健脾燥湿汤治疗胆囊切除术后慢性腹泻脾虚湿盛证临床疗效
|
摘要
目的:观察健脾燥湿汤在胆囊切除术后慢性腹泻脾虚湿盛证的应用效果,优化临床治疗效果。方法:选择2011年3月—2012年11月门诊收治的90例胆囊切除术后慢性腹泻患者作为观察对象,按治疗方法差异随机分为观察组45例和对照组45例,对照组给予蒙脱石联合双歧杆菌乳杆菌三联活菌片治疗,观察组给予健脾燥湿汤加减治疗,30d为1个疗程,两组均治疗3个疗程,所有患者随访6个月,观察两组患者症状疗效及近远期临床疗效,采用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+)。结果:观察组和对照的腹泻疗效与临床疗效分别为88.89%∶64.44%,88.89%∶66.67%,差异具有统计学意义(χ2=7.516和6.728,均P<0.05),观察组随访复发4例(8.89%),对照组复发14例(31.11%),两组患者复发率差异具有统计学意义(χ2=6.944,P<0.01);观察组和对照组治疗后CD3、CD4均较治疗前明显提高,差异具有统计学意义(均P<0.05),观察组治疗后CD3、CD4高于对照组(均P<0.05),观察组和对照组治疗前后CD8差异没有统计学意义(均P>0.05)。结论:健脾燥湿汤能够提升胆囊切除术后慢性腹泻脾虚湿盛证患者T淋巴细胞亚群数值,增强细胞免疫功能,改善临床治疗效果,降低远期复发率,是一种安全有效的治疗方法,可在临床上推广使用。
Objective: To observe the effect of Jianpi Zaoshi Decoction in the treatment of postcholecystestomy syndrome of spleen deficiency and dampness excess syndrome and optimize clinical outcomes. Methods: 90 patients with postcholecystestomy syndrome of spleen deficiency and dampness excess syndrome were included as research objects. All the patients were randomly divided into 45 cases of observation group and 45 cases of control group according to different treatment. The control group received Montmorillonite and triple viable Bifidobacterium Lactobacillus sheet and the observation group were given Jianpi Zaoshi Decoction on the basis of the control group,30 d for a course. Both groups had been treated for 3 courses. All patients had been followed for six months,and then the efficacy efficacy,short and long term clinical efficacy were observed and the T lymphocyte subsets( CD3+,CD4 +,CD8 +) were detected by flow cytometry.Results: 1 The diarrhea efficacy and clinical efficacy of observation and control groups were 88. 89% vs 64. 44%,66. 67% vs 88. 89%. The difference was statistically significant( χ2= 7. 516,6. 728,both P < 0. 05). Four cases were recurrent in the observation group( 8. 89%) and 14 cases in the control group( 31. 11%). The recurrence rates between the two groups were statistically significant( χ2= 6. 944,P < 0. 01). 2In observation and control groups after treatment,CD3 and CD4 improved significantly and the difference was statistically significant( P < 0. 05). CD3 and CD4 were higher in the observation group after treatment( all P < 0. 05). The observation group and control group's CD8 was not statistically significant( P > 0. 05). 2CD3+and CD4+of the observation and control groups after treatment were statistically higher than those before treatment and the difference was statistically significant( P < 0. 05). CD3+and CD4+of the observation group after treatment were statistically higher than those of the control group and the difference was statistically significant( P < 0. 05). CD8+of the observation and control groups was not statistically significant after treatment( P >0. 05). Conclusion: Jianpi Zaoshi Decoction can enhance T lymphocyte subsets and immune function of the patients withpostcholecystestomy syndrome of spleen deficiency and dampness excess syndrome and improve clinical outcomes and reduce the long- term recurrence rate and can be recommended as a safe and effective treatment for clinical practice.
Objective: To observe the effect of Jianpi Zaoshi Decoction in the treatment of postcholecystestomy syndrome of spleen deficiency and dampness excess syndrome and optimize clinical outcomes. Methods: 90 patients with postcholecystestomy syndrome of spleen deficiency and dampness excess syndrome were included as research objects. All the patients were randomly divided into 45 cases of observation group and 45 cases of control group according to different treatment. The control group received Montmorillonite and triple viable Bifidobacterium Lactobacillus sheet and the observation group were given Jianpi Zaoshi Decoction on the basis of the control group,30 d for a course. Both groups had been treated for 3 courses. All patients had been followed for six months,and then the efficacy efficacy,short and long term clinical efficacy were observed and the T lymphocyte subsets( CD3+,CD4 +,CD8 +) were detected by flow cytometry.Results: 1 The diarrhea efficacy and clinical efficacy of observation and control groups were 88. 89% vs 64. 44%,66. 67% vs 88. 89%. The difference was statistically significant( χ2= 7. 516,6. 728,both P < 0. 05). Four cases were recurrent in the observation group( 8. 89%) and 14 cases in the control group( 31. 11%). The recurrence rates between the two groups were statistically significant( χ2= 6. 944,P < 0. 01). 2In observation and control groups after treatment,CD3 and CD4 improved significantly and the difference was statistically significant( P < 0. 05). CD3 and CD4 were higher in the observation group after treatment( all P < 0. 05). The observation group and control group's CD8 was not statistically significant( P > 0. 05). 2CD3+and CD4+of the observation and control groups after treatment were statistically higher than those before treatment and the difference was statistically significant( P < 0. 05). CD3+and CD4+of the observation group after treatment were statistically higher than those of the control group and the difference was statistically significant( P < 0. 05). CD8+of the observation and control groups was not statistically significant after treatment( P >0. 05). Conclusion: Jianpi Zaoshi Decoction can enhance T lymphocyte subsets and immune function of the patients withpostcholecystestomy syndrome of spleen deficiency and dampness excess syndrome and improve clinical outcomes and reduce the long- term recurrence rate and can be recommended as a safe and effective treatment for clinical practice.
