外台六物黄芩汤对腹泻型肠易激综合征寒热错杂证患者生活质量及肠道菌群的影响

Effect of Waitai Liuwu Huangqin Decoction on Life Quality and Intestinal Microbiota of Diarrhea-predominant Irritable Bowel Syndrome Patients with Cold and Heat Mixed Syndrome

[目的]探讨外台六物黄芩汤对腹泻型肠易激综合征(IBS-D)寒热错杂证患者的生活质量及肠道菌群多样性和菌群结构的影响。[方法]选取IBS-D寒热错杂证患者30例,予外台六物黄芩汤治疗3周,分别于治疗前、治疗后、疗程结束后4周使用SF-36量表、IBS病情严重程度量表(IBS-SSS)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)和中医证候评定量表进行评分。同时分别收集患者治疗开始当天、治疗结束当天的粪便标本,并随机抽取10例粪便样本进行肠道菌群分析。[结果]治疗后及疗程结束后4周IBS-D患者的SF-36量表评分升高,IBS-SSS评分、HAMA评分、HAMD评分降低。30例患者中显效8例,有效19例,无效3例,证候疗效总有效率为90.00%。患者肠杆菌科的丰度较治疗前降低(P<0.05)。10例粪便样本中,共有7例治疗后出现双歧杆菌与肠杆菌科的比值(B/E值)升高。[结论]外台六物黄芩汤可有效改善IBS-D寒热错杂证患者的临床症状,并对患者的精神心理情况有一定的调节作用,有利于提高患者的生活质量,其作用机制可能与调节肠道菌群的结构及丰度有关。

[Objective]To explore the effect of Waitai Liuwu Huangqin decoction on the quality of life of diarrheapredominant irritable bowel syndrome(IBS-D)patients with cold and heat mixed syndrome,and analyze its impact on the diversity and community structure of intestinal microbiota.[Methods]Thirty IBS-D patients with cold and heat mixed syndrome were treated with Waitai Liuwu Huangqin decoction for 3 weeks.All the cases were scored with the SF-36 scale,IBS symptom severity scale(IBS-SSS),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and traditional Chinese medicine syndrome assessment scale at 3 time points before treatment,after treatment,and 4 weeks after treatment ending.The fecal samples of all the cases were collected separately before and after treatment.And 10 among these samples were randomly selected for intestinal microbiota analysis.[Results]The SF-36scale scores increased while the scores of IBS-SSS,HAMA,and HAMD decreased after treatment and 4 weeks after treatment ending comparing to those before treatment.Among these 30 cases,8 cases were significantly effective,19cases were effective,and 3 cases were ineffective.The overall effective rate was 90.00%.The abundance of enterobacteriaceae significantly decreased compared to that of before treatment(P<0.05).7 out of 10 fecal samples experienced an increase in B/E value after treatment.[Conclusion]Waitai Liuwu Huangqin decoction can effectively improve the clinical symptoms of IBS-D patients with cold and heat mixed syndrome,and has a certain regulatory effect on the mental and psychological conditions of IBS-D patients,which is beneficial for improving their life quality.Its mechanism effect may be related to regulating the structure and abundance of intestinal microbiota.