中西医结合治疗对腹泻型肠易激综合征患者血清炎性细胞因子水平的影响及疗效研究

Efficacy of integrated traditional Chinese medicine with Western medicine in patients with diarrhea-predominant irritable bowel syndrome and its relation to serum inflammatory cytokines

目的 探讨中西医结合治疗对腹泻型肠易激综合征（diarrhea-predominant of irritable bowel syndrome,IBS-D）患者血清炎性细胞因子水平的影响及其疗效.方法 将2013年7月10日至2015年8月10日于浙江金华广福肿瘤医院消化内科就诊的164例IBS-D患者按随机数字表法分为中西医治疗组与对照组,各82例.对照组给予口服布拉酵母菌治疗,中西医治疗组在对照组基础上给予疏肝健脾汤连续治疗4周,比较治疗前后两组患者的血清炎性细胞因子[干扰素-γ（IFN-γ）、肿瘤坏死因子-α（TNF-α）和白细胞介素-10（IL-10）]水平、总有效率、临床症状及生命质量评分.结果治疗后,中西医治疗组患者血清IFN-γ水平[（1.00±0.44）ng/L比（2.88±1.38）ng/L,t=11.609]、TNF-α水平[（24.13±3.27）ng/L比（41.26±5.29）ng/L,t=24.636]低于治疗前,IL-10水平高于治疗前[（170.23±33.45）ng/L比（142.23±21.58） ng/L,t=6.291],差异均有统计学意义（均P〈0.01）.中西医治疗组总有效率高于对照组[87.50%（70/80）比68.75%（55/80）, x2=8.228], 差异有统计学意义（P〈0.01）.治疗后,中西医治疗组患者临床症状总评分低于对照组[（5.71±1.41）分比（11.70±2.88）分,t=16.707],差异有统计学意义（P〈0.01）.治疗后,两组患者生命质量评分均比治疗前有所改善,中西医治疗组在饮食[（240±69）分比（193±60）分,t=4.597]、精神[（316±74）分比（230±69）分,t=7.603]、情绪[（297±62）分比（228±59）分,t=7.211]及睡眠[（284±62）分比（230±54）分,t=5.874]方面的改善明显优于对照组,差异有统计学意义（均P〈0.01）.结论 中西医结合治疗可降低IBS-D患者的血清IFN-γ、TNF-α水平,升高IL-10水平,治疗有效率及生命质量评分均高于单纯西药治疗.

Objective To investigate the efficacy of integrated traditional Chinese medicine （TCM） with Western medicine in treatment of diarrhea type irritable bowel syndrome （IBS-D） and its effect on serum inflammatory cytokine levels.Methods One hundred and sixty four IBS-D patients treated in Guangfu Hospital from July 2013 to August 2015 were randomly divided into study group and control group with 82 cases in each group.All patients received oral Saccharomyces boulardii 1.0 b.i.d, while patients in study group received additional Shuganjianpi decoction b.i.d for 4 weeks.The clinical efficacy was observed, serum IL-10, IFN-γ and TNF-α levels were measured in 2 groups.Results After treatment, the total score of clinical symptoms in study group was lower than that of control group [（5.71±1.41） vs.（11.70±2.88） points,t=16.707, P〈0.01].Serum levels of IFN-γ, TNF-α in study group decreased significantly after treatment [IFN-γ （2.88±1.38） ng/L vs.（1.00±0.44） ng/L, t=11.609, P〈0.01;TNF-α （41.26±5.29） ng/L vs.（24.13±3.27） ng/L,t=24.636, P〈0.01], IL-10 significantly increased [（142.23±21.58） ng/L vs.（170.23±33.45） ng/L,t=6.291,P〈0.01].The overall effective rate of study group was higher than that of control group, [87.50% （70/80） vs.68.75% （55/80）, x2=8.228, P〈0.01].After treatment, the quality of life scores in both groups were improved;but the improvement of diet, spirit, mood and sleep scores in study group were better than those in control group [（240±69） vs.（193±60）, t=4.579, （316±74） vs.（230 ± 69）, t=7.603, （297±62） vs.（228±59）, t=7.211;（284±62） vs.（230±54）, t=5.874, all P〈0.01].Conclusion The efficacy of integrated traditional Chinese medicine with Western medicine in treatment of IBS-D is significantly better than that of Western medicine alone, which may be associated with its regulatory effect on the serum inflammatory cytokine levels.