芪黄通秘软胶囊联合普芦卡必利治疗结肠慢传输型便秘患者的效果及对肠黏膜屏障功能的影响

Therapeutic effect of Qihuang Tongmi Soft Capsules combined with Prukaspiride on patients with slow transit constipation of the colon and thein impact on intestinal mucosal barrier function

目的探讨芪黄通秘软胶囊联合普芦卡必利治疗结肠慢传输型便秘患者的效果及对肠黏膜屏障功能的影响。方法前瞻性选取2021年9月至2024年2月连云港市第一人民医院收治的92例结肠慢传输型便秘患者作为研究对象,按照随机数字表法将其分为观察组与对照组,每组各46例。对照组采取普芦卡必利治疗,观察组在对照组的基础上口服芪黄通秘软胶囊,两组均连续用药4周。比较两组临床疗效,治疗前、治疗4周后的中医证候积分、肠道黏膜功能(二胺氧化酶、D-乳酸)、肠神经递质[神经肽Y、P物质、活性肠肽(VIP)]水平、大便状况[便秘评分量表(Wexner)]、性状[Bristol大便性状分型量表(BSFS)]及周排便次数。结果观察组总有效率为93.48%,高于对照组(76.09%),差异有统计学意义(P<0.05)。治疗4周后,观察组大便干结、气短懒言、面色苍白、肢倦、脉弱、乏力相关中医证候积分分别为(1.46±0.21)、(0.86±0.25)、(2.36±0.03)、(2.84±0.37)、(1.66±0.46)、(1.25±0.58)分,均低于对照组[(2.07±0.53)、(1.46±0.46)、(3.47±0.35)、(3.06±0.46)、(2.01±0.65)、(2.87±0.52)分],差异均有统计学意义(P<0.05)。治疗4周后,观察组二胺氧化酶、D-乳酸水平分别为(12.62±2.24)IU/L、(16.26±3.42)mg/L,均低于对照组[(16.85±4.32)IU/L、(27.51±4.37)mg/L],差异均有统计学意义(P<0.05)。治疗4周后,观察组神经肽Y、VIP水平分别为(81.73±17.12)pg/mL、(9.50±2.52)ng/L,均低于对照组[(97.76±15.46)pg/mL、(14.62±3.83)ng/L],观察组的P物质水平为(61.12±8.31)ng/L,高于对照组[(45.13±6.41)ng/L],差异均有统计学意义(P<0.05)。治疗4周后,观察组患者Wexner评分、BSFS评分分别为(7.58±1.32)、(1.02±0.31)分,均低于对照组[(13.36±2.45)、(1.69±0.24)分],观察组的周排便次数为(4.45±1.07)次,高于对照组[(3.32±0.38)次],差异均有统计学意义(P<0.05)。结论芪黄通秘软胶囊联合普芦卡必利可提升结肠慢传输型便秘临床疗效,减轻中医相关症状,重建肠道屏障功能,调节肠神经递质水平,进而改善结肠传输功能,进一步增加患者排便次数,改善便秘症状与大便性状。

Objective To explore the therapeutic effect of Qihuang Tongmi Soft Capsules combined with Prukaspiride on patients with slow transit constipation of the colon and thein impact on intestinal mucosal barrier function.Methods A total of 92 patients with slow transit constipation of the colon admitted to The First People's Hospital of Lianyungang from September 2021 to February 2024 were prospectively selected as the study subjects.They were divided into the observation group and the control group according to the random number table method,with 46 cases in each group.The control group received treatment with Prukaspiride,while the observation group was given Qihuang Tongmi Soft Capsules on the basis of the control group.The clinical efficacy,traditional Chinese medicine syndrome scores,intestinal mucosal function(diamine oxidase,D-lactate),intestinal neurotransmitter[neuropeptide Y,substance P,and active intestinal peptide(VIP)]levels,stool condition[the Constipation Rating Scale(Wexner)],characteristics[the Bristol stool form scale(BSFS)],and weekly bowel movements were compared between two groups before and after 4 weeks of treatment.Results The total effective rate of the observation group was 93.48%,which was higher than that of the control group(76.09%),and the difference was statistically significant(P<0.05).After 4 weeks of treatment,the TCM syndrome scores related to dry stool,shortness of breath and lazy speech,pale complexion,limb fatigue,weak pulse,and fatigue in the observation group were(1.46±0.21),(0.86±0.25),(2.36±0.03),(2.84±0.37),(1.66±0.46),and(1.25±0.58)points,respectively,which were lower than those in the control group[(2.07±0.53),(1.46±0.46),(3.47±0.35),(3.06±0.46),(2.01±0.65),and(2.87±0.52)points],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the levels of diamine oxidase and D-lactate in the observation group were(12.62±2.24)IU/L and(16.26±3.42)mg/L,respectively,which were lower than those in the control group[(16.85±4.32)IU/L and(27.51±4.37)mg/L],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the levels of neuropeptide Y and VIP in the observation group were(81.73±17.12)pg/mL and(9.50±2.52)ng/L,respectively,which were lower than those in the control group[(97.76±15.46)pg/mL and(14.62±3.83)ng/L],the level of substance P in the observation group was(61.12±8.31)ng/L,which was higher than that in the control group[(45.13±6.41)ng/L],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the Wexner score and BSFS score of the observation group were(7.58±1.32)and(1.02±0.31)points,respectively,which were lower than those of the control group[(13.36±2.45)and(1.69±0.24)points],the weekly bowel movements of the observation group were(4.45±1.07)times,which was higher than those of the control group[(3.32±0.38)times],and the differences were statistically significant(P<0.05).Conclusion The combination of Qihuang Tongmi Soft Capsules and Prukaspiride can improve the clinical efficacy of slow transit constipation in the colon,alleviate traditional Chinese medicine related symptoms,rebuild intestinal barrier function,regulate intestinal neurotransmitter levels,thereby improving colon transit function,further increasing the frequency of defecation in patients,and improving constipation symptoms and stool characteristics.