自拟五仁汤治疗慢性顽固性便秘气阴两虚证临床研究
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摘要
目的观察自拟五仁汤治疗慢性顽固性便秘气阴两虚证患者的临床疗效,探讨其对肠道功能的影响及可能的作用机制。方法采用随机数字表法将200例患者分为对照组和观察组各100例。对照组予乳果糖口服溶液,每次5 mL,每日1次口服;观察组在对照组基础上予自拟五仁汤,每日1剂,水煎,分2次口服。2组均2周为1个疗程,连续治疗2个疗程。比较2组临床疗效,于治疗前及治疗2、4周评价2组中医症状积分、Wexner便秘评分、胃肠道生活质量指数(GIQLI)评分,检测结肠动力学及血清胃动素(MTL)、生长抑素(SS)、5-羟色胺(5-HT)、神经肽Y(NPY)水平,观察不良反应及复发情况。结果观察组总有效率为95.00%(95/100),对照组为84.00%(84/100),观察组明显优于对照组(P<0.05)。与本组治疗前比较,2组治疗后中医症状积分、Wexner便秘评分下降,GIQLI评分升高,结肠动力学指标左半结肠通过时间、右半结肠通过时间、乙状结肠直肠通过时间缩短,血清MTL、5-HT水平上升,SS、NPY水平下降,以治疗4周的变化更为明显(P<0.05);2组治疗2、4周比较,观察组上述各指标改善均优于对照组(P<0.05)。观察组不良反应率、复发率明显低于对照组(P<0.05)。结论自拟五仁汤可改善慢性顽固性便秘气阴两虚证患者便秘程度,增强胃肠动力,其机制可能与纠正脑肠肽异常代谢有关。
Objective To observe the clinical efficacy of self-designed Wuren Decoction in treating qi-yin deficiency patients with chronic intractable constipation; To explore its effects on enteric function and its mechanism.Methods Totally 200 patients were divided into control group and observation group according to random number table method, with 100 cases in each group. Patients in the control group were given lactose oral solution, 5 mL, one a day. Patients in the observation group were added to self-designed Wuren Decoction one dosage per day, for two times. Both groups were treated for two coures, with two weeks of one course. The clinical efficacy of both groups were compared, and the TCM syndrome scores, Wexner constipation score and GIQLI score were evaluated before treatment, 2 weeks of treatment and 4 weeks of treatment. Colon dynamics and the levels of MTL, SS, 5-HT and NPY were detected. Results The total effective rate of the observation group was 95.00%(95/100), and that of the control group was 84.00%(84/100). The observation group was significantly better than the control group(P<0.05). After treatment, the TCM syndrome scores and Wexner constipation score of both groups significantly decreased, GIQLI score increased significantly, colonic motility index was significantly shortened by left colonic transit time(LCTT), right colonic transit time(RCTT), sigmoid rectal transit time(SRTT), serum MTL and 5-HT levels, SS and NPY decreased significantly, and the change of 4 weeks of treatment was more obvious(P<0.05). The observed indexes of the observation group were more obvious(P<0.05). Adverse reaction rate and relapse rate of the observation group lower than that of the control group(P<0.05). Conclusion Self-designed Wuren Decoction can improve the degree of constipation in patients with chronic intractable constipation with qi-yin deficiency, and enhance gastrointestinal motility. Its effect may be achieved by correcting abnormal metabolism of brain intestinal peptide.
Objective To observe the clinical efficacy of self-designed Wuren Decoction in treating qi-yin deficiency patients with chronic intractable constipation; To explore its effects on enteric function and its mechanism.Methods Totally 200 patients were divided into control group and observation group according to random number table method, with 100 cases in each group. Patients in the control group were given lactose oral solution, 5 mL, one a day. Patients in the observation group were added to self-designed Wuren Decoction one dosage per day, for two times. Both groups were treated for two coures, with two weeks of one course. The clinical efficacy of both groups were compared, and the TCM syndrome scores, Wexner constipation score and GIQLI score were evaluated before treatment, 2 weeks of treatment and 4 weeks of treatment. Colon dynamics and the levels of MTL, SS, 5-HT and NPY were detected. Results The total effective rate of the observation group was 95.00%(95/100), and that of the control group was 84.00%(84/100). The observation group was significantly better than the control group(P<0.05). After treatment, the TCM syndrome scores and Wexner constipation score of both groups significantly decreased, GIQLI score increased significantly, colonic motility index was significantly shortened by left colonic transit time(LCTT), right colonic transit time(RCTT), sigmoid rectal transit time(SRTT), serum MTL and 5-HT levels, SS and NPY decreased significantly, and the change of 4 weeks of treatment was more obvious(P<0.05). The observed indexes of the observation group were more obvious(P<0.05). Adverse reaction rate and relapse rate of the observation group lower than that of the control group(P<0.05). Conclusion Self-designed Wuren Decoction can improve the degree of constipation in patients with chronic intractable constipation with qi-yin deficiency, and enhance gastrointestinal motility. Its effect may be achieved by correcting abnormal metabolism of brain intestinal peptide.
引文
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[13]周峰,张旗,张永安,等.益气养阴方治疗气阴两虚型慢性功能性便秘疗效及对患者症状积分的影响[J].四川中医,2018,36(3):82-85.
[14]李寒冰,吴宿慧,张颜语,等.基于肠道内环境调整的火麻仁润下作用的现代研究[J].中草药,2018,49(14):3334-3342.
