多塞平联合匹维溴铵及培菲康治疗腹泻型肠易激综合征的临床研究

Clinical Study of factors that related to diarrhea predominant irritable bowel syndrome

目的选用胃肠动力调节剂、肠道微生态制剂以及三环类抗抑郁药,针对IBS发病可能的病因干预治疗,观察单药、双药及三药治疗对腹泻型肠易激综合征(D-IBS)的临床疗效及交互治疗作用。方法选择D-IBS患者128例,均符合罗马Ⅱ标准,并经肠镜排除肠道器质性疾病,其中103例按规定要求完成。患者按用药分为以下4组:单用匹维溴铵(商品名:得舒特)组26例,匹维溴铵+双歧三联活菌(商品名:培菲康)组28例,匹维溴铵+多塞平组25例,匹维溴铵+双歧三联活菌+多塞平组24例。用药前后4周分别作IBS症状评分及SF-36生活质量评分。结果针对IBS可能的发病因素给于干预阻断治疗后,4组治疗前后自身对照在肠道症状的控制和生活质量的改善方面都有十分明显作用,联合干预则作用更明显;多塞平和双歧三联活菌对IBS患者生活活力及社会功能的影响效应存在协同作用(P<0.05);多塞平对缓解IBS患者躯体疼痛及提高情感职能起主效应(P<0.05)。结论针对IBS发病相关因素进行不同干预都可有效治疗IBS患者,IBS发病因素间互为影响,从治疗角度支持脑-肠互动在IBS发病中的重要作用。

OBJECTIVE To evaluate the effecacy of irritable bowel syndrome （IBS） with pinaverium bromide,probiotics and tricyclic antidepressant.Investigate the treatment interaction between probiotics and tricyclic antidepressant.METHODS 128 patients with diarrhea-predominant IBS,who fulfilled the Rome Ⅱ criteria and excluded organic disease by enteroscope,were recruited,Among them 103 patients completed the trial.The patients were randomly divided into pinaverium bromide treatment group（Dicetel,n=26）,pinaverium bromide with Bifco（n=28） or combinded with doxepin group（n=25）or combinded with Bifco and doxepin group（n=24）.The IBS symptoms and quality of life were evaluated using IBS symptom table and SF-36 table before and after 4 weeks treatment,respectively.RESULTS The symptoms of IBS and quality of life of all patients were improved after treatment,multi-interventions had an obviously better effect than minority interventions.Bifico and doxepin had an obvious additive effect on improving vitality and social functions（P0.05）.Doxepin had an obvious effect on ameliorating bodily pain and emotional problems（P0.05）.CONCLUSION There is close relation between brain and gut in patients with IBS,which may be involved in the pathogenesis of IBS.