痛泻四神汤腹泻型肠易激综合征的胃肠激素水平变化及临床意义观察

目的:探究痛泻四神汤对腹泻型肠易激综合征胃肠激素水平的影响。方法:选取2017年2月至2018年6月西安市中医医院收治的腹泻型肠易激综合征患者124例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组62例。对照组给予西医常规治疗,观察组在对照组基础上加用痛泻四神汤加减治疗,均治疗2周。观察和比较2组治疗前后淋巴细胞指标CD3^+、CD4^+、CD8^+、CD4^+/CD8^+变化,观察并比较2组治疗前后胃肠激素指标血浆胃动素(MOT)、降钙素相关基因肽(CGRP)、血管活性肠肽(VIP)、生长抑素(SS)、一氧化氮(NO)变化;观察并比较2组治疗前后在γ-干扰素(IFN-γ)、5-羟色胺(5-HT)、神经肽Y(NPY)含量变化;观察并比较2组治疗前后临床症状腹痛、腹胀、肠鸣失气、急躁易怒、神疲乏力、纳呆食少症状评分变化;治疗过程中进行不良反应记录,治疗结束后进行统计。结果:1)2组患者治疗前CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比较,差异无统计学意义(P>0.05),治疗后2组CD3^+、CD4^+、CD4^+/CD8^+较治疗前均显著上升,CD8^+显著下降(均P<0.05);治疗后观察组患者CD3^+、CD4^+、CD4^+/CD8^+显著高于对照组,CD8^+显著低于对照组(P<0.05)。2)2组治疗前MOT、CGRP、VIP、SS、NO比较,差异无统计学意义(P>0.05),治疗后2组MOT、NO较治疗前显著升高,CGRP、VIP、SS显著下降(P<0.05);治疗后观察组CGRP、VIP、SS显著低于对照组,MOT、NO显著高于对照组(P<0.05)。3)2组治疗前IFN-γ、5-HT、NPY比较,差异无统计学意义(P>0.05),治疗后2组IFN-γ、5-HT、NPY较治疗前均显著下降(P<0.05);治疗后观察组IFN-γ、5-HT、NPY显著低于对照组(P<0.05)。4)2组治疗前腹痛、腹胀、肠鸣失气、急躁易怒、神疲乏力、纳呆食少积分比较,差异无统计学意义(P>0.05),治疗后2组以上各症状评分较治疗前显著下降(P<0.05);治疗后观察组以上各积分显著低于对照组(P<0.05)。5)2组口干、头痛、皮疹、胃肠道反应发生率比较,差异无统计学意义(P>0.05)。结论:痛泻四神汤能改善腹泻型肠易激综合征胃肠激素水平,改善临床症状,提高机体免疫力,提高疗效。

Changes of Gastrointestinal Hormones in Diarrhea Predominant Irritable Bowel Syndrome Treated by Tongxie Sishen Decoction and Its Clinical Significance

Objective:To explore the effects of Tongxie Sishen Decoction on gastrointestinal hormone level in diarrhea-predominant irritable bowel syndrome(IBS),so as to select the best treatment plan and improve the curative effect.Methods:A total of 124 patients with diarrhea-predominant irritable bowel syndrome were enrolled in Xi′an Traditional Chinese Medicine Hospital from February 2017 to June 2018.They were randomly divided into a control group(62 cases)and an observation group(62 cases).The control group was treated with routine western medicine,while the observation group was treated with Tongxie Sishen Decoction for 2 weeks.The changes of lymphocyte indexes CD3^+,CD4^+,CD8^+,CD4^+/CD8^+ before and after treatment were observed and compared between the 2 groups.The gastrointestinal hormone indexes such as plasma motilin(MOT),calcitonin-related gene peptide(CGRP),vasoactive intestinal peptide(VIP),somatostatin(SS)and nitric oxide(NO)were observed before and after treatment.Changes and comparisons were made between the 2 groups before and after treatment.Changes in the contents of interferon-gamma(IFN-gamma),serotonin(5-HT),neuropeptide Y(NPY)were observed and compared between the 2 groups before and after treatment.Changes in clinical symptoms such as abdominal pain,abdominal distention,intestinal ringing,irritability,mental fatigue and low appetite scores were observed and compared between the 2 groups before and after treatment.The adverse reactions during the treatment were compared and recorded,and make statistics after the end of treatment.Results:1)There was no significant difference in CD3^+,CD4^+,CD8^+,CD4^+/CD8^+ between the 2 groups before treatment(P>0.05).After treatment,CD3^+,CD4^+,CD4^+/CD8^+ in the 2 groups increased significantly,while CD8^+decreased significantly(P<0.05).After treatment,CD3^+,CD4^+,CD4^+/CD8^+ in the observation group were significantly higher than those in the control group.CD8^+ was significantly lower than that in the control group(P<0.05).2)There was no significant difference in MOT,CGRP,VIP,SS and NO between the 2 groups before treatment(P>0.05).After treatment,MOT and NO in the 2 groups increased significantly,and CGRP,VIP and SS decreased significantly(P<0.05).After treatment,CGRP,VIP and SS in the study group were significantly lower than those in the control group,while MOT and NO were significantly higher than those in the control group(P<0.05).3)There was no significant difference in IFN-gamma,5-HT and NPY between the 2 groups before treatment(P>0.05).After treatment,the levels of IFN-gamma,5-HT and NPY in the 2 groups were significantly decreased than those before treatment(P<0.05).After treatment,the levels of IFN-gamma,5-HT and NPY in the study group were significantly lower than those in the control group(P<0.05).4)There was no significant difference in the scores of abdominal pain,abdominal distension,intestinal ringing and loss of breath,irritability,mental fatigue and less starvation before treatment between the 2 groups(P>0.05).After treatment,the scores of the 2 groups decreased significantly compared with those before treatment(P<0.05),and those of the study group were significantly lower than those of the control group(P<0.05).There was no significant difference in the ratio of dry mouth,headache,rash and gastrointestinal reaction between the 2 groups(P>0.05).Conclusion:Tongxie Sishen Decoction can improve the gastrointestinal hormone level,clinical symptoms,immunity and curative effect of diarrhea-predominant irritable bowel syndrome.