参苓白术颗粒联合匹维溴铵对腹泻型肠易激综合征患者免疫功能和肠道菌群及脑肠肽的影响

Effects of Shenling Baizhu Granule combined with pivilium bromide on immune function,intestinal flora and brain intestinal peptide in irritable bowel syndrome with predominant diarrhea

目的探讨参苓白术颗粒联合匹维溴铵对腹泻型肠易激综合征(irritable bowel syndrome with predominant diarrhea,IBS-D)患者免疫功能、肠道菌群及脑肠肽的影响。方法选取2018年2月—2021年9月收治的168例IBS-D患者为研究对象,随机分为观察组和对照组,每组84例。对照组服用匹维溴铵治疗,观察组在对照组基础上采用参苓白术颗粒治疗。比较两组患者的疗效、免疫功能、肠道菌群、脑肠肽及不良反应。结果观察组有效率(90.48%)高于对照组(73.81%),差异有统计学意义(χ2=8.207,P=0.042)。治疗后,观察组的免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白M(immunoglobulin M,IgM)、CD3+、CD4+和CD4+/CD8+水平均显著高于对照组(t=7.955、8.371、9.712、7.684、4.817,P<0.001)。治疗后,观察组的双歧杆菌、乳酸杆菌、拟杆菌的菌落数水平明显高于对照组(t=4.256、5.328、4.007,P<0.001),肠杆菌和肠球菌的菌落数水平明显低于对照组(t=-4.764、-8.083,P<0.001)。观察组治疗后的神经生长因子(nerve growth factor,NGF)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、5-羟色胺(5-hydroxytryptamine,5-HT)和P物质(substance P,SP)水平明显低于对照组(t=-9.639、-13.529、-17.321、-16.902,P<0.001)。分层线性回归表明,参苓白术颗粒使男性患者的双歧杆菌、乳酸杆菌、拟杆菌的暴露风险上升了21%、32%和36%,使肠杆菌和肠球菌的暴露风险下降了33%和25%;参苓白术颗粒使女性患者的双歧杆菌、乳酸杆菌、拟杆菌的暴露风险上升了23%、29%和32%,使肠杆菌和肠球菌的暴露风险下降了37%和22%。不同性别和组别之间无明显交互效应(P=0.376、0.283、0.197、0.356、0.241)。结论参苓白术颗粒能够提高IBS-D患者的疗效,增强免疫功能,调节肠道菌群,降低血清NGF、BDNF水平,有很好的临床应用价值。

Objective To investigate the effects of Shenling Baizhu Granule combined with pivectium bromide on intestinal flora and serum nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)in patients of irritable bowel syndrome with predominant diarrhea(IBS-D).Methods A total of 168 IBS-D patients admitted to our hospital from February 2018 to September 2021 were randomly divided into observation group and control group,with 84 cases in each group.The control group was treated with pivemonium bromide,and the observation group was treated with Shenling Baizhu Granule on the basis of the control group.The efficacy,immune function,intestinal flora,brain intestinal peptide and adverse reactions were compared between the two groups.Results The effective rate of observation group(90.48%)was higher than that of control group(73.81%),the difference was statistically significant(P=0.042).After treatment,the levels of immunoglobulin A(IgA),immunoglobulin M(IgM),CD3+,CD4+and CD4+/CD8+in the observation group were significantly higher than those in the control group(t=7.955,8.371,9.712,7.684 and 4.817,P<0.001).After treatment,the colony number levels of bifidobacterial,lactobacillus and bacteroidetes in the observation group were significantly higher than those in the control group(t=4.256,5.328 and 4.007,P<0.001),while the colony number levels of enterobacteria and enterococcus were significantly lower than those in the control group(t=-4.764 and-8.083,P<0.001).The levels of NGF,BDNF,5-hydroxytryptamine(5-HT)and substance P(SP)in the observation group were significantly lower than those in the control group after treatment(t=-9.639,-13.529,-17.321 and-16.902,P<0.001).Hierarchical linear regression showed that Shenmai injection increased the exposure risk of bifidobacteria,Lactobacillus and Bacteroidetes by 21%,32%and 36%in male patients,and decreased the exposure risk of enterobacteria and enterococcus by 33%and 25%.Shenmai injection increased the exposure risk of bifidobacterial,Lactobacillus and Bacteroidetes by 23%,29%and 32%,and decreased the exposure risk of enterobacteria and enterococcus by 37%and 22%.There was no significant interaction effect between different genders and groups(P=0.376,0.283,0.197,0.356 and 0.241).Conclusion Shenling Baizhu Granule can improve the curative effect of IBS-D patients,enhance immune function,regulate intestinal flora,and reduce serum levels of NGF and BDNF,which has good clinical application value.