温肾健脾调枢法治疗腹泻型肠易激综合征临床研究

Clinical Study on the Treatment of Diarrheic Irritable Bowel Syndrome by Warming Kidney and Invigorating Spleen and Regulating Pivot

目的 探讨温肾健脾调枢法治疗腹泻型肠易激综合征(diarrheic irritable bowel syndrome,IBS-D)的临床疗效。方法 将105例IBS-D患者随机进行分组,对照组(n=52)给予马来酸曲美布汀胶囊治疗,观察组(n=53)给予基于“脑肠同调”的温肾健脾调枢法治疗。治疗4周后,比较2组患者中医证候积分、肠道菌群、蛋白酶激活受体-2(protease-activated receptor-2,PAR-2)及蛋白酶激活受体-4(protease-activated receptor-4,PAR-4)表达水平的变化。结果 治疗后,观察组乳酸杆菌、双歧杆菌水平高于对照组(P<0.05),大肠杆菌、肠球菌水平低于对照组(P<0.05);观察组PAR-2、PAR-4表达水平低于对照组(P<0.05);观察组腹痛、腰膝酸软、食欲不振、晨起泄泻等中医证候积分均低于对照组(P<0.05)。结论 温肾健脾调枢法治疗IBS-D能够降低患者中医证候积分,调节肠道菌群和PAR-2、PAR-4表达水平,值得临床推广应用。

Objective To investigate the clinical efficacy of warming kidney and invigorating spleen and regulating pivot in the treatment of diarrheic irritable bowel syndrome(IBS-D).Methods A total of 105 patients with IBS-D were randomly divided into two groups.The control group(n=52)was given trimebutine maleate capsule,while the observation group(n=53)was given the treatment based on“brain-gut harmonization”to warm kidney and strengthen spleen and regulate pivot.TCM syndrome scores,intestinal microflora,levels of protease-activated receptor-2(PAR-2)and protease-activated receptor-4(PAR-4)were compared between the two groups after four weeks of treatment.Results After treatment,the levels of lactobacillus and bifidobacterium in the observation group were higher than those in the control group(P<0.05),while the levels of Escherichia coli and Enterococcus were lower than those in the control group(P<0.05).The levels of PAR-2 and PAR-4 in the observation group were lower than those in the control group(P<0.05).The TCM syndrome scores of abdominal pain,soreness and weakness of waist and knee,poor diet and morning diarrhea in the observation group were lower than those in the control group(P<0.05).Conclusion The treatment of IBS-D by warming kidney and invigorating spleen and regulating pivot could reduce the TCM syndrome scores of patients,regulate the intestinal microflora and the expression of PAR-2 and PAR-4.It is worthy of clinical application.