从“气”论治法对便秘型肠易激综合征的临床疗效及对部分脑肠肽的影响

Clinical efficacy of the Qi in treating constipation-predominant irritable bowel syndrome and its effect on brain-gut peptides

目的观察从“气”论治法对肝郁气滞证便秘型肠易激综合征(IBS-C)的临床疗效及对部分脑肠肽的影响。方法选择2016年7月至2018年6月在南通市海门区人民医院中医科及内科门诊就诊的肝郁气滞证IBS-C患者57例,按随机数字表法分为治疗组28例采用中药治疗,对照组29例采用西药治疗。两组疗程均为8周。于入组时、第4周末、第8周末分别获取肠易激综合征病情严重程度量表(IBS-SSS)积分、促肾上腺皮质激素释放激素(CRH)水平、促肾上腺皮质激素(ACTH)水平及临床疗效,进行组间同期对照及组内治疗前后比较。比较两组患者在8周治疗时间内不良反应发生情况。结果治疗组除腹胀程度外,其余指标在第8周末均较第4周末进一步降低(P<0.05);对照组中,仅腹痛持续时间第8周末水平较第4周末进一步降低(P<0.05)。治疗组的第4、第8周末的腹痛持续时间、腹痛程度、排便满意度积分、CRH及ACTH水平均显著低于同期对照组(P<0.05)。治疗组第8周末生活满意度、IBS-SSS总积分显著低于同期对照组(P<0.05)。第8周末,治疗组总有效率为96.43%,显著高于对照组的79.31%(P=0.049)。治疗期间,两组患者不良反应发生情况差异无统计学意义(P=0.604)。结论较常规西药治疗,从“气”论治法对肝郁气滞证IBS-C患者疗效更好,部分患者抑郁症状能得到显著改善。

Objective To observe the clinical efficacy of the Qi in treating constipation-predominant irritable bowel syndrome(IBS-C)due to liver-depression and Qi-stagnation and its effect on brain-gut peptides.Methods A total of 57 patients with IBS-C due to liver-depression and Qi-stagnation who attended the Outpatient Clinic of the Department of Traditional Chinese Medi cine and Internal Medicine in Haimen People’s Hospital of Nantong City from July 2016 to June 2018 were selected as study subjects.They were randomly divided into 28 patients in the treatment group(treated with Chinese materia medica)and 29 patients in the control group(treated with western medicine)according to the random number table method.Both groups were treated for 8 weeks.The IBS-Symptom Severity Scale(IBS-SSS)s cores,corticotropin-releasing hormone(CRH)levels,adrenocorticotropic hormone(ACTH)levels and clinical efficacy were compared between groups at the same time,at the end of the 4th and 8th week of treatment,respectively,for concurrent control and before-after comparison in the same time intra group comparison before and after treatment.The incidence of adverse reactions during the 8-week treatment period was compared between the two groups.Results In the treatment group,all indexes except the degree of abdominal distension were further decreased at the end of the 8th week on the basis of the end of the 4th week(P<0.05).In the control group,only the duration of abdominal pain at the end of the 8th week was further shortened on the basis of the end of the 4th week(P<0.05).The duration of abdominal pain,degree of abdominal pain,degree of defecation satisfaction,CRH and ACTH levels in the treatment group were significantly lower than those in the control group at the end of the 4th and 8th week(P<0.05).The life satisfaction and total IBS-SSS score in the treatment group were significantly lower than those in the control group at the end of the 8th week(P<0.05).The total effective rate in the treatment group(96.43%)was significantly higher than that in the control group(79.31%)at the end of the 8th week(P=0.049).During the treatment period,there was no significant difference between the two groups in the incidence of adverse reactions(P=0.604).Conclusion The Qi is more effective than conventional western medicine in treating patients with IBS-C due to liver-depression and Qi-stagnation,and some patients’depressive symptoms can be significantly improved with the intervention of Qi.