果胶治疗腹泻型肠易激综合征的临床疗效

Efficacy of pectin in the treatment of diarrhea predominant irritable bowel syndrome

目的：探讨果胶治疗腹泻型肠易激综合征（IBS-D）的临床疗效。方法采用随机、双盲、安慰剂对照的方法，前瞻性纳入2011年7月至2013年12月期间南京军区南京总医院收治的87例IBS-D患者，根据入院时间按随机数字表法将患者分为果胶组（金陵Ⅰ号，3次／d ；46例）和安慰剂组（麦芽糖糊精，3次／d ；41例）。分别在治疗前和治疗6周后评价两组患者IBS-D评分，包括粪便性状评分（Bristol分型法）、症状评分（Likert量表）及生活质量评分（IBS-QOL调查问卷）；采用实时荧光定量PCR方法检测两组治疗前后肠道菌群变化；检测患者外周血单核细胞产生的细胞因子水平，并选取年龄和性别匹配的20名健康志愿者作正常对照。结果全部患者均完成试验，未有因严重药物不良反应退出试验者。安慰剂组在治疗前后的IBS-D评分、肠道菌群以及炎性反应水平无明显变化（均P＞0．05）。治疗6周后，与治疗前及安慰剂组比较，果胶组的粪便性状评分和IBS症状评分明显降低，生活质量评分明显改善，梭菌属数量明显降低，双歧杆菌数量明显增多（均P＜0．05）。治疗前，与健康志愿者相比，果胶组及安慰剂组患者IL-10／IL-12比值明显降低（P＜0．01）；治疗后，果胶组IL-10／IL-12比值明显升高（P＜0．01），与健康志愿者相当（P＞0．05），且明显高于安慰剂组（P＜0．01）。结论果胶可选择性刺激双歧杆菌生长恢复肠道微生态，并能改善IBS-D症状和减轻机体炎性反应，可作为治疗IBS-D的首选用药。

Objective To evaluate the efficacy of pectin, a kind of soluble dietary fiber, in diarrhea predominant irritable bowel syndrome （IBS-D）. Methods A total of 87 patients with IBS-D were selected in the Jinling Hospital between July 2011 and December 2013. Using a randomized , controlled trial, the efficacy of pectin for IBS-D was prospectively evaluated. Subjects were randomly assigned to receive 24 g pectin powder/d （n=46） or a placebo （n=41）. Before and after 6 weeks of treatment, colonic microflora was examined by real-time PCR and compared between groups. Changes in stool frequency and form （Bristol stool scale）, composite score of symptoms （Likert scale） and QOL scores （IBS-QOL questionnaire） were also monitored. Peripheral blood sample from patients with IBS-D was obtained to estimate the cytokines level, which was compared with that obtained from a group of age- and sex-matched healthy volunteers （n=20）. Results Those patients randomized to pectin experienced a greater reduction in composite symptom scores and Bristol stool scale scores , as well as significant improvement in QOL scores （P〈0.05）. The pectin acted as prebiotics and significantly enhanced faecal bifidobacteria and decreased total Clostridium sp （P〈0.05）. At baseline, patients with IBS-D demonstrated an abnormal IL-10/IL-12 ratio, which was normalized by pectin feeding alone （P〈0.01）. Placebo did not exert these effects on the aforementioned parameters after treatment. No significant adverse effects were reported during the study. Conclusions Pectin acts as a prebiotic in specifically stimulating gut bifidobacteria in IBS-D patients and is effective in alleviating clinical symptoms, balancing colonic microflora and relieving systemic inflammation. In view of its ability to re-establish a healthy gut ecosystem, pectin has the potential of being a therapeutic agent in IBS-D.