益气健脾通便方联合针刺治疗慢传输型便秘肺脾气虚证35例临床观察

Clinical observation on 35 cases of slow transit constipation with deficiency of lung and spleen qi syndrome treated by Yiqi Jianpi Tongbian Fang(益气健脾通便方)combined with acupuncture

目的观察益气健脾通便方联合针刺治疗慢传输型便秘肺脾气虚证的临床疗效,并观察其对血清肠神经递质一氧化氮(NO)、血管活性肽(VIP)含量的影响,探讨其作用机制。方法将105例慢传输型便秘肺脾气虚证患者采用随机数字表法分为西药组、中药组、针药组3组,各35例。西药组给予枸橼酸莫沙必利分散片治疗,中药组给予益气健脾通便方治疗,针药组在中药组治疗方法的基础上联合针刺治疗。治疗4周后比较3组的临床疗效,以及治疗前后大肠内标记物数量,便秘症状评分,便秘患者生活质量自评量表(PAC-QOL)评分,血清肠神经递质NO、VIP的含量。结果针药组总有效率为97.1%(34/35),中药组为77.1%(27/35),西药组为71.4%(25/35),针药组总有效率明显高于中药组和西药组,差异均有统计学意义(P<0.05);治疗后3组大肠内标记物数量,粪便性状、排便间隔时间、排便困难程度、汗出气短、便后乏力评分及总评分,便秘患者PAC-QOL各项(生理状态、心理状态、担忧、满意度)评分及总评分,血清肠神经递质NO、VIP含量均明显降低,与同组治疗前比较差异有统计学意义(P<0.05或P<0.01),且治疗后针药组明显低于西药组和中药组,差异均有统计学意义(P<0.05或P<0.01)。结论益气健脾通便方联合针刺治疗慢传输型便秘肺脾气虚证疗效显著,其作用机制可能与其调控血清肠神经递质NO、VIP水平,刺激胃肠道平滑肌运动有关。

Objective To observe the clinical efficacy of Yiqi Jianpi Tongbian Fang(益气健脾通便方,YJTF)combined with acupuncture in the treatment of slow transit constipation(STC)with deficiency of lung and spleen qi syndrome and its effect on the content of serum enteric neurotransmitter nitric oxide(NO)and vasoactive intestinal peptide(VIP)and to explore its action mechanism.Methods Totally 105 cases of STC in patients with deficiency of lung and spleen qi syndrome were divided into 3 groups according to random number table method including Western medicine group,Chinese materia medica(CMM)group and acupuncture and medicinal group,with 35 cases in each group.The Western medicine group was given mosapride citrate dispersible tablets,the CMM group was given YJTF,and the acupuncture and medicinal group was combined with acupuncture on the basis of the therapeutic method of the CMM group.After 4 weeks of treatment,the clinical efficacy,the number of large intestinal internal markers,constipation symptom score,patient assessment of constipation quality of life(PAC-QOL)questionnaire score,and serum enteric neurotransmitters NO and VIP content before and after treatment among the 3 groups were compared.Results The total effective rate of the acupuncture and medicinal group was 97.1%(34/35),that of the CMM group was 77.1%(27/35),and that of the Western medicine group was 71.4%(25/35).The total effective rate of the acupuncture and medicinal group was significantly higher than that of the CMM group and the Western medicine group,and the differences were statistically significant(P<0.05).After treatment,the number of large intestinal internal markers,fecal traits,defecation interval time,scores and total scores of degree of defecation difficulty,sweating with shortness of breath,fatigue after defecation,each item score and total score of PAC-QOL(physiological state,psychological state,worry and satisfaction degree),serum enteric neurotransmitters NO and VIP content in 3 groups all significantly decreased,and the differences were statistically significant compared with those in the same group before treatment(P<0.05 or P<0.01),moreover,the acupuncture and medicinal group was significantly lower than the Western medicine group and CMM group after treatment,and the differences were statistically significant(P<0.05 or P<0.01).Conclusion It has marked efficacy to use YJTF combined with acupuncture in the treatment of STC with deficiency of lung and spleen qi syndrome and its action mechanism may be related to the regulation of levels of serum enteric neurotransmitters NO and VIP and the stimulation of gastrointestinal smooth muscle movement.