健脾止泻汤联合匹维溴铵片治疗腹泻型肠易激综合征肝郁脾虚证临床研究

Clinical Study on Jianpi Zhixie Decoction Combined with Pinaverium Bromide Tablets for Diarrhea-Predominant Irritable Bowel Syndrome with Liver Constraint and Spleen Deficiency Syndrome

目的:观察健脾止泻汤联合匹维溴铵片治疗腹泻型肠易激综合征(IBS-D)肝郁脾虚证的临床疗效。方法:选取IBS-D肝郁脾虚证患者96例为研究对象,按随机数字表法分为对照组和观察组各48例。对照组给予匹维溴铵片治疗,观察组在对照组基础上联合健脾止泻汤治疗。2组均治疗4周。评价2组临床疗效,比较2组治疗前后中医证候评分、IBS症状严重程度积分(IBS-SSS)、血清细胞因子指标、肠屏障功能指标。结果:观察组总有效率为93.75%,高于对照组79.17%(P<0.05)。治疗后,2组腹痛、腹胀、腹泻、急躁易怒、纳呆、两胁胀满及身倦乏力评分较治疗前降低(P<0.05),且观察组各项评分低于对照组(P<0.05)。治疗后,2组生活困扰度、腹痛天数、腹痛程度、腹胀程度、排便满意度评分及总分较治疗前降低(P<0.05),且观察组各项评分低于对照组(P<0.05)。治疗后,2组血清白细胞介素-2 (IL-2)、干扰素-γ (IFN-γ)、二胺氧化酶(DAO)、D-乳酸(D-LA)、肠脂肪酸结合蛋白(IFABP)水平较治疗前降低(P<0.05),且观察组低于对照组(P<0.05);2组血清白细胞介素-4 (IL-4)、白细胞介素-10 (IL-10)水平较治疗前升高(P<0.05),且观察组高于对照组(P<0.05)。结论:健脾止泻汤治疗IBS-D患者,通过抑制胃肠道炎性反应,修复肠屏障功能,有效缓解腹痛、腹泻等临床症状,进而改善患者日常生活。

Objective:To observe the clinical effect of Jianpi Zhixie Decoction combined with Pinaverium Bromide Tablets for diarrhea-predominant irritable bowel syndrome(IBS-D)with liver constraint and spleen deficiency syndrome.Methods:A total of 96 cases IBS-D patients with liver constraint and spleen deficiency syndrome were selected as the study objects and divided into the control group and the observation group according to the random number table method,with 48 cases in each group.The control group was treated with Pinaverium Bromide Tablets,and the obsrevation group was additionally treated with Jianpi Zhixie Decoction based on the treatment of the control group. Both groups were treated for4 weeks. Clinical effects were evaluated in the two groups. Traditional Chinese medicine syndrome scores,scores of Irritable Bowel Syndrome-Symptom Severity Scale (IBS-SSS), serum cytokine indicators, andintestinal barrier function indicators were compared between the two groups before and after treatment.Results:The total effective rate was 93.75% in the observation group,higher than that of 79.17% in thecontrol group (P<0.05). After treatment, the scores of abdominal pain, abdominal distention, diarrhea,irritability and irascibility, torpid intake, distention and fullness in the rib- side, and fatigue and lack ofstrength in the two groups were decreased when compared with those before treatment (P<0.05), andeach score in the observation group was lower than that in the control group (P<0.05). After treatment,thescores of influence of IBS on life, abdominal pain frequency, abdominal pain intensity, abdominaldistension, and dissatisfaction with bowel habits, as well as the total scores in the two groups weredecreased when compared with those before treatment (P<0.05);and each score in the observation groupwere lower than those in the control group (P<0.05). After treatment, the levels of serum interleukin-2(IL-2) and interferon- γ (IFN- γ), diamine oxidase (DAO), D-lactic acid (D-LA), and intestinal fatty acidbinding protein (IFABP) in the two groups were decreased when compared with those before treatment (P<0.05);and the above levels in the observation group were lower than those in the control group (P<0.05);the levels of serum interleukin-4 (IL-4) and interleukin-10 (IL-10) in the two groups were increased whencompared with those before treatment (P<0.05);the above two levels in the observation group werehigher than those in the control group (P<0.05). Conclusion:Jianpi Zhixie Decoction is used to treat IBS-Dpatients by inhibiting gastrointestinal inflammatory reactions and repairing intestinal barrier function,whichcan effectively relieve clinical symptoms such as abdominal pain and diarrhea, and improve the patient'sdaily life.