慢性肠炎肠道菌群和中医证型相关性及中药联合抗生素灌肠疗效研究

Study on Correlation between Intestinal Flora in Chronic Enteritis and Chinese Medicine Syndrome Types and Clinical Effect of Chinese Medicine Combined with Antibiotic Enema

目的:探究慢性肠炎不同中医证型的肠道菌群情况及中药辨证施治联合抗生素灌肠的疗效。方法:选取慢性肠炎患者110例为研究组,根据中医证候分型为热毒型(36例)、湿毒型(35例)、正虚邪恋型(39例),均行中药分型施治联合抗生素灌肠治疗;同期纳入健康者40例为对照组。观察肠道菌群菌落数及双歧杆菌/大肠杆菌菌落比值,观察各证型患者治疗后肠道菌群改善程度、大便常规指标、中医证候疗效。结果:不同中医证型患者肠道菌群菌落数量与对照组比较,差异均有统计学意义(P <0.05);正虚邪恋型、热毒型双歧杆菌、双歧杆菌/大肠杆菌值低于湿毒型,大肠杆菌、肠球菌、葡萄球菌菌落数高于湿毒型,差异有统计学意义(P <0.05)。治疗后,除I度肠道菌群失调患者外,三种证型患者肠道菌群状况均优于治疗前,大便性状评分高于治疗前,白细胞、红细胞计数低于治疗前(P<0.05);而不同证型患者肠道菌群失调改善程度、大便常规指标比较,差异无统计学意义(P> 0.05)。中医证候总有效率热毒型(97.22%)、湿毒型(94.29%)、正虚邪恋型(92.31%)三者比较,差异无统计学意义(P> 0.05)。结论:慢性肠炎患者存在肠道菌群失调状况,不同中医证型间存在肠道菌群差异,中药辨证施治联合抗生素灌肠可显著改善不同证型肠道菌群失调及大便常规指标,提高中医证候疗效,其机制可能与调节肠道菌群有关。

Objective:To discuss the intestinal flora of different Chinese medicine syndrome types of chronic enteritis and the curative effect of Chinese medicine syndrome differentiation treatment combined with antibiotic enema.Methods:Selected 110 cases of patients with chronic enteritis in the study group and divided them into different types such as the heat toxin type(36 cases),the dampness toxin type(35 cases)and the type of deficient vital qi leading to lingering pathogen(39 cases)according to the classification of Chinese medicine syndrome;these patients were all treated with Chinese medicine classification treatment combined with antibiotic enema treatment.At the same time,40 cases of healthy patients were included in the control group.Observed the number of colony count of intestinal flora and the colony ratio of bifidobacteria to escherichia coli as well as the improvement of intestinal flora,the routine stool indexes and the curative effect of Chinese medicine syndrome in patients of each syndrome type after treatment.Results:There were significant differences being found in the comparisons of the number of colonies of intestinal flora in patients of different Chinese medicine syndrome types between the study group and that in the control group(P<0.05).The value of bifidobacterium and the ratio of bifidobacteria to escherichia coli of the type of deficient vital qi leading to lingering pathogen and the heat toxin type was lower than that of the dampness toxin type;the number of colonies of escherichia coli,enterococcus and staphylococcus was higher than that of the dampness toxin type,difference being significant(P<0.05).After treatment,apart from the patients with intestinal dysbacteriosis I,the intestinal flora of patients of these three syndrome types was better than that before treatment;the defecation trait score was higher than that before treatment;and the white blood cell and red blood cell counts were lower than those before treatment(P<0.05).There was no significant difference being found in the comparison of the improvement of intestinal dysbacteriosis and stool routine indexes in patients of different syndrome types(P>0.05).There was no significant difference being found in the comparison of the total effective rate of Chinese medicine syndromes of the heat toxin type(97.22%),the dampness toxin type(94.29%)and the type of deficient vital qi leading to lingering pathogen(92.31%)(P>0.05).Conclusion:There is intestinal dysbacteriosis in patients with chronic enteritis and differences in intestinal flora are found in different Chinese medicine syndrome types.The application of the combination of Chinese medicine syndrome differentiation treatment and antibiotic enema can significantly improve the intestinal dysbacteriosis and stool routine indexes of different syndrome types and increase the curative effect of Chinese medicine syndromes.The mechanism may be related to its regulation for intestinal flora.