痛泻要方合四君子汤加减对腹泻型肠易激综合征患者脑肠肽的影响

目的 探讨痛泻要方合四君子汤治疗腹泻型肠易激综合征（IBS-D）患者的临床疗效及其对血浆脑肠肽的影响。方法 53例患者符合Rome Ⅲ制定的IBS-D的诊断标准，随机分为2组:治疗组27例，予痛泻要方合四君子汤加减；对照组26例，予得舒特片联合思连康片；疗程4周，观察2组患者治疗前后的临床症状积分、生活质量量表（IBS-QOL）、神经肽Y（NPY）、降钙素基因相关肽（CGRP）及血管活性肠肽（VIP）水平的变化。结果 治疗组总有效率为92.6%，明显高于对照组76.9%( P ＜0.05)；治疗后治疗组的临床症状评分明显低于对照组（ P ＜0.05）；治疗组IBS-QOL量表积分高于对照组( P ＜0.05)。治疗后2组血浆NPY水平显著升高，CGRP和VIP水平显著下降（ P ＜0.05~0.01），2组间差异有统计学意义（ P ＜0.05）。结论 痛泻要方合四君子汤能显著改善IBS-D患者的临床症状，提高生活质量，其作用机制可能通过升高血浆NPY水平，降低CGRP和VIP水平，调节脑肠肽分泌平衡相关。 

Effect of Tongxie Yao Fang Combined with Sijunzi Decoction on Brain-Gut Peptide in Irritable Bowel Syndrome Patients with Diarrhea Type

OBJECTIVE To explore the clinical efficacy and the brain-gut peptide effect of Tongxie Yao Fang combined with Sijunzi Decoction in the treatment of Irritable Bowel Syndrome (IBS-D) patients with diarrhea type. METHODS 53 patients diagnosed with IBS-D according to Rome Ⅲ standards were randomly divided into two groups. 27 patients in treatment group were treated with Tongxie Yao Fang combined with Sijunzi Decoction， and 26 patients in control group were given by the Pinaverium Bromide and Bifidobacterium Tablets for four weeks. The changes of clinical symptom index， quality of life (IBS-QOL)， neuropeptide Y (NPY)， calcitonin gene related peptide (CGRP) and vasoactive intestinal peptide (VIP) before and after treatment were observed. RESULTS The total effective rates in treatment group were 92.6%， significantly higher than 76.9% in control group ( P <0.05). The clinical symptom index in treatment group was significantly lower than that of the control group after treatment( P <0.05). And the score of IBS-QOL in treatment group was higher than that in control group ( P <0.05). The level of plasma NPY in both groups increased significantly after treatment， while CGRP and VIP levels decreased significantly ( P <0.05， P <0.01)， and the difference between the two groups was statistical significance ( P <0.05). CONCLUSION Tongxie Yao Fang combined with Sijunzi Decoction can significantly improve clinical symptom and QOL of IVS-D patients， and its mechanism may through the increase of plasma NPY level and the decrease of CGRP and VIP level， regulating the balance of brain-gut peptide secretion.