皮内针加匹维溴铵对腹泻型肠易激综合征患者胃肠激素水平的影响

Effects of intradermal needle therapy plus pinaverium bromide on gastrointestinal hormone levels in irritable bowel syndrome-diarrhea patients

目的:观察不同治疗方案治疗肝郁脾虚腹泻型肠易激综合征(IBS-D)的临床疗效差异及对血清5-羟色胺(5-HT)、P物质(SP)和血管活性肠肽(VIP)水平的影响,揭示皮内针疗法联合匹维溴铵治疗IBS-D的作用机理.方法:将123例IBS-D患者按随机数字表法分为观察组、西药组和西药加中药组,每组41例.西药组口服匹维溴铵片,每次50 mg,每日3次.西药加中药组在西药组的基础上口服痛泻要方中草药,每日1剂.观察组在西药组治疗基础上加用皮内针疗法.疗程为6周.观察治疗前后胃肠道症状、中医证候、IBS严重程度、IBS-QOL量表评分及血清5-HT、SP和VIP水平,并评价临床疗效.结果:观察组总有效率为92.7%,西药组为68.3%,西药加中药组为78.1%,观察组总有效率高于其他2组,西药加中药组总有效率高于西药组,组间差异均有统计学意义(均P<0.05).治疗后,3组胃肠道症状、中医证候、IBS严重程度评分均明显下降,与本组治疗前均有统计学差异(均P<0.05);观察组胃肠道症状、中医证候、IBS严重程度评分明显低于其他2组(均P<0.05),西药加中药组上述3项评分均低于西药组(均P<0.05).治疗后,3组患者的IBS-QOL量表的8项评分均较本组治疗前明显升高(均P<0.05);观察组IBS-QOL量表8项评分均明显高于其他2组(均P<0.05);西药加中药组IBS-QOL量表8项评分均高于西药组(均P<0.05).治疗后,3组患者血清5-HT、SP和VIP水平均较本组治疗前明显降低(均P<0.05);观察组血清5-HT、SP和VIP水平面明显低于其余2组(均P<0.05),西药加中药组血清5-HT、SP和VIP水平均低于西药组(P<0.05).结论:皮内针疗法联合匹维溴铵明显地改善腹泻型肠易激综合征肝郁脾虚证患者的胃肠道症状及生活质量,可有效调节机体胃肠激素分泌.

Objective:To observe the clinical efficacy difference in treating irritable bowel syndrome-diarrhea(IBS-D)of liver-qi stagnation and spleen-deficiency pattern with different treatment protocols,and the effects on serum levels of 5-hydroxytryptamine(5-HT),substance P(SP)and vasoactive intestinal peptide(VIP),for unveiling the mechanism of intradermal needle therapy plus pinaverium bromide in treating IBS-D.Methods:A total of 123 IBS-D patients were divided into an observation group,a Western medication group and an integrated Western and Chinese medication group using the random number table method,with 41 cases in each group.The Western medication group was given oral pinaverium bromide,50 mg each time and 3 times a day.The integrated Western and Chinese medication group was given additional Chinese herbal medicine Tong Xie Yao Fang,one dose each day.The observation group was given additional intradermal needle therapy on the basis of the Western medication group.The whole intervention lasted for 6 weeks.Before and after treatment,the scores of gastrointestinal symptoms,traditional Chinese medicine(TCM)symptoms,irritable bowel syndrome(IBS)symptom severity scale(IBS-SSS)and IBS quality of life(IBS-QOL)questionnaire,as well as the serum levels of 5-HT,SP and VIP were observed.The clinical efficacy was estimated.Results:The total effective rate was 92.7%in the observation group,68.3%in the Western medication group and 78.1%in the integrated Western and Chinese medication group.The total effective rate was higher in the observation group than in the other two groups,and higher in the integrated Western and Chinese medication group than in the Western medication group,showing statistical significance(all P<0.05).After treatment,the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS showed significant decreases in the three groups,presenting statistical significance compared with the baseline(all P<0.05);the scores of gastrointestinal symptoms,TCM symptoms and IBS-SSS were notably lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the eight component scores of IBS-QOL showed significant increases in the three groups compared with the baseline(all P<0.05);the eight component scores in IBS-QOL were significantly higher in the observation group than in the other two groups(all P<0.05),and higher in the integrated Western and Chinese medication group than in the Western medication group(all P<0.05).After treatment,the serum levels of 5-HT,SP and VIP decreased markedly in the three groups compared with the baseline(all P<0.05);the serum levels of 5-HT,SP and VIP were significantly lower in the observation group than in the other two groups(all P<0.05),and lower in the integrated Western and Chinese medication group than in the Western medication group(P<0.05).Conclusion:Treatment with intradermal needle therapy plus pinaverium bromide results in significant improvements in the gastrointestinal symptoms and quality of life in patients with IBS-D of liver-qi stagnation and spleen deficiency pattern,and effectively regulates the gastrointestinal hormone production.