安肠止泻方剂联合针刺治疗肠易激综合征(脾虚湿盛型)疗效研究

Clinical effect of Anchang Zhixie prescription combined with acupuncture in the treatment of irritable bowel syndrome(spleen deficiency and dampness excess syndrome)

目的探讨安肠止泻方剂联合针刺治疗肠易激综合征(IBS)(脾虚湿盛型)的临床疗效及对患者肠道菌群、黏膜屏障功能的影响。方法选取2021年8月至2022年8月开封市祥符区中医院收治的84例脾虚湿盛型IBS患者为研究对象,采用随机数表法分为联合中药组和针刺组各42例。两组患者均给予常规西医药物治疗,针刺组同时给予针刺疗法治疗,联合中药组则在针刺组治疗的基础上给予安肠止泻方剂联合治疗。治疗1个月后,比较两组患者的临床疗效,治疗前及治疗1个月后肠道菌群数目、黏膜屏障功能指标[二胺氧化酶(DAO)、D-乳酸、内毒素]、血清相关因子[5-羟色胺(5-HT)、白细胞介素-8(IL-8)、γ-干扰素(IFN-γ)]及治疗期间的不良反应发生情况。结果治疗1个月后,联合中药组患者的治疗总有效率为95.24%,明显高于针刺组的78.57%,差异有统计学意义(P<0.05);治疗1个月后,联合中药组患者的肠球菌、乳酸杆菌数目分别为(12.84±1.54)lg(CFU/g)、(9.96±1.58)lg(CFU/g),明显多于针刺组的(10.18±1.42)lg(CFU/g)、(8.93±1.49)lg(CFU/g),酵母样真菌数目为(3.02±0.47)lg(CFU/g),明显少于针刺组的(3.65±0.56)lg(CFU/g),差异均有统计学意义(P<0.05);治疗1个月后,联合中药组患者的血清内毒素、DAO、D-乳酸、5-HT、IL-8、IFN-γ水平分别为(0.59±0.08)pg/mL、(9.85±1.63)U/L、(7.05±1.25)mg/L、(350.28±27.14)pg/mL、(2.85±0.84)ng/L、(25.84±3.46)pg/mL,明显低于针刺组的(0.72±0.11)pg/mL、(11.24±1.85)U/L、(8.64±1.38)mg/L、(368.53±29.48)pg/mL、(4.25±0.96)ng/L、(30.26±3.68)pg/mL,差异均有统计学意义(P<0.05);治疗期间联合中药组患者的不良反应总发生率为11.90%,略高于针刺组的7.14%,但差异无统计学意义(P>0.05)。结论安肠止泻方剂联合针刺治疗脾虚湿盛型IBS可改善患者的黏膜屏障功能、肠道微生态及炎症状态,临床疗效显著且具有较高的安全性。

Objective To investigate the clinical efficacy of Anchang Zhixie prescription combined with acupuncture in the treatment of irritable bowel syndrome(IBS)(spleen deficiency and dampness excess syndrome),and its effect on intestinal flora and mucosal barrier function.Methods Eighty-four patients with IBS(spleen deficiency and dampness excess syndrome)were selected in Kaifeng Xiangfu District Traditional Chinese Medicine Hospital from August 2021 to August 2022 were selected and divided into combined TCM group and acupuncture group according to random number table method,with 42 cases in each group.Based on conventional western medicine,acupuncture group was treated with acupuncture therapy,and the combined TCM group was treated with Anchang Zhixie prescription on the basis of acupuncture group.The clinical efficacy after 1 month of treatment,intestinal flora number,mucosal barrier function[diamine oxidase(DAO),D-lactic acid,endotoxin],serum related factors[5-hydroxytryptamine(5-HT),interleukin-8(IL-8),gamma-interferon(IFN-γ)]before and after 1 month of treatment,and adverse reactions during treatment were compared between the two groups.Results After 1 month of treatment,the total effective rate in the combined TCM group was 95.24%,which was significantly higher than that in the acupuncture group(78.57%),P<0.05.After 1 month of treatment,the numbers of Enterococcus and Lactobacillus in the combined TCM group were(12.84±1.54)lg(CFU/g)and(9.96±1.58)lg(CFU/g),respectively,which were significantly higher than(10.18±1.42)lg(CFU/g)and(8.93±1.49)lg(CFU/g)in the acupuncture group;the number of yeast-like fungi was(3.02±0.47)lg(CFU/g),which was significantly lower than(3.65±0.56)lg(CFU/g)in acupuncture group;the differences were statistically signifi cant(P<0.05).After 1 month of treatment,the serum levels of endotoxin,DAO,D-lactic acid,5-HT,IL-8,and IFN-γ were(0.59±0.08)pg/mL,(9.85±1.63)U/L,(7.05±1.25)mg/L,(350.28±27.14)pg/mL,(2.85±0.84)ng/L,and(25.84±3.46)pg/mL,respectively,which were significantly lower than(0.72±0.11)pg/mL,(11.24±1.85)U/L,(8.64±1.38)mg/L,(368.53±29.48)pg/mL,(4.25±0.96)ng/L,(30.26±3.68)pg/mL in acupuncture group(P<0.05).During treatment,the total incidence of adverse reactions in the combined TCM group was 11.90%,which was slightly higher than 7.14% in acupuncture group,but the difference was not statistically significant(P>0.05).Conclusion Anchang Zhixie prescription combined with acupuncture therapy in the treatment of IBS(spleen deficiency and dampness excess syndrome)can improve the mucosal barrier function,intestinal microecology,and inflammatory state,with significant clinical efficacy and high safety.