基于16S rDNA探讨健脾温阳解毒颗粒治疗脾肾阳虚型艾滋病相关腹泻的临床疗效

Clinical Efficacy of Jianpi Wenyang Jiedu Granules(健脾温阳解毒颗粒)in the Treatment of AIDS-Related Diarrhea of Spleen-Kidney Yang Deficiency(脾肾阳虚)Based on 16S rDNA

目的:基于16S rDNA观察健脾温阳解毒颗粒治疗脾肾阳虚型艾滋病相关腹泻的临床疗效。方法:采用随机对照临床研究,将40例患者分为治疗组(20例)和对照组(20例),治疗组给予健脾温阳解毒颗粒,对照组给予蒙脱石散,疗程4 w,观察两组病例组内、组间治疗前后的临床疗效和肠道菌群变化。结果:治疗组总有效率85%(17/20),对照组为65%(13/20),两组比较差异没有统计学意义(P>0.05)。与治疗前相比较,治疗组在门水平上,可显著减少蓝藻门丰度,在属水平上可显著增加粪杆菌属、多尔氏菌属、Anaerostipes、粪球菌_3、丁酸球菌属丰度,减少Nakamurella、氨基酸球菌属、颤螺旋菌属丰度(P<0.05);治疗后,与对照组比较,治疗组总症状积分差值明显升高(P<0.05);肠道菌群与临床症状相关性分析,胃脘痞满与氨基酸球菌、粪杆菌属丰度呈正相关,胃脘疼痛与粪杆菌属、颤螺旋菌属丰度呈正相关,食欲减退与多尔氏菌属、粪球菌-3丰度呈负相关(P<0.05)。结论:健脾温阳解毒颗粒治疗脾肾阳虚型艾滋病相关腹泻临床疗效优于蒙脱石散,安全性好,可以改善患者临床症状,提高患者肠道菌群多样性,减轻肠道炎症,对肠道菌群有调节作用。

Objective:To observe the clinical efficacy of Jianpi Wenyang Jiedu Granules(健脾温阳解毒颗粒)in treating AIDS-related diarrhea of spleen-kidney yang deficiency(脾肾阳虚)based on 16S rDNA analysis.Methods:A randomized controlled clinical trial was conducted with 40 patients divided into a treatment group(20 cases)and a control group(20 cases).The treatment group received Jianpi Wenyang Jiedu Granules,while the control group was given montmorillonite powder,with the course of treatment lasting 4 weeks.The clinical efficacy and the changes in intestinal microbiota within and between the two groups were observed before and after treatment.Results:The overall effective rate was 85%(17/20)in the treatment group and 65%(13/20)in the control group,with no statistically significant difference(P>0.05).Compared with the conditions before treatment,both groups showed increased Shannon,Observed species,Simpson,and PD_whole_tree after treatment,along with a decreased abundance of Proteobacteria and Shigella(P>0.05).In the treatment group,there was a marked reduction in the abundance of Cyanobacteria at the phylum level,and a marked increase in the abundance of Faecalibacterium,Dorea,Anaerostipes,Coprococcus_3,and Butyricicoccus,while the abundance of Nakamurella,Acidaminococcus,and Oscillospira decreased(P<0.05).After treatment,the difference in total symptom score between the treatment and control groups was significant(P<0.05).Correlation analysis between intestinal microbiota and clinical symptoms indicated that epigastric fullness was positively correlated with the abundance of Acidaminococcus and Faecalibacterium;epigastric pain was positively correlated with the abundance of Faecalibacterium and Oscillospira;appetite loss was negatively correlated with the abundance of Dorea and Coprococcus_3(P<0.05).Conclusion:Jianpi Wenyang Jiedu Granules had superior clinical efficacy compared with montmorillonite powder in treating AIDS-related diarrhea of spleen-kidney yang deficiency.It could improve the clinical symptoms of patients,increase the diversity of intestinal flora,alleviate intestinal inflammation,and regulate intestinal microbiota,showing high safety.