摘要
为了总结刘凤斌教授中医药治疗胃食管反流病的理论思想和临床经验，采用同顾性病例系列研究和专家访谈结合设计，首先回顾广州中医药大学第一附属医院就诊的胃食管反流病患者资料，提取所用中药、疾病、证型、医疗费用和药物数量等信息，数据整理后采用统计描述和二分类Logistic回归分析确定证型和初步的主药及加减变化；然后进行专家访谈讨论形成最终的证型及用药。结果共收集到112例胃食管反流病患者资料，平均年龄（48．97±13．13）岁，男性35人（31．3％），女性77人（68．7％）。包含肝胃不和证（40例，35．7％）、肝胃郁热证（26例，23．2％）、气阴两虚证（19例，17．0％）、脾虚湿热证（17例，15．2％）、脾胃不和证（10例，8．9％）共5种证型，共用80味中药，其中26味中药在各个组别间存在显著性差异。然后进行数据整理，以各证型为因变量，纳入前23味中药进行Logistic回归分析，形成各证型下的加减用药变化。专家评阅修改后认为病因与情志内伤、饮食失调、久病劳累有关，病机是“脾虚气逆”，删除脾胃不和证，确定了4个证型10味主药，包括太子参、茯苓、白术、甘草、浙贝母、海螵鞘、枳壳、沉香、蒲公英、栀子炭，并确定了加减变化和心理饮食干预等综合诊疗措施。该研究基于临床实践数据和专家访谈信息总结了刘凤斌教授中医药治疗胃食管反流病的思想经验，设计严谨，具有良好的科学性和实用性。
To analyze and summarize Professor LIU Feng-bin＇s clinical experience and academic thoughts on gastroesophageal reflux disease （GERD）, the study group adopted the retrospective study for case series and expert interview, extracted the retrospective data, including the herbs, diseases, syndrome type, medical expense and quantity of herbs of GERD patients attended the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Statistical description and binary Logistic regression were used for the identifi- cation and modification of syndrome type and initial core herbs. After expert interviews were performed for the syndrome type and herbs, the final scheme were formed. A total of 112 GERD patients ages （48.97 ± 13. 13 ）y; male： 35 （31.3%）, female： 77 （ 68. 7% ） were enrolled. The numbers of patients with liver and stomach incoordination syndrome, heat stagnation of liver and stomach syndrome, syndrome of dual deficiency of Qi and Yin, syndrome of spleen deficiency and dampness-heat, spleen-stomach disharmony syndrome were 40, 26, 19, 17 and 10, respectively. Tile patients used totally 80 herbs, and 26 of them had significant differences among different syndrome groups. According to the logistic regression analysis on the 23 herbs used by 112 patients, the herbs scheme was modified for the second time. After the expert interviews and modification, the final consensus was reached. The main causes for GERD were dietary, inegularities, moodiness, and weak constitution. The basic mechanism of GERD was spleen deficiency with Qi ad- verseness. The spleen-stomach disharmony syndrome was deleted by expert interviews. The 10 core herbs for GERD treatment were Taizishen（ Pseudostellariae Radix ~ , Fuling （ Poria ） , Baizhu （ Atractylodismacrocephalae Rhizoma ） , Gancao （ Glycyrrhizae Radix Et Rhizoma） , Zhebeimu （ Fritillariae Thunbergii Bulbus ） , Haipiaoxiao （ Sepiae Endoconcha ） , Zhiqiao （ Aurantii Fructus ） , Chenxiang （Alosewood）, Pugongying（ Taraxaci Herha ）, Zhizitan （Cape Jasmine Fruit ）. The modification and psychological and diet interventions were also identified. This study summarized Professor LIU Feng-bin＇s clinical experience and academic thoughts of chronic atrophic gastritis based on data mining of case series and expert interviews. The quality of methodologies and report were both well. The results provide a foundation and ideas for further study on the comolex intervention for GERD_ and can be directly applied in clinical practice.
作者
侯政昆
李吉平
陈卓群
刘凤斌
HOU Zheng-kun1 , LI Ji-ping2 , CHEN Zhuo-qun3, LIU Feng-bin1(1. Gastroenterology Department, First Affiliated Hospital, Gwangzhou University of Chinese Medicine, Guangzhou 510405, China; 2. Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China; 3. The Offwe of Academic Affairs, Guangzhou University of Chinese Medicine, Guangzhou 510006, Chin)
出处
《中国中药杂志》
CAS
CSCD
北大核心
2018年第6期1261-1267,共7页
China Journal of Chinese Materia Medica
基金
国家自然科学基金项目(81774450,81774264)
广东省科技计划项目(2017A020215107)
广州市珠江科技新星专项(201710010077)
国家体育总局健身气功管理中心科技攻关重点项目(QG2017037)
广东省医学科学技术研究基金(A2017504)
广州中医药大学岭南医学研究中心高水平大学建设项目(广中医研[2017]10号)
关键词
胃食管反流病
病例系列
临床经验
学术思想
数据挖掘
LOGISTIC回归
脾虚
气逆
gastroesophageal reflux disease
case series
clinical experience
academic thoughts
data mining
Logistic regression
spleen deficiency
Qi stagnation
