胃食管反流病中西医结合治疗及疗效标准研究——附116例临床观察

目的探讨胃食管反流病（GERD）的中西医结合治疗及疗效标准。方法116例患者随机分两组,分别用中西医结合治疗和单纯西医治疗,并观察治疗前后症状改善、中医症候变化、内镜变化及复发情况。结果总有效率中西医组为84．5％,西药组为67．2％;但停药后两组均复发;中西医组长期疗效优于西药组（P〈0．05）,而短期疗效两组比较差异无显著性。中医辨证为虚证和虚实夹杂证比实证易复发（P〈0．05）;发病与精神因素相关的患者易复发（P〈0．05）;20例靠药物维持一直未停药者,平均服药（10．4±11．4）个月。本病内镜下食管黏膜正常者占69．0％。结论本病基本无治愈,可将“治愈”改为“临床控制”或“显效”,增设“不变”标准。且见食管黏膜破损异常与本病症状表现与转归不统一,故单以内镜积分判断疗效值得商榷。

Study on Integrated Chinese and Western Therapy and Criterion for Efficacy Evaluation of Gastroesophageal Reflux Disease--A Clinical Observation on 116 Cases

OBJECTIVE: To explore the criterion for efficacy evaluation of gastroesophageal reflux diseases (GERD) and the effect of treatment with integrated Chinese and Western medicine. METHODS: One hundred and sixteen patients of GERD were randomly assigned to two groups, group A treated with Western medicine and group B with integrated Chinese and Western medicine. Changes of symptoms, TCM syndromes, and endoscopic picture were observed before and after treatment. And the condition of recurrence was also inspected. RESULTS: The total effective rate was 84.5% and 67.2% in group A and B respectively. The long-term efficacy was better in group B than that in group A (P < 0.05), while there was no significant difference in short-term efficacy between the two groups. But the recurrence happened in both groups after withdrawal of treatment. The recurrence rate was significantly higher in patients of deficiency syndrome type and coexistence of deficiency and excess syndrome type than that in those of excess syndrome type (P < 0.05), and it was also higher in those whose pathogenesis was associated with mental factor (P < 0.05). In the other 20 patients the treatment was sustained for 10.4 +/- 11.4 months on average. There were 69.0% of the patients with normal esophagus mucosa shown by endoscope examination, and the pathological changes were not coincident with the symptoms and prognosis. CONCLUSIONS: Basically, no case of GERD could be cured, so, it is supposed that the item of "cure" in the criteria of therapeutic efficacy evaluation is advisably made over to "clinical control" or "obvious efficacy", and add an item of "no change" in the criterion. The importance of endoscopic picture for efficacy evaluation is doubtful and needs to be further discussed.