[15]宗阳,孙明明,乐音子,等.基于网络药理学探讨白术-枳实药对治疗慢性传输型便秘的作用机制[J].中国药房,2018,29(13):1798-1802.
[16]杜丽娟,占煜,吴至久,等.大黄对慢性便秘模型大鼠结肠血管活性肠肽水平及肠动力影响研究[J].川北医学院学报,2016,31(4):470-472.
[17]杜丽东,牛亭惠,吴国泰,等.当归对血虚便秘模型小鼠胃肠激素与酪氨酸激酶受体C-kit表达的影响[J].中国临床药理学杂志,2018,34(10):1195-1198.
[18]邓陈哲.铁皮石斛多糖对便秘小鼠肠道细菌多样性及相关酶活性的影响[J].中国临床药理学杂志,2018,34(15):1875-1877.
[19]唐学贵,伍静,刘芳.便塞通合剂调节慢性便秘大鼠血清GAS、MTL和SP含量实验研究[J].中华中医药学刊,2011,29(7):1549-1551.
[20]裴丽霞,朱莉,陈璐,等.针刺对便秘型肠易激综合征患者血浆5-HT、NPY和CGRP的影响[J].南京中医药大学学报,2015,31(5):416-419.
[21]蔡凌威,王勇杰,钱卫珍.活血益气润肠汤对慢性顽固性便秘患者结肠动力学的影响[J].中国生化药物杂志,2016,36(12):137-139,143.
[22]窦迎春,许倩倩,孟欣颖.脑肠肽及焦虑、抑郁在便秘中的研究进展[J].胃肠病学和肝病学杂志,2017,26(5):497-502.
[2]PARK M,BANG Y G,CHO K Y.Risk factors for functional constipation in young children attending daycare centers[J].JKorean Med Sci,2016,31(8):1262-1265.
[3]FARMER A D,HOLT C B,DOWNES T J,et al.Pathophysiology,diagnosis,and management of opioid-induced constipation[J].Lancet Gastroenterol Hepatol,2018,3(3):203-212.
[4]NERI L,IOVINO P.Bloating is associated with worse quality of life,treatment satisfaction,and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation[J].Neurogastroenterol Motil,2016,28(4):581-591.
[5]YOUSEFSHAHI F,TAHMASEBI M.Long-lasting orthostatic hypotension and constipation after celiac plexus block;a case report[J].Anesth Pain Med,2018,8(1):e63221.
[6]凌杰,张文忠,徐斌.比沙可啶治疗慢传输型便秘大鼠的实验研究[J].中华胃肠外科杂志,2016,19(12):1365-1369.
[7]DROSSMAN A.The function gastroinle-stinal disorders and the RomeⅢprocess[J].Gastroenterology,2006,130:1377-1390.
[8]中华医学会消化病学分会胃肠动力学组.中国慢性便秘诊治指南(2013,武汉)[J].胃肠病学,2013,18(10):605-612.
[9]中华中医药学会脾胃病分会.慢性便秘中医诊疗共识意见[J].北京中医药,2011,30(1):3-7.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:132.
[11]AGACHAN F,CHEN T,PFEIFER J,et al.A constipation scoring system to simplify evaluation and management of constipated patients[J].Dis Colon Rectum,1996,39(6):681-685.
[12]MENTES B B,AKIN M,IRK?RüCüO,et al.Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy[J].Surg Endosc,2001,15(11):1267-1272.
[13]周峰,张旗,张永安,等.益气养阴方治疗气阴两虚型慢性功能性便秘疗效及对患者症状积分的影响[J].四川中医,2018,36(3):82-85.
[14]李寒冰,吴宿慧,张颜语,等.基于肠道内环境调整的火麻仁润下作用的现代研究[J].中草药,2018,49(14):3334-3342.
[15]宗阳,孙明明,乐音子,等.基于网络药理学探讨白术-枳实药对治疗慢性传输型便秘的作用机制[J].中国药房,2018,29(13):1798-1802.
[16]杜丽娟,占煜,吴至久,等.大黄对慢性便秘模型大鼠结肠血管活性肠肽水平及肠动力影响研究[J].川北医学院学报,2016,31(4):470-472.
[17]杜丽东,牛亭惠,吴国泰,等.当归对血虚便秘模型小鼠胃肠激素与酪氨酸激酶受体C-kit表达的影响[J].中国临床药理学杂志,2018,34(10):1195-1198.
[18]邓陈哲.铁皮石斛多糖对便秘小鼠肠道细菌多样性及相关酶活性的影响[J].中国临床药理学杂志,2018,34(15):1875-1877.
[19]唐学贵,伍静,刘芳.便塞通合剂调节慢性便秘大鼠血清GAS、MTL和SP含量实验研究[J].中华中医药学刊,2011,29(7):1549-1551.
[20]裴丽霞,朱莉,陈璐,等.针刺对便秘型肠易激综合征患者血浆5-HT、NPY和CGRP的影响[J].南京中医药大学学报,2015,31(5):416-419.
[21]蔡凌威,王勇杰,钱卫珍.活血益气润肠汤对慢性顽固性便秘患者结肠动力学的影响[J].中国生化药物杂志,2016,36(12):137-139,143.
[22]窦迎春,许倩倩,孟欣颖.脑肠肽及焦虑、抑郁在便秘中的研究进展[J].胃肠病学和肝病学杂志,2017,26(5):497-502.