氟西汀联用加味痛泻要方治疗难治性感染后肠易激综合征

目的：探讨氟西汀联用加味痛泻要方治疗难治性感染后肠易激综合征（postinfectious irritable bowel syndrome,PI-IBS）的疗效.方法：选择2006年3月-2008年12月难治性PI-IBS患者38例,IBS诊断符合罗马Ⅲ诊断标准,中医辨证属肝郁脾虚,随机分入两组：氟西汀组（n=19）：接受常规药物治疗,并口服氟西汀20 mg,每日1次,疗程12周;氟西汀＋加味痛泻要方组（n=19）：接受常规药物及氟西汀治疗,并服用加味痛泻要方,每日1剂,疗程8或12周.常规药物治疗包括匹维溴铵、双八面体蒙脱石或洛哌丁胺、培菲康.并予健康宣教和饮食指导.疗程结束继续随访24周,并根据需要继续常规药物治疗.所有患者在治疗前、后采用症状频率和严重指数、SCL-90症状自评量表和SF-36生活质量量表对肠道症状、一般精神状态、生活质量进行评价.结果：氟西汀＋加味痛泻要方组患者肠道症状评分从治疗前的11.80±5.41在第8周和第12周时分别降低至7.15±3.15（P＜0.05）和5.94±3.70（P＜0.01）,氟西汀组在治疗前、第8周和第12周时评分分别为11.23±5.35、9.80±4.02和10.11±4.48.两组间的差异持续至随访期结束.氟西汀＋加味痛泻要方组患者一般精神状态明显改善,尤其是抑郁和焦虑因子分在第20周时分别从治疗前的2.89±0.92和2.83±0.73降低至1.87±0.51和1.85±0.50.氟西汀＋加味痛泻要方组患者生活质量明显改善.两组患者各有1例恶心,氟西汀组1例口干、烦躁不安,氟西汀＋加味痛泻要方组1例头痛.结论：氟西汀联用加味痛泻要方可有效改善难治性PI-IBS患者肠道症状、一般精神状态和生活质量,并具有良好的安全性.

Efficacy of Fluoxetine Combined with Modified Recipe for Diarrhea with Pain (Tongxie Yaofang) on Refractory Postinfectious Irritable Bowel Syndrome

Objective： To investigate the efficacy of fluoxetine combined with Modified Recipe for Diarrhea with Pain （Tongxie Yaofang, MRDP） on refractory postinfectious irritable bowel syndrome （IBS）. Methods： From March, 2006 to December, 2008, thirty-eight patients with refractory IBS after acute gastroenteritis, which were diagnosed according to Rome Ⅲ criteria and Traditional Chinese Medical syndrome differentiation, were randomly assigned to two groups. Fluoxetine Group （n= 19）： received fluoxetine 20 mg/d for 12 weeks besides routine treatments. Fluoxetine ＋ MRDP Group （n= 19）： besides routine treatments and fluoxetine, received MRDP for 8 or 12 weeks. The routine treatments include pinaverium bromide, smeetite, lopemmide, and bifico （Peifeikang） as well as health education about IBS and guidance on diets. All patients were followed up for following 24 weeks with receiving routine treatments when necessary. The clinical outcomes were evaluated by severity index of symptoms of IBS, Symptom Chectlist- 90 （SCL- 90） for general psychiatric health, and SF- 36 tables for quality of life before and after treatments, respectively. Results： The severity index of symptoms of IBS in Fluoxetine ＋ MRDP Group decreased from 11.80 ± 5.41 at baseline to 7.15 ± 3.15 （ P 〈 0.05） at week 8, and 5.94 ±3.70 （ P 〈 0. 01 ） at week 12, comparing from 11.23 ± 5.35 at baseline to 9.80 ± 4.02 at week 8, and 10. 11± 4.48 at week 12 in Fluoxetine Group, respectively. The significantly statistic differences persisted during the follow- up period. The status of general psyehi- attic health of patients in Fluoxetine ＋ MRDP Group was improved significantly, especially in which the scores of depression and anxiety decreased from 2.89 ± 0.92 and 2.83 ±0.73 at baseline to 1.87 ± 0.51 and 1.85 ± 0.50 at week 20, respectively. The quality of life in Fluoxetine ＋ MRDP Group was also improved significantly at week 12, and continuing improvements were found during the follow- up period. Slight side effects includ- ing nausea in 2 cases, dry mouth and fidgetiness in lcase, and headache in 1 case were recorded in two groups. Conclusion： The treatment of fluox- etine combined with MRDP in patients with refractory postinfectious IBS revealed efficacy in reducing severity index of symptoms, improving general psychiatric health and quality of life, with satisfactory safety.