四逆散加味联合布拉氏酵母菌治疗小儿功能性消化不良的临床疗效及对血清细胞因子的影响
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摘要
目的:探讨四逆散加味(气滞胃痛颗粒)联合布拉氏酵母菌治疗小儿功能性消化不良(FD)的临床疗效及血清细胞因子、胃肠激素的变化。方法:将156例FD患者随机分为对照组和观察组,每组78例,对照组单纯用布拉氏酵母菌0. 25 g/次,2次/d,餐后口服;观察组在对照组基础上联合四逆散加味(气滞胃痛颗粒) 2. 5 g/次,3次/d,餐前30 min口服。4周为1疗程。观察两组临床疗效、症状改善时间、血清细胞因子及胃肠激素水平的变化,且随访6个月观察其复发率。结果:观察组总有效率(96. 15%)较对照组(82. 05%)显著升高(P <0. 01)。治疗前两组患者血清干扰素-γ(IFN-γ),肿瘤坏死因子-α(TNF-α),白细胞介素-10(IL~(-1)0),胃动素(MTL)和血清瘦素(Leptin)水平比较无统计学差异。治疗后,两组血清IL~(-1)0,MTL水平均较本组治疗前上升,IFN-γ,TNF-α,Leptin水平较本组治疗前下降,但治疗组下降或上升幅度显著大于对照组(P <0. 01)。观察组症状消失时间显著短于对照组(P <0. 01)。随访6月后观察组复发率6. 67%,较对照组的18. 75%明显降低(P <0. 05)。结论:四逆散加味(气滞胃痛颗粒)联合布拉氏酵母菌治疗小儿FD具有显著的临床疗效及较低的复发率。其作用机制可能与中西医结合用药能有效调节血清细胞因子及胃肠激素水平有关。
Objective: To discuss the clinical efficacy of modified Sinisan( Qizhi Weitong granule) and saccharomyces boulardi in treating functional dyspepsia( FD) in children,and its effect on changes in serum cytokine and gastrointestinal hormones. Method: Totally 156 cases were divided into control group( 78 cases) and observation group( 78 cases). The control group was treated with saccharomyces boulardi,0. 25 g,po,bid,after meal. In addition to the therapy of control group,the observation group was also given modified Sinisan( Qizhi Weitong granule),2. 5 g,po,tid,30 minutes before meal. Four weeks was a course of treatment. Then the clinical efficacy,the time of symptom improvement and the change of serum cytokine and gastrointestinal hormones were observed. Result: The total effective rate of observation group( 96. 15%) was higher than that of control group( 82. 05%), with statistical difference( P < 0. 01). The serum levels of interleukin-10( IL~(-1)0),interferon-γ( IFN-γ),tumor necrosis factor-α( TNF-α),plasma motilin( MTL) and Leptin of both groups had no statistical difference before treatment. After treatment,the serum levels of IL~(-1)0,MTL of both group were increased,while the serum levels of IFN-γ, TNF-α, Leptin of both group were decreased. However, the decreasing range and the increasing range of observation group were statistically obvious than those of control group( P < 0. 01). After the 6-month follow-up,the recurrent rate( 6. 67%) of the observation group was statistically lower than that of control group( 18. 75%). Conclusion: Modified Sinisan( Qizhi Weitong granule) combined with saccharomyces boulardi have an obvious clinical efficacy in treating child's FD,with a low recurrence. The mechanism may be correlated with the effect of integrated Chinese and Western medicines in regulating serum cytokine and gastrointestinal hormones levels.
Objective: To discuss the clinical efficacy of modified Sinisan( Qizhi Weitong granule) and saccharomyces boulardi in treating functional dyspepsia( FD) in children,and its effect on changes in serum cytokine and gastrointestinal hormones. Method: Totally 156 cases were divided into control group( 78 cases) and observation group( 78 cases). The control group was treated with saccharomyces boulardi,0. 25 g,po,bid,after meal. In addition to the therapy of control group,the observation group was also given modified Sinisan( Qizhi Weitong granule),2. 5 g,po,tid,30 minutes before meal. Four weeks was a course of treatment. Then the clinical efficacy,the time of symptom improvement and the change of serum cytokine and gastrointestinal hormones were observed. Result: The total effective rate of observation group( 96. 15%) was higher than that of control group( 82. 05%), with statistical difference( P < 0. 01). The serum levels of interleukin-10( IL~(-1)0),interferon-γ( IFN-γ),tumor necrosis factor-α( TNF-α),plasma motilin( MTL) and Leptin of both groups had no statistical difference before treatment. After treatment,the serum levels of IL~(-1)0,MTL of both group were increased,while the serum levels of IFN-γ, TNF-α, Leptin of both group were decreased. However, the decreasing range and the increasing range of observation group were statistically obvious than those of control group( P < 0. 01). After the 6-month follow-up,the recurrent rate( 6. 67%) of the observation group was statistically lower than that of control group( 18. 75%). Conclusion: Modified Sinisan( Qizhi Weitong granule) combined with saccharomyces boulardi have an obvious clinical efficacy in treating child's FD,with a low recurrence. The mechanism may be correlated with the effect of integrated Chinese and Western medicines in regulating serum cytokine and gastrointestinal hormones levels.
引文
[1]齐纪芳.小儿功能性消化不良的诊断和治疗现状[J].现代消化及介入诊疗,2015,20(5):557-559.
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[8]李庭红,高进,付彦超.气滞胃痛颗粒联合双歧杆菌治疗肠易激综合征疗效观察[J].中医临床研究,2015,7(32):52-54.
