痛泻要方对肝郁脾虚型IBS-D患者的临床疗效及其机制

目的:观察痛泻要方对肝郁脾虚型肠易激综合征(irritable bowel syndrome-D,IBS-D)的临床疗效,通过比治疗前后肠道菌群变化探讨其调节脑肠交互机制。方法:将2016年7月至2018年12月就诊的116例肝郁脾虚型IBS-D患者,随机分为观察组及对照组,各58例,观察组患者使用痛泻要方全方口服治疗,对照组患者接受匹维溴铵口服治疗,两组患者治疗周期均为4周。比较两组患者治疗前后中医证候疗效评分(traditional Chinese medicine pattern curative effect scoring system,TCMPES),IBS生活质量问卷评分(IBS quality of life questionnaire,IBS-QOL),焦虑自评量表(self-rating anxiety scale,SAS)积分及抑郁自评量表(self-rating depression scale,SDS)积分;采用酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)检测患者治疗前后血浆血管活性肽(vasoactive intestinal peptide,VIP),降钙素基因相关肽(calcitonin gene related peptide,CGRP)水平;采用实时荧光定量聚合酶链式反应(quantitative Real-time,PCR)检测治疗前后患者大肠埃希菌、双歧杆菌、嗜酸乳杆菌、粪链球菌等肠道菌群变化。结果:两组患者治疗后TCM-PES评分下降,IBS-QOL评分提高,观察组患者治疗后TCM-PES评分低于对照组,IBS-QOL评分高于对照组(P<0.05);观察组患者中医证候疗效有效率明显高于对照组(P<0.05);观察患者治疗后SAS,SDS评分明显降低,治疗后观察组患者SAS,SDS评分低于对照组(P<0.05);两组患者治疗后血浆CGRP,VIP均下降,观察组患者血浆CGRP,VIP明显低于对照组(P<0.05);两组患者治疗后大肠埃希菌均差异无统计学意义,观察组患者治疗后肠道嗜酸乳杆菌、双歧杆菌、粪链球菌较本组治疗前增长(P<0.05),对照组患者治疗后肠道嗜酸乳杆菌较本组治疗前增长(P<0.05),观察组患者治疗后肠道嗜酸乳杆菌、双歧杆菌、粪链球菌较对照组增长(P<0.05)。结论:中药痛泻要方可减轻肝郁脾虚型IBS-D患者腹痛、腹泻等临床症状,改善患者不良情绪,提高患者生活质量,这可能与痛泻要方改善患者肠道菌群失调,调节脑肠肽分泌,降低内脏高敏有关。

Clinical Efficacy and Mechanism of Tongxie Yaofang on Patients with IBS-D of Liver Depression and Spleen Deficiency

Objective To observe the clinical efficacy of Tongxie Yaofang on irritable bowel syndrome-D (IBS-D) of liver-stagnation and spleen-deficiency type, in order to explore its mechanism in regulating brain-intestine interaction by changing the intestinal flora before and after treatment.Method Totally 116 patients with IBS-D with liver stagnation and spleen deficiency who were diagnosed from July 2016 to December 2018 were randomly divided into observation group and control group, with 58 patients in each group. Observation group was treated with Tongxie Yaofang orally. Control group was treated with pivalvonium orally. Both groups were treated for 4 weeks. Scores of traditional Chinese medicine pattern curative effect scoring system (TCM-PES), IBS quality of life questionnaire (IBS-QOL), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) of two groups were compared before and after treatment. Calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP) were detected before and after treatment by enzyme-linked immunosorbent assay (ELISA). Real-time fluorescent quantitative polymerase chain reaction(Real-time PCR) was used to detect changes in Escherichia coli, Bifidobacteria, Lactobacillus acidophilus and Streptococcus faecalis and other intestinal flora before and after treatment.Result TCM-PES and IBS-QOL scores of two groups were improved after treatment. TCM-PES and IBS-QOL scores of observation group were higher than those of control group (P<0.05). TCM syndromes of observation group were significantly higher than those of control group (P<0.05). SAS and SDS scores were significantly lower after treatment. SAS and SDS scores of observation group were lower than those of control group after treatment (P<0.05). Plasma CGRP and VIP decreased after treatment. Plasma CGRP and VIP in observation group were significantly lower than those in control group (P<0.05). There was no significant change in E. coli after treatment in two groups. After treatment, L. acidophilus, Bifidobacterium, and S. faecalis increased (P<0.05). In control group, intestinal L. acidophilus increased after treatment (P<0.05). The differences of intestinal L. acidophilus, Bifidobacterium, S. faecalis in two groups were statistically significant (P<0.05).Conclusion TCM can alleviate clinical symptoms, such as abdominal pain and diarrhea in patients with IBS-D, improve patients'' bad mood and improve their quality of life. This may be related to improvement of intestinal flora imbalance, regulation of brain intestinal peptide secretion and reduction of visceral hypersensitivity.