摘要
目的观察瑞巴派特联合伏诺拉生治疗内镜黏膜下剥离术后人工溃疡的疗效。方法采用前瞻性随机对照研究方法,选取南阳市第二人民医院消化内镜中心2021年12月至2024年12月收治的内镜黏膜下剥离术后人工溃疡患者106例,根据随机数字表法将其分为单药组和联合组,每组各53例。单药组患者接受伏诺拉生治疗,联合组患者在单药组用药方案基础上加用瑞巴派特治疗。单药组和联合组患者均接受持续治疗6周。比较单药组和联合组患者治疗前后溃疡愈合情况(包括溃疡面积)、消化道症状评分、健康调查量表36评分、胃肠激素(包括胃泌素、胃动素)水平、炎症因子(包括C反应蛋白、肿瘤坏死因子α、白细胞介素6)水平,以及治疗后溃疡愈合质量、临床总有效率及不良反应发生率。结果联合组患者的临床总有效率高于单药组[90.57%(48/53)vs 73.58%(39/53)],差异有统计学意义(χ^(2)=5.194,P<0.05)。治疗后联合组和单药组患者的溃疡面积[(33.12±8.15)、(41.24±7.48)mm^(2)]均小于治疗前[(128.45±23.23)、(127.93±29.85)mm^(2)],且联合组小于单药组,差异有统计学意义(t=5.344,P<0.05)。治疗后联合组患者的溃疡愈合质量高于单药组[84.91%(45/53)vs 67.92%(36/53)],差异有统计学意义(χ^(2)=4.240,P<0.05)。治疗后联合组和单药组患者的消化道症状评分[(24.12±2.33)、(26.57±3.13)分]均低于治疗前[(34.61±4.23)、(34.43±4.92)分],联合组低于单药组,差异有统计学意义(t=4.571,P<0.05)。联合组和单药组患者的健康调查量表36评分[(76.79±7.22)、(65.51±7.24)分]高于治疗前[(58.71±6.30)、(58.65±6.27)分],且联合组高于单药组,差异有统计学意义(t=8.031,P<0.05)。治疗后联合组和单药组患者的胃泌素、胃动素水平[(98.25±13.32)、(102.35±28.35),(120.35±15.77)、(132.52±30.44)ng/L]均低于治疗前[(141.25±18.58)、(287.35±36.68),(141.32±18.66)、(275.58±35.52)ng/L],且联合组患者的胃泌素、胃动素水平均低于单药组,差异均有统计学意义(t=7.794、5.245,均P<0.05)。治疗后联合组和单药组患者的C反应蛋白、肿瘤坏死因子α、白细胞介素6水平[(3.24±1.54)mg/L、(24.10±3.29)pg/mL、(5.33±1.20)ng/L,(4.64±1.78)mg/L、(26.83±3.67)pg/mL、(7.56±1.25)ng/L]均低于治疗前[(9.63±1.67)mg/L、(33.14±4.10)pg/mL、(11.21±2.13)ng/L,(9.25±1.36)mg/L、(32.95±4.23)pg/mL、(11.62±2.73)ng/L],联合组低于单药组(t=4.330、4.032、9.369,均P<0.05)。联合组患者的不良反应发生率为13.21%(7/53),单药组为20.75%(11/53),差异无统计学意义(χ^(2)=1.071,P>0.05)。结论瑞巴派特联合伏诺拉生治疗内镜黏膜下剥离术后人工溃疡具有显著效果,可有效促进溃疡愈合、提升生活质量、减轻消化道症状及炎症反应,且安全性良好。
Objective To observe the efficacy of rebamipide combined with vonoprazan in the treatment of artificial ulcer after endoscopic submucosal dissection(ESD).Methods A total of 106 patients with artificial ulcers after ESD admitted to the Digestive Endoscopy Center of Nanyang Second General Hospital from December 2021 to December 2024 were selected and divided into the monotherapy group and the combination group according to the random number table method,with 53 cases in each group.Patients in the monotherapy group received vonoprazan treatment,while those in the combination group received rebamipide in addition to the monotherapy regimen.Both groups received continuous treatment for 6 weeks.The ulcer healing status(including ulcer area),gastrointestinal symptom scores,36-Item Short Form Health Survey(SF-36)scores,gastrointestinal hormones(including gastrin and motilin),inflammatory factors(including C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)),as well as the quality of ulcer healing,overall clinical effectiveness rate,and incidence of adverse reactions after treatment were compared between the two groups.Results The overall clinical response rate in the combination group was higher than that in the monotherapy group(90.57%(48/53)vs 73.58%(39/53)),and the difference was statistically significant(χ^(2)=5.194,P<0.05).After treatment,the ulcer area in both the combination group and the monotherapy group((33.12±8.15)mm^(2),(41.24±7.48)mm^(2),respectively)was significantly smaller