四逆散加味联合布拉氏酵母菌治疗小儿功能性消化不良的临床疗效及对血清细胞因子的影响

Clinical Efficacy of Modified Sinisan Combined with Saccharomyces Brasiliensis on Functional Dyspepsia in Children and Its Effect on Serum Cytokines

目的:探讨四逆散加味(气滞胃痛颗粒)联合布拉氏酵母菌治疗小儿功能性消化不良(FD)的临床疗效及血清细胞因子、胃肠激素的变化。方法:将156例FD患者随机分为对照组和观察组,每组78例,对照组单纯用布拉氏酵母菌0. 25 g/次,2次/d,餐后口服;观察组在对照组基础上联合四逆散加味(气滞胃痛颗粒) 2. 5 g/次,3次/d,餐前30 min口服。4周为1疗程。观察两组临床疗效、症状改善时间、血清细胞因子及胃肠激素水平的变化,且随访6个月观察其复发率。结果:观察组总有效率(96. 15%)较对照组(82. 05%)显著升高(P<0. 01)。治疗前两组患者血清干扰素-γ(IFN-γ),肿瘤坏死因子-α(TNF-α),白细胞介素-10(IL-10),胃动素(MTL)和血清瘦素(Leptin)水平比较无统计学差异。治疗后,两组血清IL-10,MTL水平均较本组治疗前上升,IFN-γ,TNF-α,Leptin水平较本组治疗前下降,但治疗组下降或上升幅度显著大于对照组(P<0. 01)。观察组症状消失时间显著短于对照组(P<0. 01)。随访6月后观察组复发率6. 67%,较对照组的18. 75%明显降低(P<0. 05)。结论:四逆散加味(气滞胃痛颗粒)联合布拉氏酵母菌治疗小儿FD具有显著的临床疗效及较低的复发率。其作用机制可能与中西医结合用药能有效调节血清细胞因子及胃肠激素水平有关。

Objective: To discuss the clinical efficacy of modified Sinisan( Qizhi Weitong granule) and saccharomyces boulardi in treating functional dyspepsia( FD) in children,and its effect on changes in serum cytokine and gastrointestinal hormones. Method: Totally 156 cases were divided into control group( 78 cases) and observation group( 78 cases). The control group was treated with saccharomyces boulardi,0. 25 g,po,bid,after meal. In addition to the therapy of control group,the observation group was also given modified Sinisan( Qizhi Weitong granule),2. 5 g,po,tid,30 minutes before meal. Four weeks was a course of treatment. Then the clinical efficacy,the time of symptom improvement and the change of serum cytokine and gastrointestinal hormones were observed. Result: The total effective rate of observation group( 96. 15%) was higher than that of control group( 82. 05%), with statistical difference( P< 0. 01). The serum levels of interleukin-10( IL-10),interferon-γ( IFN-γ),tumor necrosis factor-α( TNF-α),plasma motilin( MTL) and Leptin of both groups had no statistical difference before treatment. After treatment,the serum levels of IL-10,MTL of both group were increased,while the serum levels of IFN-γ, TNF-α, Leptin of both group were decreased. However, the decreasing range and the increasing range of observation group were statistically obvious than those of control group( P< 0. 01). After the 6-month follow-up,the recurrent rate( 6. 67%) of the observation group was statistically lower than that of control group( 18. 75%). Conclusion: Modified Sinisan( Qizhi Weitong granule) combined with saccharomyces boulardi have an obvious clinical efficacy in treating child's FD,with a low recurrence. The mechanism may be correlated with the effect of integrated Chinese and Western medicines in regulating serum cytokine and gastrointestinal hormones levels.