伊托必利联合双歧杆菌治疗围绝经期功能性便秘患者的临床效果

Clinical effects of itopride combined with bifidobacterium in the treatment of perimenopausal functional constipation

目的探讨伊托必利联合双歧杆菌治疗围绝经期功能性便秘患者的临床效果,并分析其对患者胃肠激素水平的影响。方法选取2019年2月—2022年10月在温州市中心医院消化内科治疗且符合纳入、排除标准的围绝经期功能性便秘患者82例为研究对象,回顾性分析其临床资料。评价患者治疗效果并根据疗效对患者进行分组。对比不同组间患者年龄、体质量指数(BMI)、高血压患病史、糖尿病患病史及妊娠史等一般临床资料,血清中胃泌素(GAS)、胃动素(MTL)、P物质(SP)及生长抑素(SS)的表达水平。对于存在组间差异的指标进一步通过Spearman相关性分析和二元logistic回归分析筛选围绝经期功能性便秘患者治疗无效的独立危险因素或保护因素。结果纳入研究的患者治疗总有效率为78.00%,其中临床有效组患者64例,临床无效组患者18例。两组患者平均年龄[(64.25±1.57)岁vs.(64.50±1.72)岁]、平均BMI[(24.41±1.95)kg/m^(2)vs.(23.98±1.66)kg/m^(2)]、合并高血压比例(17.19%vs.22.22%)、合并糖尿病比例(12.50%vs.16.67%)及妊娠史(71.88%vs.61.11%)比较,差异均无统计学意义(t/χ^(2)=0.583、0.860、0.238、0.210及0.768,均P>0.05)。临床有效组患者血清GAS[(49.45±3.52)pg/ml vs.(44.17±2.46)pg/ml]、MTL[(321.32±18.85)ng/ml vs.(297.86±13.15)ng/ml]及SP[(48.23±4.92)pg/ml vs.(42.61±3.76)pg/ml]水平均显著高于临床无效组患者,而血清SS[(14.23±1.88)ng/L vs.(16.44±1.55)ng/L]水平显著低于临床无效组患者,差异均有统计学意义(t=5.962、4.940、4.475及4.545,均P<0.05)。相关性分析结果显示,患者血清GAS、MTL及SP水平与围绝经期功能性便秘患者治疗无效呈负相关关系(r=-0.541、-0.480、-0.463,均P<0.05),而血清SS水平与围绝经期功能性便秘患者治疗无效呈正相关关系(r=0.449,P<0.05)。二元logistic回归分析结果显示,血清GAS、MTL及SP水平降低均是围绝经期功能性便秘患者治疗无效的独立危险因素(HR=0.558、0.992及0.724,均P<0.05)。结论伊托必利联合双歧杆菌治疗方案治疗围绝经期功能性便秘患者具有较好疗效,同时能够有效改善患者胃肠激素水平。监测围绝经期功能性便秘患者血清GAS、MTL及SP水平对于更好地判断患者治疗效果和预后具有一定临床意义。

Objective To explore the clinical effects of itopride combined with Bifidobacterium in the treatment of perimenopausal functional constipation,and to analyze its effects on the gastrointestinal hormone levels in the patients.Methods A total of 82 perimenopausal patients with functional constipation who were treated in the Department of Gastroenterology of Wenzhou Central Hospital from February 2019 to October 2022 and met the inclusion and exclusion criteria were selected as the study subjects,whose clinical data were analyzed retrospectively.The therapeutic effect for the patients was evaluated,and the patients were grouped based on the therapeutic effect.General clinical data including age,body mass index(BMI),hypertension history,diabetes history,and pregnancy history,as well as expression of gastrin(GAS),motilin(MTL),substance P(SP),and somatostatin(SS)in serum were compared between different groups.For the indicators with dfferences between groups,Spearman correlation analysis and binary Logistic regression were performed to screen for the independent risk factors or protective factors for treatment failure in perimenopausal patients with functional constipation.Results The total effective rate among the patients included in the study was 78.00%;64 and 18 patients were included in the clinically effective group and clinically ineffective group,respectively.There were no statistically significant differences between the two groups in mean age[(64.25±1.57)years vs.(64.50±1.72)years]or mean BMI[(24.41±1.95)kg/m^(2)vs.(23.98±1.66)kg/m^(2)]of patients,or in proportions of patients with hypertension(17.19% vs.22.22%),diabetes(12.50% vs.16.67%),or pregnancy history(71.88%vs.61.11%)(t/χ^(2)=0.583,0.860,0.238,0.210,and 0.768,all P>0.05).Compared with the clinically ineffectively group,serum GAS[(49.45±3.52)pg/ml us.(44.17±2.46)pg/ml),MTL[(321.32±18.85)ng/mlus.(297.86±13.15)ng/ml)andSP[(48.23±4.92)pg/ml us.(42.61±3.76)pg/ml]were significantly higher,while serum SS[(14.23±1.88)ng/L us.(16.44±1.55)ng/L]was significantly lower in the clinically effective group,all with statistically significant dfferences(t=5.962,4.940,4.475,and 4.545,all P<0.05).Correlation analysis showed that serum GAS,MTL,and SP were negatively correlated with treatment failure in the patients(r=-0.541,-0.480,and-0.463,all P<0.05),while serum SS was positively correlated with treatment failure in the patients(r=0.449,P<0.05).Decreased serum GAS,MTL,and SP were shown to be independent risk factors for treatment failure in the patients(HR=0.558,0.992 and 0.724,all P<0.05).Conclusion The treatment regimen of itopride combined with Bifidobacterium produced a satisfactory therapeutic effect in the treatment of perimenopausal functional constipation,and effectively improved the gastrointestinal hormone levels in the patients.Monitoring serum GAS,MTL and SP in perimenopausal patients with functional constipation would be of clinical significance for better assessing the therapeutic effect and patient prognosis.