加味芪榔方对药物依赖性便秘患者粪便短链脂肪酸的影响

Effect of Jiawei Qi-Lang Decoction on fecal short-chain fatty acids in patients with drug dependent constipation

目的 观察加味芪榔方对药物依赖性便秘患者粪便短链脂肪酸的影响及其可能机制。方法 将我院160例药物依赖性便秘患者随机分为治疗组和对照组,各80例,分别予以加味芪榔方+乳果糖口服液模拟剂,乳果糖口服液+加味芪榔方模拟剂,疗程均为8周。记录治疗前后患者便秘主要症状积分、中医证候积分、粪便短链脂肪酸水平及复发情况。结果 治疗组患者FAS(full analysis set,全分析集)及PPS(per protocol set,符合方案集)的总有效率分别为91.14%和93.51%,均高于对照组的73.33%和76.39%(均P<0.000 1)。治疗后,治疗组患者便秘主要症状总积分、中医证候总积分均较治疗前显著降低,且优于对照组(t=-6.113 6、-7.035 2,均P<0.000 1)。治疗后,治疗组患者粪便总短链脂肪酸水平较治疗前升高,且高于对照组(t=7.024 6,P<0.000 1)。随访至第2周和第4周时,对照组复发率均高于治疗组(χ^(2)=59.645 2,P<0.000 1;χ^(2)=17.064 5,P=0.000 4)。结论 加味芪榔方治疗药物依赖性便秘的疗效显著,患者复发率低,可能与其能调节粪便中短链脂肪酸水平和改善肠道动力有关。

Objective To observe the effect of Jiawei Qi-Lang(Modified Astragalus-Areca) Decoction on fecal shortchain fatty acids in patients with drug dependent constipation(DDC) and its possible mechanism. Methods A total of 160patients with DDC in our hospital were randomly divided into treatment group(n=80) or control group(n=80), and treated with Jiawei Qi-Lang Decoction and Lactulose oral liquid simulator, or Lactulose oral liquid and Jiawei Qi-Lang Decoction simulator, respectively. The course of treatment was 8 weeks. The scores of main symptoms and TCM syndromes, fecal short-chain fatty acids and recurrence of constipation before and after treatment were recorded. Result The total efficiency rates of FAS(Full Analysis Set) and PPS(Per Protocol Set) in the treatment group were 91.14% and 93.51% respectively, higher than the 73.33% and 76.39% in the control group(all P<0.000 1). After treatment, the total score of main symptoms of constipation and total score of TCM syndromes in the treatment group were lower than before treatment and were better than those in the control group(t=-6.113 6,-7.035 2, all P<0.000 1). After treatment, the total short-chain fatty acids in the treatment group were higher than before, and higher than in the control group(t=7.024 6, P<0.000 1).The recurrence rate in the control group was higher than that in the treatment group at the second and fourth weeks of follow-up(χ^(2)=59.645 2, P<0.000 1;χ^(2)=17.064 5, P=0.000 4). Conclusion Jiawei Qi-Lang Decoction is effective in the treatment of drug-dependent constipation with low recurrence rate, which may be related to its ability to regulate the level of short-chain fatty acids in feces and improve intestinal motility.