中西医结合治疗难治性胃食管反流的机制与效果研究

A Study on the Mechanism and Efficacy of Integrated Traditional Chinese and Western Medicine in Treating Refractory Gastroesophageal Reflux Disease

摘要: 目的：探讨中西医结合治疗难治性胃食管反流(rGERD)的作用机制及临床效果，为rGERD临床治疗提供依据。方法：选取2023年1月至2024年1月我院86例rGERD患者，随机分为对照组与观察组各43例。对照组予常规西医治疗(雷贝拉唑 + 多潘立酮)，观察组加用中医辨证治疗(肝胃不和证用柴胡疏肝散加减，脾胃湿热证用清中汤加减)，均治疗8周。比较两组疗效、症状评分、食管黏膜愈合率及不良反应。结果：观察组总有效率93.02%，高于对照组74.42% (P < 0.05)。治疗后观察组胃灼热、反酸、胸骨后疼痛评分及总评分均低于对照组(P < 0.05)；食管黏膜愈合率86.05%，高于对照组65.12% (P < 0.05)；两组不良反应发生率(9.30% vs 13.95%)无差异(P > 0.05)。结论：中西医结合治疗rGERD疗效确切，可改善症状、促进黏膜愈合且安全，其机制与调节胃肠动力、抑酸护膜、改善炎症相关。

Abstract: Objective: To investigate the mechanism and clinical efficacy of integrated traditional Chinese and Western medicine (TCM-WM) in treating refractory gastroesophageal reflux disease (rGERD), and to provide evidence for its clinical management. Methods: A total of 86 rGERD patients admitted to our hospital from January 2023 to January 2024 were selected and randomly divided into a control group (n = 43) and an observation group (n = 43). The control group received conventional Western medicine treatment (rabeprazole + domperidone), while the observation group received additional TCM syndrome differentiation treatment: Chaihu Shugan San modified for liver-stomach disharmony syndrome, or Qingzhong Tang modified for spleen-stomach damp-heat syndrome. Both groups were treated for 8 weeks. The efficacy, symptom scores, esophageal mucosal healing rate, and adverse reactions were compared between the two groups. Results: The total effective rate in the observation group was 93.02%, significantly higher than 74.42% in the control group (P < 0.05). After treatment, the scores for heartburn, acid reflux, retrosternal pain, and the total symptom score in the observation group were all lower than those in the control group (P < 0.05). The esophageal mucosal healing rate in the observation group was 86.05%, higher than 65.12% in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (9.30% vs. 13.95%, P > 0.05). Conclusion: Integrated TCM-WM therapy is effective for rGERD, improving symptoms, promoting mucosal healing, and demonstrating safety. The mechanism is related to regulating gastrointestinal motility, inhibiting acid and protecting the mucosa, and improving inflammation.