自拟培土顺木汤治疗肝郁脾虚型腹泻型肠易激综合征临床观察

Clinical Observation of Self-prescribed Peitu Shunmu Decoction for the Treatment of Diarrhea-predominated Irritable Bowel Syndrome of Liver Stagnation and Spleen Deficiency Type

【目的】观察自拟培土顺木汤治疗肝郁脾虚型腹泻型肠易激综合征的临床疗效。【方法】将72例肝郁脾虚型腹泻型肠易激综合征患者随机分为观察组和对照组,每组各36例。对照组给予布拉氏酵母菌口服治疗,观察组给予自拟培土顺木汤治疗,连续治疗4周。观察2组患者治疗前后中医证候积分、肠易激综合征严重程度量表(IBS-SSS)评分、肠易激综合征生活质量量表(IBS-QOL)评分、汉密尔顿焦虑量表(HAMA)评分和汉密尔顿抑郁量表(HAMD)评分的变化情况,并评价2组患者的中医证候疗效和安全性。【结果】(1)研究过程中,观察组失访5例,自行退出1例,对照组失访4例,自行退出2例;最终观察组和对照组各有30例患者完成试验。(2)治疗4周后,观察组的总有效率为93.33%(28/30),对照组为70.00%(21/30),组间比较,观察组的中医证候疗效明显优于对照组(P<0.05)。(3)治疗后,2组患者的中医证候积分和IBS-SSS评分均较治疗前明显改善(P<0.05),且观察组对中医证候积分和IBS-SSS评分的改善作用均明显优于对照组(P<0.05)。(4)治疗后,2组患者IBS-QOL量表的焦虑不安(DY)、健康忧虑(HW)、行为障碍(IN)、饮食限制(FA)评分均较治疗前明显改善(P<0.05),且观察组对IBS-QOL量表的DY、HW、IN、FA评分的改善作用均明显优于对照组(P<0.05)。(5)治疗后,2组患者的HAMA、HAMD评分均较治疗前明显改善(P<0.05),且观察组对HAMA、HAMD评分的改善作用均明显优于对照组(P<0.05)。(6)治疗过程中,2组患者均无发生不良反应,具有较高的安全性。【结论】自拟培土顺木汤治疗肝郁脾虚型腹泻型肠易激综合征疗效确切,不仅可改善患者胃肠症状,同时还可调节患者情绪,改善患者肠道外不适,提高患者生活质量。

Objective To observe the clinical efficacy of self-prescribed Peitu Shunmu Decoction in treating diarrhea-predominated irritable bowel syndrome(IBS-D)of liver stagnation and spleen deficiency type.Methods Seventy-two IBS-D patients with liver stagnation and spleen deficiency type were randomly divided into observation group and control group,with 36 cases in each group.The control group was given oral use of Saccharomyces boulardii sachets,while the observation group was given self-prescribed Peitu Shunmu Decoction.The treatment for both groups lasted 4 consecutive weeks.The changes in traditional Chinese medicine(TCM)syndrome scores,irritable bowel syndrome severity scoring system(IBS-SSS)scores,irritable bowel syndrome quality of life(IBS-QOL)scores,Hamilton Anxiety Scale(HAMA)scores and Hamilton Depression Scale(HAMD)scores in the two groups were observed before and after treatment.Meanwhile,the TCM syndrome efficacy and clinical safety of the two groups were evaluated.Results(1)During the trial,there were 5 cases losing to follow-up and one case quitting the trial voluntarily in the observation group,while there were 4 cases losing to follow-up and 2 cases quitting the trial voluntarily in the control group.And eventually,30 patients in each group completed the trial.(2)After 4 weeks of treatment,the overall effective rate of the observation group was 93.33%(28/30)and that of the control group was 70.00%(21/30).The intergroup comparison showed that the TCM syndrome efficacy of the observation group was significantly superior to that of the control group(P<0.05).(3)After treatment,the TCM syndrome scores and IBS-SSS scores of patients in both groups were significantly improved compared with those before treatment(P<0.05),and the effect on improving the TCM syndrome scores and IBS-SSS scores in the observation group was significantly superior to that in the control group(P<0.05).(4)After treatment,the scores of dysphoria(DY),health worry(HW),interference with activity(IN)and food avoidance(FA)domains of the IBS-QOL scale in the two groups were significantly improved compared with those before treatment(P<0.05),and the effect on improving the scores of DY,HW,IN and FA domains of the IBSQOL scale in the observation group was significantly superior to that in the control group(P<0.05).(5)After treatment,the HAMA scores and HAMD scores in the two groups were significantly improved compared with those before treatment(P<0.05),and the effect on improving HAMA and HAMD scores in the observation group was significantly superior to that in the control group(P<0.05).(6)During the treatment,there were no adverse reactions occurring in the two groups,showing a high safety profile.Conclusion Self-prescribed Peitu Shunmu Decoction exerts certain effect in treating IBS-D of liver stagnation and spleen deficiency type,which can not only improve the gastrointestinal symptoms,but also regulate the emotions,and improve non-intestinal discomforts and quality of life of the patients.