益肠止泻方治疗腹泻型肠易激综合征50例

目的:探讨益肠止泻方治疗腹泻型肠易激综合征(IBS-D)的临床疗效及对血清5-羟色胺(5-HT),P物质(SP),血管活性肠肽(VIP),生长抑素(SS)等脑肠肽因子的影响。方法:将100例IBS-D患者采用随机按数字表法分为对照组和观察组各50例,对照组采用氟哌噻吨美利曲辛片,1片/次,于早晨和中午口服;双歧杆菌三联活菌散口服,2 g/次,3次/d;蒙脱石散口服,3 g/次,3次/d。观察组在对照组治疗的基础上加服益肠止泻方,1剂/d。两组疗程均为4周。记录治疗前后消化系统主要症状评分;于治疗前、治疗后及随访期进行IBS患者专用生活质量量表(IBS-QOL)评分;记录3个月随访期患者得发率情况,检测治疗前后患者血清5-HT,SP,VIP和SS水平。结果:经Ridit分析,观察组临床疗效优于对照组(P0.05);治疗后观察组消化系主要症状(腹痛、腹胀、排便次数、粪便形状和黏液便)评分低于对照组(P0.01);观察组在治疗后和随访期IBS-QOL评分均高于对照组(P0.01);随访3个月后,观察组复发率为45.8%,低于对照组的69.2%(P0.05);治疗后观察组5-HT,SP,VIP和SS水平低于对照组(P0.01)。结论:益肠止泻方能减轻IBS-D患者临床症状、提高患者生活质量,降低远期复发率,其作用机制可能是通过调节5-HT,SP,VIP和SS等脑肠肽因子来实现的,值得进一步研究。

Clinical Research of Yichang Zhixie Decoction in Treating 50 Cases with Diarrhea Predominant Irritable Bowel Syndrome

Objective: To discuss the clinical effects of Yichang Zhixie decoction on diarrhea predominant irritable bowel syndrome (IBS-D) and to investigate its influence on brain-gut peptide factors including serum 5-hydroxytryptamine (5-HT), substance P (SP), vasoactive intestinal peptide (VIP), somatostatin (SS), etc. Method: One hundred patients with IBS-D were randomly divided into the control group and the observation group (50 cases in each group). Patients in control group took orally 1 piece of flupentixol and melitracen tablet each morning and noon, and 2 g live combined bifidobacterium thrice daily. Based on the treatment of control group, patients in the observation group added 1 does of Yichang Zhixie decoction. Patients in both groups received a 4-week period of treatment. The digestive main symptom and the special quality of life scale (IBS-QOL) were scored before and after treatment. The prevalence and incidence situation of patients were recorded during 3-month period of follow-up. The levels of serum 5-HT, SP, VIP and SS were detected. Result: The clinical curative effect of observation group was superior to that of control group (P<0.05). The main digestive symptoms scores (abdominal pain, abdominal distension, defecation times, stool shape and mucous stool) in observation group were less than those in control group (P<0.01). IBS-QOL score of observation group was higher than that of control group after treatment and during follow-up period (P<0.01). The recurrence rate of observation group was 45.8%, which was inferior to 69.2% of control group during follow-up period (P<0.05). Levels of 5-HT, SP, VIP and SS in observation group were lower than those in control group (P<0.01). Conclusion: Yichang Zhixie decoction could reduce clinical symptoms, improve quality life and reduce long-term recurrence rate of IBS-QOL patients. Its action mechanism may be related to adjusting the levels of 5-HT, SP, VIP, and SS, although the exact mechanism deserves further study.