附子理中汤合四神丸加减治疗脾肾阳虚型腹泻型肠易激综合征

目的:探讨附子理中汤合四神丸加减治疗腹泻型肠易激综合征(IBS-D)脾肾阳虚型的疗效以及对直肠黏膜蛋白酶激活受体(PAR)2和PAR4的影响。方法:收集就诊于IBS-D患者共120例,采用数字表法随机分为治疗组和对照组各60例;基础治疗参照《肠易激综合征中西医结合诊治方案(草案)》制定标准给予非药物治疗;对照组口服枯草杆菌二联活菌肠溶胶囊,2粒/次,2次/d;治疗组采用附子理中汤合四神丸加减治疗,1剂/d,常规水煎煮2次,分早晚2次内服。两组患者均连续治疗6周。比较两组临床症状评分、大便性状评分和排便情况;检测两组直肠黏膜中PAR2和PAR4水平。结果:治疗组治疗后患者临床症状评分明显低于对照组(P0.01);治疗组临床总有效率为96.67%,对照组为83.33%,比较差异有统计学意义(P0.05);治疗组治疗后患者大便性状评分和10 d中排便急迫天数均明显减少(P0.01);治疗后治疗组PAR2和PAR4水平均明显低于对照组,比较差异有统计学意义(P0.01)。结论:附子理中汤合四神丸加减治疗IBS-D脾肾阳虚证可减少临床症状,改善排便情况,提高临床疗效,下调直肠黏膜PAR2和PAR4水平。

Treatment of Fuzi Lizhong Tang Plus Sishen Wan in Treating Diarrhea Type Irritable Bowel Syndrome with Spleen and Kidney Deficiency Syndrome

Objective: To investigate the efficacy of Fuzi Lizhong Tang plus Sishen Wan in treating diarrhea type irritable bowel syndrome (IBS-D) with spleen and kidney deficiency syndrome and observe its effect on protease activated receptor 2 (PAR2)and PAR4 of mucous membrane of rectum. Method: One hundred and twenty IBS-D patients were randomly divided into treatment group (60 cases) and control group (60 cases) according to random number table. All cases were given with non-drug therapy referring to Diagnosis and Treatment Plan of Integrated Chinese and Western Medicine for Irritable Bowel Syndrome. Patients of control group also orally received bacillus subtilis and enterococcus faecium enteric-coated capsules, 2 tablets/time and bid. While the patients of treatment group were also given with Fuzi Lizhong Tang plus Sishen Wan, 1dose/d and bid. The treatment course was 6 weeks for both groups. The clinical symptom scores, stool property score, and defecation were compared between two groups. PAR2 and PAR4 levels of mucous membrane of rectum were detected for two groups. Result: The clinical symptom scores in treatment group were significantly lower than those in control group after treatment (P<0.01). The clinical efficacy was 96.67% and 83.33% respectively in treatment group and control group, with statistically significant difference between two groups (P<0.05). Scores of stool property and days for defecation urgency within 10 days in treatment group were significantly decreased after treatment (P<0.01). After treatment, PAR2 and PAR4 levels of mucous membrane of rectum in treatment group were lower than those in control group, with statistically significant difference (P<0.01). Conclusion: Fuzi Lizhong Tang plus Sishen Wan in treatment of IBS-D with spleen and kidney deficiency can decrease symptom scores, improve defecation, enhance clinical efficacy, and down-regulate PAR2 and PAR4 levels of mucous membrane of rectum.