从脑-肠轴探讨四君子汤对脑瘫患儿功能性便秘的影响

Discussion on the Effect of Sijunzi Decoction on Functional Constipation in Children with Cerebral Palsy Based on Brain Gut Axis System

目的 基于脑-肠轴调控学说探讨四君子汤对脑瘫患儿功能性便秘的影响及机制。方法 90例脑瘫患儿随机分为3组:益生菌组予双歧杆菌乳杆菌三联活菌片;四君子汤组予四君子颗粒(党参、白术、茯苓、炙甘草);联合组予上述2种药物,每组30例。疗程1个月。观察治疗前后周排便次数及粪便性状评分、临床总有效率、双歧杆菌、乳酸杆菌、粪肠球菌、多形拟杆菌菌落数、细胞因子TNF-α、IL-6、IFN-γ的含量变化。结果 治疗后大便次数联合组(5.52±0.67)次/周,四君子汤组(5.01±0.64)次/周,益生菌组(4.60±0.53)次/周(P <0.05)。大便性状评分联合组(1.52±0.36)分,四君子汤组(1.78±0.53)分,益生菌组(2.23±0.41)分(P <0.05)。总有效率比较,联合组96.67%,四君子汤组73.33%,益生菌组40.00%(P <0.05)。与治疗前比较,治疗后各组肠道双歧杆菌和乳酸杆菌菌落数均增多(P <0.05),粪肠球菌和多形拟杆菌菌落数均减少(P <0.05),各组治疗后组间比较,联合组调节肠道菌群菌落数作用优于益生菌组,益生菌组优于四君子汤组,且差异均有统计学意义(P <0.05)。治疗后TNF-α、IL-6、IFN-γ含量联合组均低于四君子汤组(P <0.05),四君子汤组均低于益生菌组(P <0.05)。结论 四君子汤联合益生菌治疗能改善脑瘫患儿功能性便秘的临床症状,其作用机制可能通过调节肠道菌群平衡,降低细胞炎性因子TNF-α、IL-6、IFN-γ含量相关。

Objective Objective:Explore the effect and mechanism of Sijunzi Decoction on functional constipation in children with cerebral palsy based on brain gut axis regulation theory.Methods 90 children with cerebral palsy were randomly divided into three groups:Probiotics group was given Bifidobacterium Lactobacillus triple viable tablets;Sijunzi Decoction group was given Sijunzi granules( Codonopsis pilosula,Atractylodes macrocephala,Poria cocos,roasted licorice);the combination group was given the above two drugs,30 cases in each group.The course of treatment was 1 month.The defecation frequency,fecal character score,clinical total effective rate,Bifidobacterium,Lactobacillus,Enterococcus faecalis,Bacteroides polymorpha,TNF-α,IL-6 and IFN-γ were observed before and after treatment.Results after treatment,the number of defecation in the combined group was 5.52 ± 0.67 times/week,the Sijunzi Decoction group was 5.01 ± 0.64 times/week,and the probiotics group was 4.60 ± 0.53 times/week( P < 0.05).36 points,Sijunzi Decoction group 1.78 ± 0.53 points,probiotics group 2.23 ± 0.41 points( P < 0.05).The total effective rate was 96.67% in combination group,73.33% in Sijunzi Decoction group and 40.00% in probiotics group( P < 0.05).Compared with before treatment,the colony numbers of Bifidobacterium and Lactobacillus increased in each group after treatment( P < 0.05),while the colony numbers of Enterococcus faecalis and Bacteroides polymorpha decreased( P < 0.05).After treatment,the effect of combination group on regulating the colony number of intestinal flora was better than that of probiotics group,and probiotics group was better than Sijunzi Decoction group,and the differences were statistically significant( P < 0.05).After treatment,the levels of TNF-α,IFN-γ,IL-6,IFN-α and IFN-γ,respectively The content of IFN-γ in combined group was lower than that in Sijunzi Decoction group( P <0.05),and that in Sijunzi Decoction group was lower than that in probiotics group( P < 0.05).Conclusion Sijunzi Decoction Combined with probiotics can improve the clinical symptoms of functional constipation in children with cerebral palsy.The mechanism of action may be related to regulating the balance of intestinal flora and reducing the contents of TNF-α,IL-6 and IFN-γ.