基于“脑-肠-菌”轴观察理气通便方对气滞证慢传输型便秘患者的影响

Observation of Liqi Tongbian Decoction on patients with qi stagnation syndrome slow transit constipation based on the‘brain-intestine-bacteria’axis

目的:探讨理气通便方治疗气滞证慢传输型便秘(STC)患者的疗效及对脑肠肽和与肠道菌群的影响。方法:纳入60例气滞证STC患者,按随机数字表法分为中药治疗组(30例)和西药对照组(30例),另招募20名健康志愿者为正常对照组。中药治疗组予理气通便方内服治疗,西药对照组给予枸橼酸莫沙必利片与小麦纤维素颗粒治疗。观察两组患者的气滞证便秘症候积分、每周自发完全排便次数的变化,以及对两组患者治疗前后及正常对照组的血清5-羟色胺受体4、胃动素、一氧化氮、P物质及肠道菌群进行检测。结果:中药治疗组的临床疗效显著优于西药对照组(P<0.01);中药治疗组在气滞证便秘症状积分、每周自发完全排便次数方面改善均优于西药对照组(P<0.05);中药治疗组患者治疗后的5-羟色胺受体4、胃动素和P物质水平均显著高于西药对照组(P<0.05),一氧化氮水平显著低于西药对照组(P<0.05);中药治疗组患者治疗后肠道菌群的相对丰度显著低于治疗前(P<0.05),多样性显著低于西药对照组(P<0.05)。结论:理气通便方可明显改善气滞证STC患者便秘的症状,增加每周自发完全排便次数,其作用机制可能是通过调节脑肠肽的分泌与肠道菌群的丰度及多样性。

Objective:To investigate the efficacy of Liqi Tongbian Decoction in treating patients with qi stagnation syndrome and slow transit constipation(STC)and its influence on brain-gut peptides and intestinal flora.Methods:Sixty STC patients in qi stagnation syndrome were divided into traditional Chinese medicine treatment group(30 cases)and western medicine control group(30 cases)according to a random number table.Another 20 healthy volunteers were recruited as a normal control group.The traditional Chinese medicine treatment group was treated with Liqi Tongbian Decoction,and the western medicine control group was treated with mosapride citrate tablets and wheat cellulose granules.The constipation scores of qi stagnation syndrome,and the changes in the number of spontaneous complete bowel movements per week.5-HTR4,MTL,NO,SP and the intestinal flora in the two groups before and after treatment,as well as the normal contol group were tested.Results:The clinical efficacy of the traditional Chinese medicine treatment group was significantly better than that of the western medicine control group(P<0.01);the traditional Chinese medicine treatment group was significantly better than the western medicine control group in improving the score of qi stagnation syndrome and the number of spontaneous complete bowel movements per week(P<0.05);The levels of 5-HTR4,MTL and SP in the traditional Chinese medicine treatment group were significantly higher than those in the western medicine control group(P<0.05),and the NO level was significantly lower than the western medicine control group(P<0.05);the traditional Chinese medicine treatment group patients after treatment,the relative abundance of intestinal flora was significantly lower than before treatment(P<0.05),and its diversity was significantly lower than that of western medicine control group(P<0.05).Conclusion:Liqi Tongbian Decoction can significantly improve the symptoms of constipation STC patients in qi stagnation syndrome,and increase the number of spontaneous complete bowel movements per week.The mechanism of action might be regulating the secretion of brain-gut peptides and the abundance and diversity of intestinal flora.