【目的】 观察针刺联合加味左金丸颗粒剂治疗肝胃不和型反流性食管炎（RE）的临床疗效。【方法】 选取2022年10月至 2024年10月在自贡市第一人民医院病房及门诊收治的100例明确诊断为肝胃不和型RE的患者为研究对象。按随机数字表将 患者随机分为观察组和对照组，每组各50例。对照组给予加味左金丸颗粒剂治疗，观察组在对照组治疗的基础上联合针刺 治疗。连续治疗4周。治疗1个月后，评价2组临床疗效。观察2组患者治疗前后中医证候积分的变化情况，以及胃液反流 的情况。比较 2组患者治疗前后胃泌素（GAS）、胃动素（MTL）、血管活性肠肽（VIP）含量的变化情况，以及肠道菌群数量的 情况。并评价2组的安全性及不良反应的发生情况。【结果】（1）治疗后，2组患者的各项中医证候积分均明显改善（P＜0.05）， 且观察组在改善各项中医证候积分方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2组患者的 24 h食管内 胃液反流次数、最长反流时间均明显改善（P＜0.05）。且观察组在改善24 h食管内胃液反流次数、最长反流时间方面明显优 于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2组患者的血清GAS、MTL、VIP含量均明显改善（P＜0.05）。且观察组 在改善血清GAS、MTL、VIP含量方面明显优于对照组，差异有统计学意义（P＜0.05）。（4）治疗后，2组患者的乳酸菌、双歧 杆菌数量较治疗前明显升高（P＜0.05），肠球菌、肠杆菌数量明显减少（P＜0.05）。观察组的肠道菌群数量改善更加明显，差 异有统计学意义（P＜0.05）。（5）观察组总有效率为96.00%（48/50），对照组为80.00%（40/50）。观察组疗效优于对照组，差异 有统计学意义（P＜0.05）。（6）观察组不良反应发生率为8.00%（4/50）；对照组为12.00%（6/50）。观察组与对照组的不良反应发 生率比较，差异无统计学意义（P＞0.05）。【结论】 针刺联合加味左金丸颗粒剂治疗肝胃不和型RE，能明显改善患者的临床症 状，有效地改善患者胃肠激素和肠道菌群水平，且安全性良好，临床疗效显著。

Objective To evaluate the clinical efficacy of acupuncture combined with Modified Zuojin Granules in treating reflux esophagitis （RE） with liver-stomach disharmony syndrome. Methods A total of 100 patients diagnosed with liver-stomach disharmony syndrome RE were enrolled from October 2022 to October 2024 at Zigong First People’s Hospital. The patients were randomly assigned to the observation group and the control group，with 50 cases in each group. The control group was treated with Modified Zuojin Granules，while the observation group was given acupuncture plus Modified Zuojin Granules，both group were treated for 4 weeks. The changes in the traditional Chinese medicine （TCM） syndrome scores，24-hour esophageal acid reflux parameters （frequency and longest duration），serum gastrointestinal hormones [gastrin （GAS），motilin （MTL），vasoactive intestinal peptide （VIP）]，gut microbiota composition （Lactobacillus，Bifidobacterium，Enterococcus，Enterobacter） were observed.The adverse reactions and safety profiles were evaluated. Results （1） Both groups showed significant improvement in TCM syndrome scores （P＜0.05），with greater improvement in the observation group，and the differences were statistically significant （P＜0.05）.（2） After treatment，both groups of patients showed significant improvements in the number of gastric reflux episodes in the oesophagus over 24 hours and the longest reflux duration （P＜0.05）. The observation group demonstrated significantly better improvements in the number of gastric reflux episodes in the oesophagus over 24 hours and the longest reflux duration compared to the control group， with statistically significant differences （P＜0.05）.（3） After treatment，the serum levels of GAS，MTL，and VIP in both groups of patients were significantly improved （P＜0.05）. The observation group showed significantly better improvement in serum GAS，MTL，and VIP levels compared to the control group，with statistically significant differences （P＜ 0.05）.（4） After treatment， the levels of Lactobacilli and Bifidobacteria in both groups increased significantly compared to before treatment （P＜0.05）， while the levels of Enterococci and Enterobacteria were significantly decreased （P＜0.05）. The improvement in intestinal microbiota levels was more pronounced in the observation group，with statistically significant differences （P＜0.05）.（5） The overall efficacy rate was 96.00% （48/50） in the observation group and 80.00% （40/50） in the control group. The observation group demonstrated superior efficacy compared to the control group，with statistically significant differences （P＜0.05）.（6） The incidence of adverse reactions in the observation group was 8.00% （4/50），while that in the control group was 12.00% （6/50）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion The combined therapy significantly improves clinical symptoms， modulates gastrointestinal hormones and gut microbiota，demonstrating excellent efficacy and safety for liver-stomach disharmony syndrome RE.

R246.9

自贡市卫生健康委员会青年项目（编号：24yb093）；自贡市第一人民医院科技计划项目（编号2024GZL21）