枳实导滞丸加减治疗慢传输型便秘热积秘证的临床观察

Clinical Efficacy of Modified Zhishi Daozhiwan on Slow Transit Constipation

目的:观察枳实导滞丸加减治疗慢传输型便秘(STC)热积秘证的疗效及对胃肠激素和肠道内菌群的影响。方法:将160例患者随机按数字表法分为对照组和观察组。对照组口服麻仁丸,6 g/次,2次/d;枸橼酸莫沙必利分散片,5 mg/次,3次/d。观察组以枳实导滞丸加减内服治疗,1剂/d。两组均连续治疗4周。进行治疗前后便秘主要性状评分和便秘患者症状自评量表(PAC-SYM)评分;记录平均每周自发完全排便次数(SCBM);进行治疗前后结肠传输试验;进行治疗前后肠道菌群和胃动素(MTL),血管活性肠肽(VIP),P物质(SP),胃泌素(GAS)检测;对治疗后SCBM≥3次患者进行12周随访,计算复发情况。结果:经秩和检验分析,观察组临床疗效好于对照组(Z=2.275,P<0.05);治疗后观察组便秘主要症状评分,PAC-SYM各维度评分和PAC-SYM总分均低于对照组(P<0.01);观察组患者在治疗后2,3,4周的SCBM次数均多于对照组(P<0.05);观察组患者在24,48,72 h残留标志物比例均低于对照组(P<0.01);观察组患者肠球菌和肠杆菌计数均低于对照组(P<0.01),双歧杆菌和乳酸杆菌计数均高于对照组(P<0.01);观察组患者GAS,MTL和SP水平均高于对照组,VIP水平低于对照组(P<0.01);观察组复发率为33.85%,低于对照组的57.69%(χ^2=6.653,P<0.05)。结论:枳实导滞丸加减治疗STC热积秘证可明显减轻便秘等症状,增加SCBM次数,调节胃肠激素和肠道内菌群,提高结肠传输功能,临床疗效好,并具有复发率低的特点,值得临床使用。

Objective: To observe the clinical efficacy of modified Zhishi Daozhiwan on slow transit constipation(STC) and the effect on gastrointestinal hormones and intestinal flora.Method: One hundred and sixty patients were randomly divided into control group and observation group by random number table.Patients in control group got Maren Wan,1-2 pills/time,2 times/days,and mosapride citrate tablets,1 piece/time,3 times/days.Patients in observation group got modified Zhishi Daozhiwan,1 dose/day.A course of treatment was 4 weeks.Before and after treatment,the main symptoms of constipation and patient assessment of constipation symptoms(PAC-SYM) were scored.And times of spontaneous complete bowel movement(SCBM) and colonic transmission test were recorded.And levels of intestinal flora and motilin(MTL),vasoactive intestinal peptide(VIP),substance P(SP) and gastrin(GAS) were detected.The 12-week follow-up of patients(SCBM≥3) was recorded,and the relapse of disease was calculated.Result: According to rank sum test analysis,the clinical efficacy in observation group was better than that in control group(Z=2.275,P<0.05).After treatment,scores of the main symptoms of constipation,PAC-SYM,and the total score of PAC-SYM were all lower than those in control group(P<0.01).At the second,third and fourth weeks after treatment,the times of SCBM were more than those in control group(P<0.01).Ratio of residual marker at 24,48 and 72 h was lower than that in control group(P<0.01).Count of enterococcus and enterobacter were lower than those in control group(P<0.01),while counts of bifidobacterium and lactobacillus were higher than in control group(P<0.01).Levels of GAS,MTL and SP were higher than those in control group,whereas level of VIP was lower than that in control group(P<0.01).And relapse rate in observation group was 33.85%,which was lower than 57.69% in control group(χ^2=6.653,P<0.05).Conclusion: Modified Zhishi Daozhiwan can alleviate constipation and other symptoms,increase the number of SCBM,regulate gastrointestinal hormones and intestinal flora,and improve colonic transit function,with a good clinical efficacy and low recurrence rate,so it is worth clinical application.