基于“脑-肠轴”探讨增液汤对改善慢传输型阴虚便秘患者血清P物质、胃动素、微管相关蛋白2的临床效果研究

The clinical effect of Zengye Decoction in improving substance P,motilin and microtubule associated protein 2 in patients with slow transit Yin deficiency constipation based on"brain-gut axis"

目的:基于“脑-肠轴”理论探讨增液汤对慢传输型阴虚便秘(STC)患者血清P物质(SP)、胃动素(MLT)和微管相关蛋白2(MAP-2)的影响及其临床疗效。方法:选取河北省沧州中西医结合医院2020年4月—2023年4月收治的116例STC患者作为研究对象,依据随机数字表法将其分为对照组(n=58)和观察组(n=58);对照组给予常规西药治疗,观察组给予“脑-肠轴”为理论的增液汤治疗,2组均治疗2个月。观察2组治疗前后便秘症状和粪便性状评分、SP、MTL、MAP-2表达水平、脑肠肽水平及心理状态评分、中医证候积分,比较2组不良反应发生率。结果:2组研究期间病例共脱落10例,最终对照组纳入54例,观察组52例;与治疗前比较,治疗后2组便秘症状评分、粪便性状评分、SP、MTL、MAP-2表达水平、脑肠肽水平、心理状态和中医证候积分均有所改善(P<0.05)。与对照组比较,观察组治疗后克利夫兰便秘评分(CCS)显著降低,布里斯托大便分类法(Bristol)评分显著升高(P<0.05);与对照组比较,观察组治疗后SP、MTL水平和MAP-2阳性率均显著升高(P<0.05);与对照组比较,观察组治疗后5-羟色胺受体4(5-HTR4)水平显著升高,一氧化氮(NO)水平显著降低(P<0.05);与对照组比较,观察组治疗后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分显著降低(P<0.05);与对照组比较,观察组治疗后中医证候积分更低(P<0.05);与对照组比较,观察组不良反应发生率更低(P<0.05)。结论:基于“脑-肠轴”理论的增液汤可以显著改善STC患者SP、MTL、MAP-2水平与便秘情况、心理状态和中医证候积分,具有较高的安全性,值得临床推广应用。

Objective To investigate the clinical effect of Zengye Decoction based on brain-gut axis theory on serum substance P(SP),motilin(MLT)and microtubule associated protein 2(MAP-2)in patients with slow transit Yin deficiency constipation(STC).Methods A total of 116 patients with STC admitted to Cangzhou Hospital Of Integrated TCM-WM·Hebei from April 2020 to April 2023 were selected and they divided into control group(n=58)and observation group(n=58)according to random number table method.The control group was treated with conventional western medicine,and the observation group was treated with Zengye decoction based on the theory of brain-gut axis.Both groups were treated for 2 months.The constipation symptom and fecal trait score of the two groups were observed before and after treatment.The expression levels of SP,MTL and MAP-2 were compared between the two groups before and after treatment.The levels of brain intestinal peptide before and after treatment were compared between the two groups.The scores of mental state before and after treatment were compared between the two groups.The scores of TCM symptoms before and after treatment were compared between the two groups.The incidence of adverse reactions was compared between the two groups.Results Compared with before treatment,constipation symptom score,fecal trait score,SP,MTL,MAP-2 expression level,brain-intestinal peptide level,psychological state and TCM syndrome score of the two groups were improved after treatment(P<0.05).Compared with the control group,the Cleveland constipation score(CCS)of the observation group was significantly decreased after treatment,and the Bristol stool classification score was significantly increased(P<0.05).Compared with the control group,the levels of SP,MTL and the positive rate of MAP-2 in the observation group after treatment were significantly increased(P<0.05).Compared with the control group,the level of 5-hydroxytryptamine receptor 4(5-HTR4)was significantly increased in the observation group after treatment,and the level of nitric oxide(NO)was significantly decreased(P<0.05).Compared with the control group,the scores of self-rating Anxiety Scale(SAS)and self-rating Depression Scale(SDS)in the observation group were significantly decreased after treatment(P<0.05).Compared with the control group,the TCM syndrome score of the observation group was significantly lower after treatment(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Zengye Decoction based on the"brain-gut axis"theory can significantly improve the levels of SP,MTL,MAP-2,constipation,psychological state and TCM syndrome scores in STC patients,and has high safety,which is worthy of clinical wide application.