补脾益肠丸联合复方谷氨酰胺治疗腹泻型肠易激综合征的临床研究

Clinical study on Bupi Yichang Pills combined with compound glutamine in treatment of diarrhea-predominant irritable bowel syndrome

目的探讨补脾益肠丸联合复方谷氨酰胺肠溶胶囊治疗腹泻型肠易激综合征的临床效果。方法选取2016年9月—2018年12月新乡医学院第一附属医院收治的96例腹泻型肠易激综合征患者,运用随机数字表法将其随机分成对照组和治疗组,每组各48例。对照组饭前口服复方谷氨酰胺肠溶胶囊,3粒/次,3次/d。治疗组在对照组治疗基础上饭前口服补脾益肠丸,6 g/次,3次/d。两组均连续治疗4周。观察两组的临床疗效,比较两组治疗前后症状评分、视觉模拟评分法(VAS)评分、直肠感觉功能参数、血清学指标和肠易激综合征生活质量(IBS-QOL)量表评分的变化情况。结果治疗后,对照组和治疗组的总有效率分别是81.25%、95.83%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组大便频率、性状评分及腹痛VAS评分较治疗前均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组症状评分显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组直肠感觉阀值、疼痛阀值、排便阀值及最大耐受阀值较治疗前均显著上升,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组这些直肠感觉功能参数显著高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血浆胃动素(MTL)、γ-干扰素(IFN-γ)、IFN-γ/白介素-4(IL-4)比值较治疗前均显著降低,而IL-4水平均显著增高,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组患者MTL、IFN-γ、IFN-γ/IL-4比值低于对照组,而血清IL-4水平高于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组IBS-QOL量表中心境恶劣评分、自体意象评分、进食逃避评分、性行为评分、关系拓展评分、社会功能评分、健康担忧评分、行为障碍评分、总评分均较治疗前显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组这些评分显著低于对照组,两组比较差异有统计学意义(P<0.05)。结论补脾益肠丸联合复方谷氨酰胺肠溶胶囊治疗腹泻型肠易激综合征具有较好的临床疗效,能有效减轻患者症状,降低内脏敏感性,调节胃肠激素分泌,改善生活质量,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Bupi Yichang Pills combined with Compound Glutamine Entersoluble Capsules in treatment of diarrhea-predominant irritable bowel syndrome.Methods Patients(96 cases)with diarrhea-predominant irritable bowel syndrome in the First Affiliated Hospital of Xinxiang Medical College from September 2016 to December 2018 were divided into control(42 cases)and treatment(42 cases)groups using the random number table method.Patients in the control group were po administered with Compound Glutamine Entersoluble Capsules,3 grains/time,three times daily.Patients in the treatment group were po administered with Bupi Yichang Pillson the basis of the control group,6 g/time,three times daily.Patients in two groups were treated for 4 weeks.After treatment,the clinical efficacy was evaluated,and the symptom score,VAS score,rectal sensory function parameters,serological indicators and IBS-QOL score in two groups before and after treatment were compared.Results After treatment,the clinical efficacy in the control and treatment groups were 81.25%and 95.83%,respectively,and there were differences between two groups(P<0.05).After treatment,the fecal frequency,trait score and VAS score of abdominal pain in the two groups were significantly lower than those before treatment,and there were differences in the same group(P<0.05).After treatment,those symptom scores in the treatment group were lower than those in the control group,and there were differences between two groups(P<0.05).After treatment,the rectal sensation threshold,pain threshold,defecation threshold and maximum tolerance threshold in two groups were significantly increased compared with those before treatment,and there were differences in the same group(P<0.05).After treatment,those parameters of rectal sensory function in the treatment group were higher than those in the control group,and there were differences between two groups(P<0.05).After treatment,MTL,IFN-γ,IFN-γ/IL-4 in two groups were significantly lower,but IL-4 was significantly higher,and there were differences in the same group(P<0.05).After treatment,MTL,IFN-γ,IFN-γ/IL-4 in the treatment group were lower than those in the control group,but IL-4 was higher than that in the control group,and there were differences between two groups(P<0.05).After treatment,the dysthymia score,self-image score,eating avoidance score,sexual behavior score,relationship development score,social function score,health concern score,behavior disorder score and total score of the IBS-QOL in the two groups were significantly lower than those before treatment,and there were differences in the same group(P<0.05).After treatment,those scores in the treatment group were lower than those in the control group,and there were differences between two groups(P<0.05).Conclusion Bupi Yichang Pills combined with Compound Glutamine Entersoluble Capsules has significant effect in treatment of diarrhea-predominant irritable bowel syndrome,and can effectively alleviate the symptoms of patients,and also can reduce visceral sensitivity,and can regulate the secretion of gastrointestinal hormones,improve the life quality,which has a certain clinical application value.