than those before treatment((128.45±23.23),(127.93±29.85)mm^(2),respectively),and the ulcer area in the combination group was smaller than that in the monotherapy group,with a statistically significant difference(t=5.344,P<0.05).After treatment,the quality of ulcer healing in the combination group was higher than that in the monotherapy group(84.91%(45/53)vs 67.92%(36/53)),and this difference was statistically significant(χ^(2)=4.240,P<0.05).After treatment,the gastrointestinal symptom scores in both the combination group and the monotherapy group((24.12±2.33),(26.57±3.13)points,respectively)were lower than those before treatment((34.61±4.23),(34.43±4.92)points,respectively),and the score in the combination group was lower than that in the monotherapy group,with a statistically significant difference(t=4.571,P<0.05).The SF-36 scores in the combination group and the monotherapy group((76.79±7.22),(65.51±7.24)points,respectively)were higher than those before treatment((58.71±6.30),(58.65±6.27)points,respectively),and the score in the combination group was significantly higher than that in the monotherapy group,with a statistically significant difference(t=8.031,P<0.05).After treatment,the levels of gastrin and motilin in both the combination group and the monotherapy group((98.25±13.32),(102.35±28.35),(120.35±15.77),(132.52±30.44)ng/L,respectively)were lower than those before treatment((141.25±18.58),(287.35±36.68),(141.32±18.66),(275.58±35.52)ng/L,respectively).Furthermore,the levels of gastrin and motilin in the combination group were lower than those in the monotherapy group,and the differences were statistically significant(t=7.794,5.245,both P<0.05).After treatment,CRP,TNF-α,and IL-6 levels in the combination group and the monotherapy group((3.24±1.54)mg/L,(24.10±3.29)pg/mL,(5.33±1.20)ng/L,(4.64±1.78)mg/L,(26.83±3.67)pg/mL,(7.56±1.25)ng/L,respectively)were lower than those before treatment((9.63±1.67)mg/L,(33.14±4.10)pg/mL,(11.21±2.13)ng/L,(9.25±1.36)mg/L,(32.95±4.23)pg/mL,(11.62±2.73)ng/L,respectively),and the levels in the combination group were lower than those in the monotherapy group(t=4.330,4.032,9.369,all P<0.05).The incidence of adverse reactions in the combination group was 13.21%(7/53),compared to 20.75%(11/53)in the monotherapy group,and the difference was not statistically significant(χ^(2)=1.071,P>0.05).Conclusion Rebamipide combined with vonoprazan is significantly effective in treating artificial ulcers after ESD.It can effectively promote ulcer healing,improve quality of life,alleviate gastrointestinal symptoms and inflammatory responses,with a good safety profile.
作者
吴成甫
张静文
李阳
董坤伦
WU Chengfu;ZHANG Jingwen;LI Yang;DONG Kunlun(Digestive Endoscopy Center,Nanyang Second General Hospital,Nanyang 473000,China)
出处
《中国药物应用与监测》
2026年第3期447-452,共6页
Chinese Journal of Drug Application and Monitoring
基金
南阳市科技计划项目(24KJGG243)。
关键词
瑞巴派特
伏诺拉生
内镜黏膜下剥离术
人工溃疡
愈合
rebamipide
vonoprazan
endoscopic submucosal dissection
artificial ulcer
healing
