不同药物治疗肠易激综合征的临床疗效

Clinical Efficacy of Different Drugs on Irritable Bowel Syndrome

背景:肠易激综合征(IBS)是消化内科常见疾病之一,但目前所用药物尚不能对所有IBS症状有疗效。目的:分析不同药物对不同类型IBS的临床疗效。方法:136例便秘型IBS患者随机分为西沙必利或莫沙必利治疗组(A组)和西沙必利或莫沙必利+乳果糖治疗组(B组);72例腹泻型IBS患者随机分为匹维溴铵治疗组(C组)和马来酸曲美布汀治疗组(D组),分别观察治疗1周、1个月和3个月时的疗效。结果:A组1周、1个月和3个月时的总有效率分别为29.8％、25.3％和19.0％,而B组分别为69.2％、51.9％和41.2％,均显著高于A组(P<0.005、P<0.005和P<0.01)。C组1周、1个月和3个月时的总有效率分别为90.9％、67.7％和61.3％,而D组分别为79.5％、51.4％和31.4％,C组3个月时的总有效率显著高于D组(P<0.05)。各组的疗效在3个月时均有所降低,但B组和C组的总有效率仍较高。结论:单用西沙必利或莫沙必利治疗便秘型IBS疗效有限,加用乳果糖可提高疗效。匹维溴铵和马来酸曲美布汀对腹泻型IBS的近期疗效较好。

Background: Irritable bowel syndrome (IBS) is one of the common diseases in the clinic of gastro-enterology, however the efficacy of the drugs used at present are not satisfied for some of the IBS symptoms. Aims: To analyze the clinical efficacy of different drugs on the subgroups of IBS. Methods: One hundred and thirty-six IBS patients with constipation predominant were randomly divided into group A and B. Group A was treated with cisapride or mosapride, and group B with cisapride or mosa-pride plus lactulose. Seventy-two IBS patients with diarrhea predominant were randomly divided into group C and D. Group C was treated with pinaverium bromide, and group D with trimebutine maleate. The efficacy rates were evaluated in the 1st week, 1st month, and 3rd month, respectively. Results: The total efficacy rate in group A was 29.8% in the 1st week, 25.3% in the 1st month, and 19.0% in the 3rd month; and in group B, they were significantly higher than those of group A (69.2%, P<0.005; 51.9%, P<0.005; and 41.2%, P<0.01), respectively. In group C, they were 90.9%, 67.7% and 61.3%; and in group D, 79.5%, 51.4% and 31.4%, respectively. In the 3rd month, the total efficacy rate of group C was significantly higher than that of group D (P<0.05). Whereas the total efficacy rates decreased in the 3rd month in all groups, they still remained higher in group B and C. Conclusions: The effectiveness of cisapride or mosapride is limited in the treatment of IBS with constipation predominant, but can be increased by addition of lactulose. The immediate efficacy of pinaverium bromide and trimebutine maleate is good for IBS with diarrhea predominant.