基于“肝-肠轴”观点运用柴枳导滞方治疗小儿功能性便秘的临床观察

Clinical Observation of Chai Zhi Daozhi Prescription for the Treatment of Functional Constipation in Children from the Perspective of Liver-Gut Axis

【目的】探讨从“肝-肠轴”观点出发,运用柴枳导滞方(由逍遥散、二陈汤和平胃散化裁而成)治疗小儿功能性便秘的临床疗效。【方法】将60例功能性便秘肝郁气滞型患儿随机分成治疗组和对照组,每组各30例。治疗组给予柴枳导滞方治疗,对照组给予小麦纤维素颗粒治疗,疗程为14 d。观察2组患儿治疗前后中医证候积分、肠道菌群及粪便胆酸(CA)、鹅去氧胆酸(CDCA)含量的变化情况,并评价2组患儿的临床疗效、复发情况和安全性。【结果】(1)治疗14 d后,治疗组的总有效率为93.33%(28/30),对照组为70.00%(21/30),组间比较,治疗组的疗效明显优于对照组(P<0.05)。(2)治疗后,2组患儿的粪便性状、排便间隔时间、排便持续时间、排便困难程度等各项主症积分及次症总积分均较治疗前明显降低(P<0.05),且治疗组的降低作用均明显优于对照组(P<0.01)。(3)治疗后,治疗组患儿的粪便CA、CDCA含量均较治疗前明显提高(P<0.05),而对照组患儿的粪便CA、CDCA含量均无显著性提高(P>0.05);组间比较,治疗组对粪便CA、CDCA含量的提高作用均明显优于对照组(P<0.01)。(4)疗程结束后对2组患儿进行1个月的随访,治疗组的复发率为13.33%(4/30),对照组为40.00%(12/30),组间比较,治疗组的复发率明显低于对照组(P<0.05)。(5)治疗过程中,2组患儿均未发生不良事件,且2组患儿治疗前后的肝、肾功能等安全性指标均未见明显异常。【结论】基于“肝-肠轴”观点运用柴枳导滞方治疗小儿功能性便秘疗效确切。

Objective To investigate the clinical efficacy of Chai Zhi Daozhi Prescription(derived from the composition of Xiaoyao Powder,Erchen Decoction and Pingwei Powder)in treating functional constipation in children from the perspective of liver-gut axis.Methods Sixty children with functional constipation of liver depression and qi stagnation type were randomly divided into the treatment group and the control group,with 30 cases in each group.The children in the treatment group were treated with Chai Zhi Daozhi Prescription and the control group was treated with Fiberform(Testa Triticum Tricum Purif)Granules.The treatment for both groups lasted 14 days.Changes in the traditional Chinese medicine(TCM)syndrome scores,intestinal flora,and fecal bile acid(CA)and chenodeoxycholic acid(CDCA)levels in the two groups were observed before and after treatment.Furthermore,the clinical efficacy,recurrence and clinical safety in the two groups were evaluated.Results(1)After 14 days of treatment,the overall effective rate of the treatment group was 93.33%(28/30)and that of the control group was 70.00%(21/30),and the intergroup comparison showed that the efficacy of the treatment group was significantly superior to that of the control group(P<0.05).(2)After treatment,the children in the two groups showed a significant reduction in the scores of the primary symptoms of stool traits,interval of the defecation,duration of defecation and the degree of difficulty in defecation as well as in the total scores of the secondary symptoms compared with those before the treatment(P<0.05),and the effect on decreasing the scores in the treatment group was significantly superior to that in the control group(P<0.01).(3)After treatment,the fecal CA and CDCA levels of the children in the treatment group were significantly increased compared those before treatment(P<0.05),whereas the fecal CA and CDCA levels in the control group were not significantly increased(P>0.05).The intergroup comparison showed that the effect on increasing the fecal CA and CDCA levels in the treatment group was significantly superior to that in the control group(P<0.01).(4)The one-month follow-up after the completion of treatment course showed that the recurrence rate in the treatment group was 13.33%(4/30)and that in the control group was 40.00%(12/30).The intergroup comparison showed that the recurrence rate in the treatment group was significantly lower than that in the control group(P<0.05).(5)During the treatment,there were no adverse events occurring in any of the children in the two groups,and no significant abnormalities were found in the safety indicators of liver and kidney function after treatment in the two groups.Conclusion Chai Zhi Daozhi Prescription exerts certain effect in treating functional constipation in children based on the liver-gut axis.