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| 辨证分型治疗LPRD及中医诊疗方案的临床研究 |
| Clinical study on the treatment of LPRD by syndrome differentiation and TCM diagnosis and treatment scheme |
| 投稿时间：2024-05-09 修订日期：2024-05-09 |
| DOI： |
| 中文关键词: 辨证分型 咽喉反流性疾病（LPRD） 咽喉反流 反流症状指数量表（RSI） 反流体征评分量表（RFS） 中医诊疗方案 临床研究 |
| 英文关键词: Syndrome differentiation and classification Laryngopharyngeal Reflux Disease（LPRD） laryngopharyngeal reflux Reflux Symptom Index Scale（RSI） Reflux Finding Score Scale（RFS） Traditional Chinese Medicine Diagnosis and Treatment Plan clinical research |
| 基金项目:2022年度浙江省中医药科技计划中医药科学研究基金项目《咽喉反流性疾病中医诊疗方案的临床研究》,项目编号:2022ZB365。 |
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| 中文摘要: |
| 【】目的:探究辨证分型治疗LPRD的临床疗效,为出台本病中医诊疗方案的提供一定的临床研究基础。方法:随机选取于2021年11月－2023年01月就诊我科门诊符合LPRD的556例患者。按无差别前提条件分成治疗组和对照组。对照组279例给予雷贝拉唑肠溶片治疗,治疗组277例患者在对照组基础上,采用中医辨证分为四型(其中肝郁气滞型146例 ；胆胃不和型67例；中虚气逆型19例；痰瘀互阻型45例)方分别用(柴胡疏肝散；温胆汤；香砂六君子汤；会厌逐瘀汤)进行加减治疗,比较两组患者的治疗4周后、治疗8周后总有效率；对比两组患者治疗前、治疗4周后、治疗8周后反流症状指数评分量表(Reflux Symptom Index,RSI)和反流体征评分量表(Reflux Finding Score,RFS),以及治疗组不同证型患者治疗前、治疗4周后、治疗8周后症状体征积分值和不良反应发生情况。结果:两组患者经过治疗后,治疗组治疗4周后、治疗8周后的总有效率均高于对照组,差异有统计学意义(P＜0.05)；两组治疗4周后、治疗8周后的RSI及RFS评分均较治疗前有明显降低,差异有统计学意义(P＜0.05),治疗组RSI及RFS评分降低程度均高于对照组,差异有统计学意义(P＜0.05)；治疗组各型治疗4周后、治疗8周后症状体征积分值均较治疗前有明显下降。观察期间,两组均未出现明显不良反应。结论:本研究对LPRD患者通过中西医结合辨病辨证诊疗模式,开展大样本量研究,采用辨证分型加减治疗配合PPI制剂治疗对比单纯应用PPI制剂,两组RSI、RFS均较前降低,治疗组比对照组降低明显,治疗组的总有效率较高,显示中药配合治疗,能够增强治疗效果,明显减轻症状,缓解不适,减少长期使用西药所致副反应,减少疾病复发率,值得在临床推广,同时通过本研究的结果,为临床治疗提供客观依据,为出台本病中医辨病辩证诊疗方案指南提供有效的现实意义。 |
| 英文摘要: |
| 【】Objective: To explore the clinical effect of syndrome differentiation and classification in the treatment of LPRD, and to provide a certain clinical research basis for the introduction of TCM diagnosis and treatment of this disease.Method:Randomly select 556 patients who met LPRD criteria and visited our outpatient department from November 2021 to January 2023. Divide into treatment group and control group based on the premise of no difference. 279 patients in the control group were treated with rabeprazole enteric coated tablets, while 277 patients in the treatment group were divided into four types based on traditional Chinese medicine syndrome differentiation (including 146 cases of liver stagnation and qi stagnation type, 67 cases of gallbladder stomach disharmony type, 19 cases of middle deficiency and qi inversion type, and 45 cases of phlegm stasis mutual obstruction type). The formulas were respectively treated with Chaihu Shugan San, Wendan Tang, Xiangsha Liujunzi Tang, and Huiyin Zhuyu Tang. The total effective rates of the two groups of patients after 4 weeks of treatment and 8 weeks of treatment were compared; Compare the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) of two groups of patients before treatment, 4 weeks after treatment, and 8 weeks after treatment, as well as the symptom and sign scores and incidence of adverse reactions of patients with different syndrome types in the treatment group before treatment, 4 weeks after treatment, and 8 weeks after treatment. Result: After treatment, the total effective rate of the treatment group after 4 weeks and 8 weeks was higher than that of the control group, and the difference was statistically significant (P<0.05); After 4 weeks and 8 weeks of treatment, the RSI and RFS scores of the two groups showed a significant decrease compared to before treatment, with a statistically significant difference (P<0.05). The degree of reduction in RSI and RFS scores in the treatment group was higher than that in the control group, with a statistically significant difference (P<0.05); After 4 weeks of treatment and 8 weeks of treatment, the symptom and sign scores of each type in the treatment group showed a significant decrease compared to before treatment. During the observation period, neither group experienced any significant adverse reactions.Result:After treatment, the total effective rate of the treatment group after 4 weeks and 8 weeks was higher than that of the control group, and the difference was statistically significant (P < 0.05). RSI and RFS scores after 4 weeks and 8 weeks of treatment were significantly lower than those before treatment, the difference was statistically significant (P < 0.05); RSI and RFS scores in the treatment group were significantly lower than those in the control group, the difference was statistically significant (P < 0.05); The scores of symptoms and signs in the treatment group after 4 weeks and 8 weeks were significantly lower than those before treatment. During the observation period, there were no obvious adverse reactions in both groups.Conclusion: This study carried out a large sample size study on LPRD patients through disease differentiation and syndrome differentiation of TCM and Western medicine. Compared with PPI preparation alone, the RSI and RFS of the two groups were lower than before, and the treatment group was significantly lower than the control group. The total effective rate of the treatment group was higher, indicating that the combined treatment with traditional Chinese medicine. It can enhance the therapeutic effect, significantly reduce symptoms, relieve discomfort, reduce the side effects caused by long-term use of Western medicine, and reduce the recurrence rate of the disease, which is worthy of clinical promotion. Meanwhile, through the results of this study, it provides objective basis for clinical treatment and provides effective practical significance for the introduction of guidelines for TCM disease differentiation and dialectical diagnosis and treatment of the disease. |
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