group （n=47）. The control group was treated with flupenthixol melitracen combined with lansoprazole capsules. The experimental group was treated with Guipi decoction combined with lansoprazole capsules. Both groups were treated for 8 weeks. RDQ scores， GERDQ scores， HAMA scale scores， and HAMD-24 scores were compared before and after treatment in both groups. While the serum 5-HT and VIP levels before and after treatment in both group were monitored. The efficiency of the two groups was calculated. Results After treatment， the total effective rate was 80.85% in the experimental group， which was better than 59.57% in the control group（P<0.05）. After the treatment， the RDQ scores， GERDQ scores， HAMD-24 scale scores were lower than those before（P<0.01）. The scores of the scales in the experimental group were significantly lower than those in the control group（P<0.05）.The serum 5-HT levels in the two groups increased after treatment， and 5-HT levels in the experimental group were significantly higher than those in the control group（P<0.05）. The VIP levels in both groups were lower than those before， but there was no statistical difference between the two groups（P>0.05）. Conclusion Guipi decoction combined with lansoprazole capsule can improve the clinical symptoms of patients with non-erosive reflux disease and depression， improve serum 5-HT levels and reduce serum VIP. Its effect is more excellent than that of Deanxit combined with lansoprazole. And the Guipi decoction combined with lansoprazole capsule has better clinical efficacy.

[Key words] Non-erosive gastroesophageal reflux disease； Depression state； Guipi Ddecoction； Brain-gut peptide； Proton pump inhibitor

非糜爛性反流病（non-erosive reflux disease NERD）是胃食管反流病中最常見的一種類型，約占胃食管反流病（gastroesophageal reflux disease，GERD）的50%～70%[1]。盡管質子泵抑制劑（proton pump inhibitors，PPIs）的問世使此類疾病的治療發生了革命性的進步，但仍有部分患者經抑酸治療后癥狀不能緩解，或反復發作，嚴重影響患者的生活和工作。研究發現，胃食管反流病與精神心理因素相關，心理因素可通過“腦腸軸”影響機體的胃腸道動力及內臟敏感性[2，3]。這主要借由神經遞質的釋放和傳遞內臟與和中樞神經系統（centralnervous system，CNS）聯系起來，這些神經遞質稱為“腦-腸肽”[4]，其中，5-HT、VIP被證實與反流關系密切[5，6]。……