利那洛肽联合聚乙二醇对比番泻叶联合聚乙二醇在便秘病人肠道准备中的应用

Application of linaclotide combined with polyethylene glycol versus Senna leaf combined with polyethylene glycol in bowel preparation of patients with constipation

目的对比利那洛肽联合聚乙二醇(PEG)与番泻叶联合聚乙二醇对便秘病人肠道准备的有效性及安全性。方法选取2020年10月至2022年5月在蚌埠医学院附属阜阳医院行肠镜检查的便秘病人150例,按数字表法分为A、B、C三组,每组50例。肠镜检查前,A组病人服用利那洛肽+2L PEG、B组病人服用番泻叶颗粒+2L PEG、C组病人服用3L PEG,其中C组为对照。主要观察指标为肠道准备效果,该指标根据波士顿肠道准备量表(BBPS)进行评分,次要观察指标为息肉检出率、再次肠道准备意愿及不良反应发生率。结果A组病人三段BBPS评分[(2.22±0.65)分、(2.12±0.66)分、(2.12±0.69)分]、B组病人三段BBPS评分[(2.08±0.75)分、(2.02±0.74)分、(1.86±0.76)分]均优于C组[(1.70±0.54)分、(1.60±0.58)分、(1.46±0.50)分](均P<0.05)。A、B组总BBPS评分[(6.46±1.05)分、(5.96±1.03)分]优于C组(5.00±0.99)分(均P<0.05),A组病人总BBPS评分优于B组(6.46±1.05)分比(5.96±1.03)分(P<0.05),A组病人各段BBPS评分与B组,差异无统计学意义(P>0.05)。A组病人息肉检出率、腹胀发生率优于C组[48%(24/50)比10%(5/50)、12%(6/50)比34%(17/50)](均P<0.017),B组病人腹胀发生率、再次肠道准备意愿优于C组[8%(4/50)比34%(17/50)、4%(2/50)比24%(12/50)](均P<0.017),A组病人息肉检出率、腹胀及恶心发生率、再次肠道准备意愿较B组差异无统计学意义[48%(24/50)比13%(26/50)、12%(6/50)比8%(4/50)、10%(5/50)比10%(5/50)、8%(4/50)比4%(2/50)](均P>0.017)。三组病人腹痛发生率差异无统计学意义[4%(2/50)、6%(3/50)、14%(7/50)](均P>0.017)。结论利那洛肽联合PEG可提高病人肠道准备质量、提高病变检出率、降低不良反应发生率、提高再次肠道准备意愿,是一项更为优化的肠道准备方案。

Objective To evaluate the efficacy and safety of linaclotide combined with polyethylene glycol versus senna leaf combined with polyethylene glycol in bowel preparation for constipation patients.Methods A total of 150 patients with constipation who underwent colonoscopy in Fuyang Hospital Affiliated to Bengbu Medical College from October 2020 to May 2022 were selected and randomized into group A,B and C,with 50 patients in each group.Before colonoscopy,group A were given linaclotide+2L PEG,group B senna leaf granules+2L PEG,group C 3L PEG,and group C was the control group.The main outcome index was intestinal preparation effect,which was scored according to the Boston Bowel Preparation Scale(BBPS).Secondary outcome indexes were polyp detection rate,willingness of bowel preparation again,and incidence of adverse reactions.Results The three-segment BBPS scores of group A[(2.22±0.65)points,(2.12±0.66)points,(2.12±0.69)points],and group B[(2.08±0.75)points,(2.02±0.74)points,(1.86±0.76)points]were better than those of group C[(1.70±0.54)points,(1.60±0.58)points,(1.46±0.50)points](all P<0.05).The total BBPS scores of groups A and B[(6.46±1.05)points,(5.96±1.03)points]were better than those of group C[(5.00±0.99)points](both P<0.05).The total BBPS score of group A was better than group B[(6.46±1.05)points vs.(5.96±1.03)points,P<0.05].There was no statistically significant difference in BBPS scores between Group A and Group B in each segment(P>0.05).The detection rate of polyps and the incidence of abdominal distension in group A were better than those in group C[48%(24/50)vs.10%(5/50),12%(6/50)vs.34%(17/50);all P<0.017].The incidence of abdominal distension and the willingness of bowel preparation again in group B were better than those in group C[8%(4/50)vs.34%(17/50),4%(2/50)vs.24%(12/50);all P<0.017].There were no significant differences in polyp detection rate,incidence of abdominal distension and nausea,and intention of bowel preparation again between group A and group B[48%(24/50)vs.13%(26/50),12%(6/50)vs.8%(4/50),10%(5/50)vs.10%(5/50),8%(4/50)vs.4%(2/50);all P>0.017].There was no significant difference in the incidence of abdominal pain among the three groups[4%(2/50),6%(3/50),14%(7/50);all P>0.017].Conclusion Linaclotide combined with PEG can improve the quality of bowel preparationand the rate of lesion detection,reduce the incidence of adverse reactions and improve the willingness of bowel preparation again,which is a more optimized bowel preparation program.