氟哌噻吨美利曲辛联合布拉酵母菌治疗腹泻型肠易激综合征患者焦虑抑郁症状疗效的研究

Therapeutic effects of flupentixol and melitracen combined with Saccharomyces boulardii on the patients with diarrhea-predominant irritable bowel syndromes accompanied with anxiety and depression

目的观察对肠易激综合征(irritable bowel syndrome,IBS)并伴有焦虑抑郁状态的患者用氟哌噻吨美利曲辛联合布拉酵母菌进行治疗的疗效。方法选择于2013年1月至2015年1月在湖北医学院附属东风公司总医院住院治疗的伴有焦虑抑郁症状的腹泻型IBS患者120例为研究对象,本次研究采取多中心、随机、前瞻性的研究方法,将这120例患者分为联合治疗组(60例)和对照组(60例),联合治疗组用氟哌噻吨美利曲辛加口服布拉酵母菌,对照组仅口服布拉酵母菌,疗程为4周。分别在治疗前、治疗1周后、治疗4周后对胃肠道症状和情绪障碍进行评估,同时观察2组患者的不良症状。统计学分析采用卡方检验。结果治疗1周后,对照组和联合治疗组患者的胃肠道症状改善有效率分别为23.3%(14/60)和31.7%(19/60),差异无统计学意义(P>0.05),汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分改善的有效率分别为11.8%(6/51)和33.3%(19/57),汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分中症状改善的有效率分别为16.1%(9/56)和35.6%(21/59),差异均具有统计学意义(P<0.05)。治疗4周后,联合治疗组和对照组的胃肠道症状改善有效率分别为93.0%(53/57)和74.1%(43/58),HAMD评分改善的有效率分别为64.8%(35/54)和34.7%(17/49);HAMA评分中症状改善的有效率分别为80.4%(45/56)和35.2%(19/54),差异均具有统计学意义(χ~2=5.679,P=0.017;χ~2=23.056,P<0.01)。治疗1周后,联合治疗组和对照组患者的不良症状发生率都为5.0%(3/60),治疗4周后,联合治疗组和对照组患者的不良症状发生率分别为3.5%(2/57)和3.4%(2/58)。2组不良症状发生率差异均不具有统计学意义(均P>0.05)。结论氟哌噻吨美利曲辛与布拉酵母菌联合治疗不仅可有效改善腹泻型IBS患者的焦虑抑郁症状,同时能够有效改善患者的消化道症状,其治疗效果明显优于单用布拉酵母菌进行治疗。

To observe the therapeutic effects of flupentixol and melitracen tablets combined with Saccharomyces boulardii on the patients with diarrhea-predominant irritable bowel syndromes(IBS)accompanied with anxiety and depression.One hundred and twenty patients with diarrhea-predominant IBS accompanied with anxiety and depression who sought medical care in the hospital from January 2013 to January 2015 were recruited for the study by using multi-centered,randomized and prospective method.The patients were randomly divided into the combined treatment group(n=60)and the control group(n=60).The patients in the former group were treated with flupentixol and melitracen tablets combined with Saccharomyces boulardii,while the patients in the latter group just received Saccharomyces boulardii,all with a treatment course of 4 weeks.Gastrointestinal symptoms and emotional disorders were respectively evaluated both before treatment,one week and 4 weeks after treatment.At the same time,adverse reactions were also observed in the patients of the 2 groups.Chitest was performed for statistic analysis.One week after treatment,the efficacy rates of gastrointestinal symptoms of the control group and the combined treatment group were respectively 23.3%(14/60)and 31.7%(19/60),without statistical significance(P>0.05).The efficacy rates of Hamilton Depression Scale(HAMD)for the control group and the combined treatment group were 11.8%(6/51)and 33.3%(19/57),and the efficacy rates of Hamilton Anxiety Scale(HAMA)were 16.1%(9/56)and 35.6%(21/59),and statistical significance could be noticed when comparisons were made between the 2 groups(P>0.05).Four weeks after treatment,the efficacy rates of gastrointestinal symptoms for the combined treatment group and the control group were respectively 93.0%(53/57)and 74.1%(43/58),the efficacy rates of HAMD for the control group and the combined treatment group were respectively 34.7%(17/49)and 64.8%(35/54),and the efficacy rates of HAMD for the control group and the combined treatment group were 35.2%(19/54)and 80.4%(45/56)respectively.Statistical significance could also be found when comparisons were made between the 2 groups(χ=5.679,P=0.017;χ=23.056,P<0.01).One week after treatment,the rates of adverse reactions for the combined treatment group and the control group were all 5.0%(3/60).However,4 weeks after the treatment,the rates of adverse reactions for the combined treatment group and the control group were respectively 3.5%(2/57)and 3.4%(2/58).There was no statistical significance in the rates of adverse reactions,when comparisons were made between the 2 groups(P>0.05).Flupentixol and melitracen combined with Saccharomyces boulardii could not only effectively improve the symptoms of anxiety and depression in the patients with diarrhea-predominant IBS,but also effectively inhibit gastrointestinal symptoms,with the efficacy of combined treatment being obvious better than that of simple Saccharomyces boulardii therapy