加味参苓白术散联合电针对35例腹泻型肠易激综合征患者临床症状及心理状态的干预作用

Modified Shenling Baizhu powder combined with electroacupuncture for treatment of diarrhea-predominant irritable bowel syndrome:Effect on clinical symptoms and psychological state

目的观察加味参苓白术散联合电针对腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome,D-IBS)患者临床症状改善及心理状态的干预作用的有效性和安全性.方法将70例D-IBS患者随机分为观察组和对照组各35例.观察组采用加味参苓白术散联合电针治疗,针刺天枢、上巨虚、足三里、三阴交、太冲、百会,留针30 min,治疗5次/wk,连续治疗4 wk.对照组采用马来酸曲美布汀片治疗,3次/d,0.1 g/次,连续服用4 wk.两组分别于治疗前、治疗4 wk结束时、治疗结束后第4周时进行肠易激综合征症状严重性量表(irritable bowel syndrome symptom severity score,IBS-SSS)、肠易激综合征生存质量量表(irritable bowel syndrome quality of life,IBS-QOL)和90项症状自评量表(symptom check list-90,SCL-90)评分,观察服药的不良反应,治疗后评价临床疗效.结果观察组临床疗效总有效率为97.1%,对照组为91.4%,观察组治疗非劣于对照组.IBSSSS量表显示治疗第4周结束时,两组患者腹痛程度、腹痛频率及SSS积分比较,差异有统计学意义(P<0.05),生活影响组间比较具有显著差异(P<0.01).治疗结束后随访第4周,两组患者组间比较,腹痛频率、排便满意度差异有统计学意义(P<0.05),生活影响及SSS总积分差异有显著差异(P<0.01).IBS-QOL量表显示治疗4 wk结束时,观察组患者焦虑不安较对照组显著改善(P<0.05).治疗结束后第4周随访,观察组在焦虑不安、躯体意念、身体角色、健康忧虑4个维度的生活质量方面改善较对照组有统计学意义(P<0.05);其中焦虑不安、健康忧虑的改善具有显著性差异(P<0.01).SCL-90症状自评量表评分显示两组组间各因子比较,差异无统计学意义(P>0.05).但在治疗结束后4 wk随访时,观察组躯体化评分与对照组比较有差异(P<0.05).结论加味参苓白术散联合电针治疗较好地改善了D-IBS患者的临床症状,对患者躯体化症状改善明显且起效较快;同时对患者的心理状态起到良好的干预作用,其治疗效果维持时间更长,远期疗效更为稳定和持久,且未见明显不适反应,显示了良好的治疗耐受性.

AIM To evaluate the safety and efficacy of modified Shenling Baizhu powder combined with electroacupuncture （EA） in the treatment of diarrhea-predominant irritable bowel syndrome （D-IBS） with regard to the improvement of clinical symptoms and psychological state. METHODS Seventy D-IBS patients were randomly divided into an observation group and a control group （n = 35 each）. The observation group was treated with modified Shenling Baizhu powder combined with EA at Tianshu （ST25）, Shangjuxu （ST37）, Zusanli （ST36）, Sanyinjia （SP6）, Taichong （LR3）, Baihui （GV20）, 30 min for each treatment, 5 times a week, for 4 wk. The control group were treated with maleic acid trimebutine, 0.1 g each time, three times a day, for 4 wk. The irritable bowel syndrome symptom severity score （IBS-SSS）, irritable bowel syndrome quality of life （IBS-QOL）, and symptom check list-90 （SCL-90） were sued to evaluate the clinical symptoms, quality of life, and psychological symptoms in the two groups before treatment, after 4 wk of treatment, and at 4 wk after treatment, respectively. Drug adverse reactions were also recorded. RESULTS The clinical curative effect was 97.1% in the observation group and 91.4% in the control group. After 4 wk of treatment, the degree and frequency of abdominal pain and overall IBS-SSS score was significantly better （P 〈 0.05）, and anxiety was more significantly improved in the observation group than in the control group. At 4 wk after treatment, the scores of anxiety, somatic mind, physical role, and health concerns were improved more significantly in the observation group than in the control group （P 〈 0.05）, with anxiety and health concerns improved most prominently （P 〈 0.01）. SCL-90 symptoms showed no statistically significant difference between the two groups before treatment （P 〉 0.05）; however, at 4 wk after treatment, there was a significant difference between the two groups with regard to somatization score （P 〈 0.05）. CONCLUSION Modified Shenling Baizhu powder combined with EA can significantly improve the clinical symptoms and psychological status of D-IBS patients, without obvious adverse reactions.