基于肠道菌群探讨化裁柴胡桂枝干姜汤治疗胆热脾寒型胆囊切除术后腹泻的临床研究

Exploration of the Clinical Research of Modified Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤)in the Treatment of Post-cholecystectomy Diarrhea with Syndrome of Gallbladder-heat and Spleen-cold Based on the Intestinal Flora

目的分析化裁柴胡桂枝干姜汤治疗胆热脾寒型胆囊切除术后腹泻的临床疗效及对肠道菌群的影响。方法采用随机数字表法将114例胆囊切除术后腹泻胆热脾寒证患者分为中药组38例、泌特组38例、培菲康组38例,分别予化裁柴胡桂枝干姜汤、复方阿嗪米特肠溶片、双歧杆菌三联活菌胶囊口服治疗,疗程为8周。对比分析治疗前后3组患者大便性状及排便频率、中医症状改善情况及治疗后肠道菌群构成、代谢情况,并记录不良反应。结果(1)3组患者大便性状及排便频率均有改善(P<0.05),泌特组、培菲康组疗效接近(P>0.05),均不及中药组(P<0.05)。(2)3组患者中医症状总积分较治疗前均显著降低(P<0.01),中药组显著优于泌特组、培菲康组(P<0.01)。(3)中药组、泌特组、培菲康组的中医证候疗效总有效率分别为91.67%、72.22%、69.44%,3组中医证候疗效总有效率差异有统计学意义(P<0.05),中药组优于泌特组、培菲康组(P<0.05)。(4)3组患者治疗后在α多样性分析方面均发生变化(P<0.05),中药组与培菲康组的Chao1、Observed features、Shannon及Simpson指数上升趋势较泌特组更显著;在β多样性分析方面,与健康对照组相比,中药组、培菲康组肠道菌群组成差异无统计学意义(P>0.05),泌特组差异有统计学意义(P<0.05);组间显著性差异方面,与健康对照组相比,中药组和培菲康组中有显著性差异的菌种较少,而泌特组较多;肠道菌群代谢通路结构差异性方面,与健康对照组相比,中药组与培菲康组代谢通路结构差异较小,泌特组差异较大。结论化裁柴胡桂枝干姜汤治疗胆热脾寒型胆囊切除术后腹泻的临床疗效显著,可有效缓解症状,调节人体肠道菌群,恢复胆囊切除术后腹泻患者肠道菌群多样性,改善肠道菌群代谢通路,值得临床推广。

Objective To analyze the clinical efficacy of Modified Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤)in the treatment of post-cholecystectomy diarrhea with syndrome of gallbladderheat and spleen-cold and the effect of the Modified Chaihu Guizhi Ganjiang Decoction in the intestinal flora.Methods 114 patients with post-cholecystectomy diarrhea with gallbladder-heat and spleencold were divided into the Chinese medicine group,the Mite group and the BIFICO group by the random number table method,and each group with 38 people.Patients were taken orally the Modified Chaihu Guizhi Ganjiang Decoction in the Chinese medicine group,patients were taken orally Compound Azimtamide Enteric-coated Tablets in the Mite group and patients were taken orally Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules,oral in the BIFICO group.The treatment course was 8 weeks.To analyze the stool characteristics and defecation frequency and the improvement of TCM symptoms before and after treatment,the composition and metabolism of intestinal flora after treatment,and adverse reactions were recorded in the three groups before and after treatment.Results(1)The stool characteristics and defecation frequency of the three groups were all improved(P<0.05),and the curative effect of the Mite group was similar to the BIFICO group(P>0.05),which were less effective than the Chinese medicine group(P<0.05).(2)The total scores of TCM symptoms in the three groups were significantly lower than those before treatment(P<0.01),and the Chinese medicine group was significantly better than the Mite group and the BIFICO group(P<0.01).(3)The total effective rates of TCM syndromes in the Chinese medicine group,the Mite group,and the BIFICO group were 91.67%,72.22%,69.44%respectively.The total effective rates of TCM syndromes in the three groups were different(P<0.05).The Chinese medicine group was superior to the Mite group and the BIFICO group(P<0.05).(4)After treatment,the intestinal flora of the three groups changed in the analysis ofαdiversity(P<0.05),and the Chao1,Observed features,Shannon and Simpson indexes of the Chinese medicine group and the BIFICO group had a higher upward trend than the Mite group.In terms of analysis ofβdiversity,compared with the healthy control group,there was no difference in the composition of the intestinal flora in the Chinese medicine group and the BIFICO group(P>0.05),but there was a difference in the Mite group(P<0.05).In terms of significant differences between groups,compared with the healthy control group,there were fewer bacterial strains with significant differences in the Chinese medicine group and the BIFICO group,and more in the Mite group.In terms of structural differences in the metabolic pathways of intestinal flora,compared with the healthy control group,there were less differences in the structure of metabolic pathways in the Chinese medicine group and the BIFICO group,and more differences in the Mite group.Conclusion Modified Chaihu Guizhi Ganjiang Decoction has significant clinical curative effect on post-cholecystectomy diarrhea with syndrome of gallbladderheat and spleen-cold,which can effectively relieve symptoms,regulate human intestinal flora,restore intestinal flora diversity in patients with post-cholecystectomy diarrhea,and improve the metabolic pathway of intestinal flora,which is worthy of clinical promotion.