加味四君子汤对脾虚型肠易激综合征患者肠黏膜5-羟色胺受体的影响

Effect of Modified Sijunzi Decoction on 5-HT Receptors in Intestinal Mucosa of IBS-D Patients with Spleen-Deficiency Syndrome

目的观察加味四君子汤对腹泻型肠易激综合征(IBS-D)中医辨证为脾虚者结肠黏膜中5-羟色胺(5-HT)受体mRNA表达水平的影响,探讨其作用机制。方法将39例脾虚型IBS-D患者随机分为治疗组和对照组,另以健康志愿者为正常组。治疗组给予加味四君子汤口服,对照组给予马来酸曲美布汀口服,疗程均为4周。观察治疗前后患者症状积分的改变。对脾虚型IBS-D患者和正常组在治疗前后行结肠镜检查并取结肠黏膜标本4块,用实时荧光定量聚合酶链反应检测5-HT3和5-HT4受体mRNA的表达水平。结果治疗组患者的总有效例数高于对照组。治疗前治疗组及对照组5-HT3和5-HT4受体mRNA在结肠黏膜的表达显著升高(P<0.01);治疗后2组的5-HT3和5-HT4受体mRNA在结肠黏膜的表达显著降低(P<0.01或P<0.05),与正常组比较差异无统计学意义(P>0.05)。结论加味四君子汤可改善脾虚型IBS-D患者的主要症状,疗效优于马来酸曲美布汀,改善结肠黏膜5-HT3和5-HT4受体表达异常可能是其机制之一。

Objective To observe the effect of Modified Sijunzi Decoction on 5-HT3 and 5-HT4 receptors mRNA expression in colonic mucosa of IBS-D patients with spleen-deficiency syndrome,and explore its mechanism.Methods Thirty-nine cases of IBS-D patients with spleen-deficiency syndrome were randomly divided into treatment group and control group.In addition,healthy volunteers were chosen as the normal group.The treatment group was treated by Modified Sijunzi Decoction,and the control group was given trimebutine maleate.The treatment course was 4 weeks.The changes of symptom score were observed after treatment.The patients and the normal group were examined through colonoscopy before and after treatment,and 4 pieces of colon mucosa were collected.Fluorescence quantitative PCR was used to detect mRNA expression level of 5-HT3 and 5-HT4 receptors in mucosa.Results The total effective cases of the treatment group was higher than that of the control group.Expression level of 5-HT3 and 5-HT4 receptors mRNA in colonic mucosa of the treatment group and the control group was higher than normal group before treatment（P〈0.01）,and decreased significantly after treatment（P〈0.01 or P〈0.05）,with no significant difference with the normal group（P〈0.05）.Conclusion Modified Sijunzi Decoction can improve the symptoms of IBS-D patients with spleen-deficiency syndrome,its efficacy was superior to trimebutine maleate.Regulating the abnormal expression of 5-HT3 and 5-HT4 receptors in colonic mucosal may be one of its mechanisms.