[9] Yarandi S S,Christie J. Functional dyspepsia in review:pathophysiology and challenges in the diagnosis and management due to coexisting gastroesophageal reflux disease and irritable bowel syndrome[J]. Gastroenterol Res Pract,2013,2013:351086.
[10]张强,史丽萍.功能性消化不良患者的临床治疗研究进展[J].临床医药文献电子杂志,2017,4(3):585,588.
[11]陈冰蓉,胡国华,潘玉瑞.布拉氏酵母菌联合加味逍遥散治疗小儿功能性再发性腹痛的临床疗及安全性[J].中国微生态学杂志,2015,27(5):555-557.
[12]陶景玉.益生菌与重症急性胰腺炎[J].中国微生态学杂志,2008,20(3):316,320.
[13] Haller D, Serrant P, Peruisseau G,et al. IL-10producing CD14 low monocytes inhibit lymphocytedependent activation of intestinal epithelial cells by commensal bacteria[J]. Microbiol Immunol,2002,46(3):195-205.
[14] Bashashati M, Rezaei N, Andrews C N, et al.Cytokines and irritable bowel syndrome:where do we stand?[J] Cytokine,2012,57(2):201-209.
[15]李生财,李艳,王凤仪. MTL、SS与肝胃不和型消化系统疾病关系的研究进展[J].中医临床研究,2015,7(10):143-145,148.
[16] Yarandi S S,Hebbar G,Sauer C G,et al. Diverse roles of leptin in the gastrointestinal tract:modulation of motility,absorption, growth, and inflammation[J].Nutrition,2011,27(3):269-275.
[17]唐荣伟,李德科,唐玲,等.厚朴温中汤加味配伍吗丁啉对功能性消化不良血浆胃肠激素的影响[J].中国实验方剂学杂志,2015,21(13):174-177.
[18]施昕琦,杨飏.益生菌临床应用的研究进展[J].实用药物与临床,2017,20(3):349-352.
[19]阳媚.疏肝理气法在功能性消化不良中的研究运用进展[J].中医研究,2014,27(11):75-77.
[20]席玉红,党中勤,张莉莉,等.加味四逆散对功能性消化不良伴抑郁状态的干预作用[J].中国实验方剂学杂志,2014,20(3):202-204.
[2]邹多武.中国功能性消化不良专家共识意见.(2015年,上海)解读:定义和流行病学[J].中华消化杂志,2016,36(4):231-232.
[3] Galmiche J P,Clouse R E,Balint A,et al. Functional esophageal disorders[J]. Gastroenterology,2006,130(5):1459-1465.
[4]中华中医药学会脾胃病分会.消化不良中医诊疗共识意见(2009)[J].中国中西医结合杂志,2010,30(5):533-537.
[5]钟华,孙娇娇.神经内科门诊抑郁障碍患者临床特点及治疗方案[J].当代临床医刊,2017,30(2):2969,2966.
[6]秦波,张俊.枳术宽中胶囊对功能性消化不良并抑郁患者的影响[J].中国实验方剂学杂志,2015,21(8):186-189.
[7]刘银鸿,金静,葛俊领.中医药治疗功能性消化不良研究进展[J].河北中医,2015,37(2):289-292.
[8]李庭红,高进,付彦超.气滞胃痛颗粒联合双歧杆菌治疗肠易激综合征疗效观察[J].中医临床研究,2015,7(32):52-54.
[9] Yarandi S S,Christie J. Functional dyspepsia in review:pathophysiology and challenges in the diagnosis and management due to coexisting gastroesophageal reflux disease and irritable bowel syndrome[J]. Gastroenterol Res Pract,2013,2013:351086.
[10]张强,史丽萍.功能性消化不良患者的临床治疗研究进展[J].临床医药文献电子杂志,2017,4(3):585,588.
[11]陈冰蓉,胡国华,潘玉瑞.布拉氏酵母菌联合加味逍遥散治疗小儿功能性再发性腹痛的临床疗及安全性[J].中国微生态学杂志,2015,27(5):555-557.
[12]陶景玉.益生菌与重症急性胰腺炎[J].中国微生态学杂志,2008,20(3):316,320.
[13] Haller D, Serrant P, Peruisseau G,et al. IL-10producing CD14 low monocytes inhibit lymphocytedependent activation of intestinal epithelial cells by commensal bacteria[J]. Microbiol Immunol,2002,46(3):195-205.
[14] Bashashati M, Rezaei N, Andrews C N, et al.Cytokines and irritable bowel syndrome:where do we stand?[J] Cytokine,2012,57(2):201-209.
[15]李生财,李艳,王凤仪. MTL、SS与肝胃不和型消化系统疾病关系的研究进展[J].中医临床研究,2015,7(10):143-145,148.
[16] Yarandi S S,Hebbar G,Sauer C G,et al. Diverse roles of leptin in the gastrointestinal tract:modulation of motility,absorption, growth, and inflammation[J].Nutrition,2011,27(3):269-275.
[17]唐荣伟,李德科,唐玲,等.厚朴温中汤加味配伍吗丁啉对功能性消化不良血浆胃肠激素的影响[J].中国实验方剂学杂志,2015,21(13):174-177.
[18]施昕琦,杨飏.益生菌临床应用的研究进展[J].实用药物与临床,2017,20(3):349-352.
[19]阳媚.疏肝理气法在功能性消化不良中的研究运用进展[J].中医研究,2014,27(11):75-77.
[20]席玉红,党中勤,张莉莉,等.加味四逆散对功能性消化不良伴抑郁状态的干预作用[J].中国实验方剂学杂志,2014,20(3):202-204.