疏肝健脾法治疗腹泻型肠易激综合征的临床研究

Clinical Study on Liver-Dispersing and Spleen-Strengthening Treatment on Diarrhea Predominant Irritable Bowel Syndrome

目的:观察疏肝健脾法治疗腹泻型肠易激综合征(IBS-D)的疗效,探寻中医药治疗腹泻型肠易激综合征可能的客观化评价指标。方法:采用随机、双盲、平行对照研究,将60例腹泻型肠易激患者用随机数字表法分为治疗组和对照组,分别用痛泻药方加减以及匹维溴胺治疗。2组治疗疗程均为4周。分别在治疗前、治疗2周、治疗4周,记录患者主要中医临床症状及中医证候积分;并在治疗前和治疗4周结束,检测患者血清胃肠激素5-羟色胺(5-HT)、降钙素相关基因肽(CGRP)、血管活性肠肽(VIP)、胆囊收缩素(CCK)的含量。结果:1)中医证候总体疗效评价:治疗组总有效率为88.9%,对照组总有效率为65.2%,疗效优于对照组(P<0.05)。2)治疗组能有效改善腹痛即泻、腹胀腹痛、肠鸣矢气、情志抑郁、急躁易怒等主要单项症状,尤其在改善腹胀腹痛、情志抑郁、急躁易怒优于对照组(P<0.05)。3)胃肠激素水平检测:2组均能有效改善胃肠激素水平,2组治疗后胃肠激素含量较治疗前均有下降;尤其在改善CGRP水平上,治疗组明显优于对照组(P<0.05)。结论:疏肝健脾法治疗腹泻型肠易激综合征具有良好的临床疗效,能够显著改善患者血清胃肠激素水平。

Objective： To observe the clinical curative effect of treating the diarrhea predominant irritable bowel syndrome with treatment of liver-dispersing and spleen-strengthening and to explore the objective parameter of IBS-D. Methods： Sixty patients were randomly divided into two groups for a double-blinded control study. The treatment group received the decoction of Tong Xie Yao Fang and the control group received Pinaverium Bromide. The treatment course was 4 weeks. The score of symptom was recorded before treatment,and 2and 4 weeks after treatment. The changes of plasma contents gastrointestinal hormone,5-hydroxytyptam-ine（ 5-HT）,calcitoningene-relatedpeptide（ CGRP）,vasoactiveintestinalpeptide（ VIP）,cholecystokinin（ CCK） were evaluated. Results： 1） As for syndromes of TCM：The effective rate of the treatment group was 88. 9%,while that of the control group was 65. 2%,and the difference between the two groups was statistically significant（ P〈0. 05）. 2） The decoction of Liver-Dispersing with Tong Xie Yao Fang effectively improved the main single-symptoms such as abdominal pain,diarrhea,distention,depression,and irritableness. Especially in terms of the improvement of diarrhea,depression,and irritableness,the treatment group showed better outcomes compared to significant Pinaverium Bromide（ P〈0. 05）. 3） Plasma contents of 5-HT,VIP,CGRP,CCK in each group were all decreased in different degree after treatment. The were more obvious improvement in the treatment group,especially in CGRP（ P〈0. 05）. Conclusion： The therapy of liver-dispersing with spleen-strengthening treating IBS-D has a good clinical curative effect and can improve the level of patients gastrointestinal hormone.