基于机体免疫功能探究柴胡桂枝汤联合匹维溴铵对肠易激综合征的作用机制

Investigation of Mechanism of Chaihu Guizhi Tang(柴胡桂枝汤)Combined with Pivetonium Bromide on Irritable Bowel Syndrome Based on Immune Function Changes

目的:基于机体免疫功能变化探究柴胡桂枝汤联合匹维溴铵对肠易激综合征(IBS)的作用机制。方法:选取2020年5月—2022年2月保定市第二中心医院诊治的144例IBS患者,依据随机数字表法分为3组,每组48例。对照A组予以柴胡桂枝汤,对照B组予以匹维溴铵,观察组予以柴胡桂枝方汤联合匹维溴铵,均连续治疗1个月。比较3组临床疗效、不良反应发生率、复发率及治疗前后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、肠易激综合征-病情严重程度(IBS-SSS)、肠易激综合征-生活质量评分(IBS-QOL)及肠道菌群(肠球菌、肠杆菌、双歧杆菌、乳酸杆菌)、T淋巴亚群(CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8))、免疫球蛋白(IgA、IgG、IgM)、Th1/Th2细胞因子[γ型干扰素(IFN-γ)和白介素-4(IL-4)、IFN-γ/IL-4]变化。结果:治疗总有效率比较:观察组较对照A、B组高(P<0.05);治疗后组间HAMA、HAMD评分比较:观察组低于对照A、B组,对照A组低于对照B组(P<0.05);IBS-SSS评分比较:观察组低于对照A、B组(P<0.05);IBS-QOL评分比较:观察组高于对照A、B组,对照A组高于对照B组(P<0.05);IgA、IgG、IFN-γ、IFN-γ/IL-4、肠球菌及肠杆菌比较:观察组低于对照A、B组,对照A组低于对照B组(P<0.05);CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)、IL-4、双歧杆菌及乳酸杆菌比较:观察组高于对照A、B组,对照A组高于对照B组(P<0.05);观察组、对照A组不良反应发生率及随访复发率较对照B组低(P<0.05)。结论:柴胡桂枝汤联合匹维溴铵治疗IBS,可显著提高临床疗效,减少不良反应,降低复发风险,其作用机制可能与柴胡桂枝汤调节免疫球蛋白合成与降解机制、纠正T细胞亚群及Th1/Th2失衡、改善肠道菌群失调有关。

Objective:To investigate the mechanism of Chaihu Guizhi Tang combined with Pivetonium bromide on irritable bowel syndrome(IBS)based on the immune function changes.Methods:From May 2020 to February 2022,144 IBS patients in the Second Central Hospital of Baoding were selected and divided into three groups according to the random number table method,48 patients in each group.The control group A was given Chaihu Guizhi Tang,the control group B was given Pivetonium Bromide,and the observation group was given Chaihu Guizhi Tang combined with Pivetonium Bromide,and all were treated continuously for 1 month.The cli-nical efficacy,incidence of adverse reactions,recurrence rate,HAMA,HAMD,IBS-SSS,IBS-QOL scores and intestinal flora(enterococcus,enterobacter,bifidobacterium,lactobacillus),T-lymphatic subpopulation(CD^(+)_(4),CD^(+)_(8),CD^(+)_(4)/CD^(+)_(8)),immunoglobulins(IgA,IgG,IgM),Th1/Th2 cytokines(IFN-γand IL-4,IFN-γ/IL-4)all were compared.Results:Total efficiency:the observation group was higher than that of the control A or B group(P<0.05);HAMA and HAMD scores:the observation group was lower than those of the control A or B group,and the control A group was lower than that of the control B group(P<0.05);IBS-SSS scores:the observation group was lower than that of the control A or B group(P<0.05).IBS-QOL score was higher in the observation group than that in the control A or B group,and higher in the control A group than in the control B group(P<0.05);IgA,IgG,IFN-γ,IFN-γ/IL-4,enterococci and enterobacteria were lower in the observation group than those in the control A or B groups,and lower in the control A group than in the control B group(P<0.05).CD^(+)_(4),CD^(+)_(4)/CD^(+)_(8),IL-4,bifidobacteria and lactobacilli were higher in the observation group than those in the control A or B groups,and in the control A group than in the control B group(P<0.05);the incidence of adverse reactions and the recurrence rate at follow-up were lower in the observation and control A groups than those in the control B group(P<0.05).Conclusion:Chaihu Guizhi Tang can significantly improve clinical symptoms,reduce adverse reactions,lower the risk of recurrence and improve the therapeutic effect in the treatment of IBS combined with Pi-vetonium bromide.Its mechanism is probably due to the fact that it can regulate the immunoglobulin synthesis and degradation,correct the ratio of T cell subpopulation and Th1/Th2 imbalance,and promote the change of intestinal flora dysbiosis.