健脾疏肝法对腹泻型肠易激综合征患者疗效观察及对肠道菌群的影响

目的:观察健脾疏肝法指导下的健脾疏肝方联合针灸,对腹泻型肠易激综合征(irritable bowel syndrome with diarrhea,IBS-D)肝郁脾虚证临床症状及肠道菌群的影响。方法:采用数字随机表法,将70例IBS-D肝郁脾虚证患者随机分成2组。观察组35例,用健脾疏肝方联合针灸治疗4周。对照组35例,口服匹维溴铵(得舒特)治疗4周,并以30例健康人作为正常组。分别采用IBS症状尺度表(IBS bowel symptom severity scale,IBS-SSS),IBS生活质量问卷(IBS quality of life questionnaire,IBS-QOL)和中医证候疗效评分表(traditional Chinese medicine pattern curative effect scoring system,TCM-PES)评估两组患者治疗后总体临床疗效、生活质量及中医证候疗效。并通过实时定量荧光聚合酶链式反应观察2组患者治疗前后粪便中双歧杆菌、乳酸杆菌、肠杆菌、拟杆菌的数量及肠道菌群定植抗力(colonization resistance,CR)的变化。结果:①IBS-SSS量表显示,与本组治疗前比较,观察组4,8,12周均能减少量表积分(P 0. 05),对照组4,8周能减少量表积分(P 0. 05),第4周观察组积分优于对照组(P 0. 05)。观察组总有效率优于对照组(P 0. 05)。②IBS-QOL量表显示,与本组治疗前比较,观察组4,8,12周,对照组4周均能增加量表积分(P 0. 05),两组间无统计学差异。③两组在中医证候总有效率方面均有改善,且观察组优于对照组(P 0. 05)。④与本组治疗前比较,中医治疗4周后双歧杆菌、乳酸杆菌数量上升,肠杆菌数量下降,CR升高(P 0. 05)。对照组治疗后对各类菌群及CR值均无明显改变。与对照组比较,观察组双歧杆菌升高,肠杆菌下降,CR升高(P 0. 05)。各组治疗后对拟杆菌均无明显调节作用。结论:健脾疏肝法指导下的健脾疏肝方联合针灸对缓解肝郁脾虚证IBS-D患者临床症状有较好疗效,其机制可能与调节肠道菌群有关。

Efficacy of Jianpi Shugan Fomula on Intestinal Flora of Patients with Diarrhea Predominant Irritable Bowel Syndrome and Its Effect on Intestinal Flora

Objective:To observe the effect of Jianpi Shugan decoction combined with acupuncture on the clinical symptoms of diarrhea-predominant irritable bowel syndrome (IBS-D) with liver depression and spleen deficiency and the intestinal flora. Method:Seventy patients with IBS-D with liver depression and spleen deficiency were randomly divided into two groups by the random number table. The treatment group was given Jianpi Shugan decoction combined with acupuncture for 4 weeks, the control group was treated with Pivavironium bromide for 4 weeks, and 30 healthy people were used as healthy control. The total effective rate, IBS bowel symptom severity scale (IBS-BSS), IBS quality of life questionnaire (IBS-QOL) and traditional Chinese medicine pattern curative effect scoring system (TCM-PES) were evaluated. The counts of Bacillus bifidus, B.acidi lactici, Enterobacteria, and Bacteroides in feces and the colonization resistance (CR) were observed by Real-time PCR. Result:The IBS-SSS scale showed that the TCM treatment group could reduce the scores at the 4^th, 8^th, and 12^th weeks (P<0.05), and the control group could reduce the scores at 4^th and 8^th weeks (P<0.05), the 4^th week scores of TCM treatment group were better than that of control group (P<0.05). The total effective rate of TCM treatment group was better than that of control group, with statistical difference between two groups (P<0.05). The IBS-QOL scale showed that the TCM treatment group increased the scale scores at the 4^th, 8^th, and 12^th weeks, and the control group increased the scores at the 4^th week (P<0.05). There was no statistical difference between two groups. The TCM treatment group was superior to control group (P<0.05). The counts of B.bifidus and B.acidi lactici increased after 4 weeks of TCM treatment, and the count of Enterobacteria decreased (P<0.05). However, no obvious change was observed in patients of control group before and after treatment. Compared with the control group, B. bifidus increased, while Enterobacteria decreased in the TCM treatment group (P<0.05). There was no significant regulatory effect of Bacteroides after treatment in each group. Conclusion:Jianpi Shugan decoction combined with acupuncture has a reliable curative effect on IBS-D patients with liver depression and spleen deficiency. The mechanism may be related to the regulation of intestinal flora imbalance.