枳术颗粒联合利那洛肽治疗便秘型肠易激综合征的临床研究

Efficacy of Zhizhu grain combined with Linaclotide in the treatment of irritable bowel syndrome with predominant constipation

目的观察枳术颗粒联合利那洛肽治疗便秘型肠易激综合征(IBS-C)的临床疗效。方法选择2020年8月至2022年8月如皋市人民医院收治的IBS-C患者118例进行回顾性研究,根据不同治疗方法分成两组,各59例。对照组患者采用利那洛肽胶囊治疗;治疗组在对照组的基础上加用枳术颗粒口服。比较两组治疗效果、IBS症状严重程度量表(IBS-SSS)评分、腹痛评分、IBS生活质量(IBS-QOL)评分,血清血管活性肠肽(VIP)、P物质、NO、促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质酮水平,肠道菌群计数。结果治疗4周后,治疗组总有效率为96.61%,显著高于对照组的83.05%(P<0.05)。两组IBS-SSS及腹痛评分显著下降,治疗组下降更显著(P均<0.01);两组IBS-QOL评分显著增加,治疗组增加更显著(P均<0.01)。两组血清VIP、NO水平均显著减少,P物质显著增加,治疗组以上指标改善更优(P均<0.01);两组大肠杆菌计数明显降低,乳酸杆菌、双歧杆菌明显升高,治疗组以上指标改善更优(P均<0.01);两组血清CRH、ACTH、皮质酮水平均显著减少,治疗组以上指标改善更优(P均<0.01)。结论联用枳术颗粒可显著增强利那洛肽治疗IBS-C的疗效,明显改善症状,提升患者的生活质量,调节多种脑肠肽因子分泌,改善肠道菌群水平和下丘脑-垂体-肾上腺轴紊乱。

Objective To investigate the efficacy of Zhizhu grain combined with Linaclotide in the treatment of irritable bowel syndrome with predominant constipation(IBS-C).Methods A total of 118 eligible IBS-C patients were retrospectively included in Rugao People's Hospital from August of 2020 to August of 2022 and divided into two groups according to different treatment method,with 59 cases each.The control group was treated with Linaclotide capsule,and the treatment group was orally given with Zhizhu grain on the basis of the control group.The therapeutic effect,IBS symptom severity scale(IBS-SSS)score,abdominal pain degree score,IBS life quality(IBS-QOL)score,and serum levels of vasoactive intestinal peptide(VIP),substance P(SP),nitric oxide(NO),corticotropin releasing hormone(CRH),adrenocorticotropic hormone(ACTH),cortisol and intestinal flora calculation were compared between the two groups.Results After 4 weeks of treatment,the total effective rate of IBS-C patients in the treatment group(96.61%)was significantly increased compared with the control group(83.05%,P<0.05).IBS-SSS and abdominal pain severity scores of IBS-C patients in the two groups were significantly decreased,but the decrease was more significant in the treatment group(P<0.01).The IBS-QOL score of IBS-C patients in both groups was significantly increased,but the increase was more significant in the treatment group(P<0.01).The serum VIP and NO levels of IBS-C patients in two groups were significantly decreased,while the SP level was significantly increased,but the above indexes improved better in the treatment group(P<0.01).The count of Escherichia coli in the two groups was significantly reduced,while Lactobacillus and Bifidobacterium were significantly increased,and the above indexes improved better in the treatment group(P<0.01).The serum levels of CRH,ACTH and CORT in the two groups were significantly reduced,but the above indexes in the treatment group were better improved(P<0.01).Conclusion Combined with Zhizhu granules can significantly enhance the efficacy of Linaclotide in the treatment of IBS-C,which can evidently improve the symptoms of IBS-C cases,improve the life quality of patients,and regulate the secretion of various brain gut peptide factors,improve levels of intestinal flora and disorder of the hypothalamic-pituitary-adrenal axis.