加味增液汤治疗气阴两虚型慢传输型便秘的疗效评价及对胃肠功能的影响

Clinical Efficacy of Modified Zengyetang Against Slow Transit Constipation Due to Qi-Yin Deficiency and Its Effect on Gastrointestinal Function

目的:观察加味增液汤治疗气阴两虚型慢传输型便秘(STC)的临床疗效及对胃肠功能的影响。方法:将130例患者随机按数字表法分为对照组65例(脱落、失访6例,完成59例)和治疗组65例(脱落、失访3例,完成62例)。对照组口服枸橼酸莫沙必利分散片,5 mg/次,3次/d。治疗组口服加味增液汤,1剂/d。两组疗程均为4周。记录治疗前后便秘主要症状评分、便秘患者症状自评量表(PAC-SYM)评分、中医证候评分、结肠传输试验情况及胃动素(MTL),血管活性肠肽(VIP),P物质(SP)水平,并记录治疗期间患者平均每周自发完全排便次数(SCBM)及其复发情况。结果:治疗后治疗组临床疗效(95.16%)明显高于对照组(81.36%)(χ^(2)=5.6314,P<0.05);治疗组复发率(30.65%)显著低于对照组(57.63%)(χ^(2)=8.9411,P<0.01);治疗后治疗组患者便秘主要症状评分低于对照组(P<0.01),治疗后治疗组患者PAC-SYM量表3个维度评分及总评分均低于对照组(P<0.01),治疗后治疗组患者中医证候评分低于对照组(P<0.01),治疗后治疗组患者在24,48,72 h残留标志物比例均低于对照组(P<0.01),治疗组患者在治疗后2,3,4周的SCBM均高于对照组(P<0.01),且治疗后与对照组比较,治疗组患者MTL,SP水平显著升高,VIP水平显著降低(P<0.01)。结论:采用加味增液汤治疗气阴两虚型STC患者可有效缓解其临床症状,调节胃肠激素分泌,增加SCBM,提高结肠传输功能,且复发率低。

Objective:To observe the clinical effect of modified Zengyetang in treating slow transit constipation(STC)due to Qi-Yin deficiency and its effect on gastrointestinal function.Method:One hundred and thirty eligible patients were randomly divided into a control group(n=65,6 cases dropped out or were lost to follow-up and 59 completed the trial)and a treatment group(n=65,3 cases dropped out or were lost to followup and 62 completed the trial).Patients in the control group received oral mosapride citrate dispersible tablets,5 mg per time,three times per day,while those in the treatment group were treated with modified Zengye Tang,one bag per day,for four successive weeks.The main symptom constipation,the Patient Assessment of Constipation Symptoms(PAC-SYM),and traditional Chinese medicine(TCM)syndrome scores,colonic transit,as well as motilin(MTL),vasoactive intestinal peptide(VIP),and substance P(SP)levels before and after treatment were recorded,together with the frequency of spontaneous complete bowel movements(SCBMs)per week and STC recurrence during treatment.Result:The clinical efficacy(95.16%)of the treatment group was higher than that(81.36%)of the control group(χ^(2)=5.6314,P<0.05),whereas the recurrence rate(30.65%)of the treatment group was significantly lower than that(57.63%)of the control group(χ^(2)=8.9411,P<0.01).After treatment,the main symptom constipation,three sub-scale and total PAC-SYM,and TCM syndrome scores in the treatment group were obviously decreased as compared with those in the control group(P<0.01).The proportions of residual markers at 24,48,and 72 h in the treatment group declined in contrast to those in the control group(P<0.01).The frequency of SCBMs per week in the 2 nd,3 rd,and 4 th weeks of the treatment group was higher than that in the control group(P<0.01).Compared with the control group after treatment,the treatment group exhibited significantly elevated MTL and SP but lowered VIP(P<0.01).Conclusion:Modified Zengyetang relieves the clinical symptoms,regulates gastrointestinal hormone secretion,increases the frequency of SCBMs,enhances colonic transit,and decreases the recurrence of patients with STC due to Qi-Yin deficiency.