中西医结合治疗对便秘型肠易激综合征和功能性消化不良重叠患者肠道微生态的影响

Influence of combined treatment with traditional Chinese medicine and Western medicine on intestinal microecology of patients with constipation-predominant irritable bowel syndrome overlapping functional dyspepsia

目的探讨中西医结合治疗对便秘型肠易激综合征(IBS-C)和功能性消化不良(FD)重叠患者肠道微生态的影响。方法90例IBS-C和FD重叠患者随机分为观察组和对照组各45例。两组患者均给予莫沙必利片5mg/次,3次/d,餐前30min口服。观察组患者加用加味半夏泻心汤,1剂/d。两组患者均连用8周。分析两组患者治疗前与治疗8周后肠道微生态变化,并判断疗效及不良反应。结果治疗8周后,两组患者肠道双歧杆菌和乳杆菌数量较治疗前不同程度增加,大肠埃希菌数量不同程度减少(P<0.05或P<0.01),且观察组患者变化幅度大于对照组(P<0.05)。同时观察组患者临床总有效率(95.56%)高于对照组(82.22%),差异有统计学意义(χ^2=4.05,P<0.05)。观察组和对照组分别出现不良反应3例(6.67%)和5例(11.11%),症状较轻微,两组比较差异无统计学意义(χ^2=0.14,P >0.05)。结论加味半夏泻心汤联合莫沙必利治疗IBS-C和FD重叠患者效果肯定,具有较高的安全性,其机制可能与其能纠正肠道微生态紊乱,重建肠道菌群平衡,改善胃肠功能密切相关。

Objective To discuss the influence of combined treatment with traditional Chinese medicine and Western medicine on intestinal microecology of patients with constipation-predominant irritable bowel syndrome (IBS-C) overlapping functional dyspepsia (FD). Methods 90 cases of IBS-C overlapping FD were randomly divided into the observation group or control group, 45 cases in each group. The patients in both groups were given Mosapride 5 mg, tid, orally, 30 minutes before meal for 8 weeks;the patients in observation group were additionally given Jiawei Banxia Xiexin Decoction, one dose daily, for 8 weeks. The changes of intestinal microecology were observed, and the clinical efficacy and adverse reactions (ADRs) were compared between two groups. Results After treatment, the quantities of Bifidobacteria and Lactobacilli in both groups were obviously increased, while those of Escherichia coli obviously were declined (P<0.05 or P<0.01), with the observation group being superior to the control group (P<0.05). The total clinical efficiency rate in observation group (95.56%) was much higher than that in control group (82.22%) (χ^2=4.05, P<0.05). Three (6.67%) and five (11.11%) cases of ADRs appeared in observation group and control group respectively with mild symptoms;the difference was not statistically significant (χ^2 =0.14, P >0.05). Conclusion The combination of Jiawei Banxia Xiexin Decoction and Mosapride has reliable efficacy for treatment of IBS-C overlapping FD with satisfactory safety. The mechanism of action is possibly related to the effects of rebuilding the balance of intestinal microecology, adjusting the disorder of intestinal flora and improving gastrointestinal function.