引文
[1]刘巧艳,王进海.西安地区胆囊切除术后腹泻流行病学及临床研究[J].中国临床研究,2012,25(9):846-848.
[2]缪惠娟.中药抑肝健脾法治疗胆囊切除术后腹泻22例的临床观察[J].贵阳中医学院学报,2011,33(6):45-46.
[3]王建军,李海林,高岩.参苓白术散汤剂加减治疗胆囊切除术后32例腹泻[J].中国实验方剂学杂志,2011,17(9):294-294.
[4]张竟如.生理学[M].4版.北京:人民卫生出版社,1995:233-247.
[5]黄志强.胆道外科[M].济南:山东科学技术出版社,1998:68-186.
[6]王建军,李海林,高岩.参苓白术散汤剂加减治疗胆囊切除术后32例腹泻[J].中国实验方剂学杂志,2011,17(9):294-294.
[7]朱建明,黄建平,钮宏文,等.健脾益气方治疗胆囊切除术后腹泻的疗效观察[J].上海中医药杂志,2009,43(5):26-28.
[8]黄倩华,谢光洪,思密达不同途径给药对菌痢疗效的影响[J].中国伤残医学,2013,21(10):202-203.
[9]余慧萍,思密达在儿科的临床应用[J],西北药学杂志,2005,20(2):96-97.
[10]李菊兰,朱戎.胆囊切除术后腹泻患者肠道菌群变化[J].中国微生态学杂志,2003,15(6):368-368.
[11]王梦华.双歧杆菌三联活菌胶囊对胆囊切除术后腹泻患者肠道菌群及s Ig A水平的影响[J].中国微生态学杂志,2014,26(10):1166-1168
[12]陈业强,潘宇政,陈永斌.脾虚证病人免疫功能的测定[J].广西医科大学学报,1998,15(3):86-87.
[13]王红伟,刘旺根,丁瑞敏.黄芪建中汤对脾虚大鼠血液成分及细胞免疫功能的影响[J].河南中医,2002,17(6):16-17.
[14]陈治水,路遥,聂志伟,等.健脾益气方药治疗脾虚腹泻的临床与实验研究[J].中国中西医结合脾胃杂志,1996,4(1):19-21.
[15]吕冠华,王长洪,孙希良,等.健脾法对腹泻型肠易激综合征食物不耐受患者肠黏膜CD3、MBP表达的影响[J].中国中医药科技,2012,19(3):202-203
[2]缪惠娟.中药抑肝健脾法治疗胆囊切除术后腹泻22例的临床观察[J].贵阳中医学院学报,2011,33(6):45-46.
[3]王建军,李海林,高岩.参苓白术散汤剂加减治疗胆囊切除术后32例腹泻[J].中国实验方剂学杂志,2011,17(9):294-294.
[4]张竟如.生理学[M].4版.北京:人民卫生出版社,1995:233-247.
[5]黄志强.胆道外科[M].济南:山东科学技术出版社,1998:68-186.
[6]王建军,李海林,高岩.参苓白术散汤剂加减治疗胆囊切除术后32例腹泻[J].中国实验方剂学杂志,2011,17(9):294-294.
[7]朱建明,黄建平,钮宏文,等.健脾益气方治疗胆囊切除术后腹泻的疗效观察[J].上海中医药杂志,2009,43(5):26-28.
[8]黄倩华,谢光洪,思密达不同途径给药对菌痢疗效的影响[J].中国伤残医学,2013,21(10):202-203.
[9]余慧萍,思密达在儿科的临床应用[J],西北药学杂志,2005,20(2):96-97.
[10]李菊兰,朱戎.胆囊切除术后腹泻患者肠道菌群变化[J].中国微生态学杂志,2003,15(6):368-368.
[11]王梦华.双歧杆菌三联活菌胶囊对胆囊切除术后腹泻患者肠道菌群及s Ig A水平的影响[J].中国微生态学杂志,2014,26(10):1166-1168
[12]陈业强,潘宇政,陈永斌.脾虚证病人免疫功能的测定[J].广西医科大学学报,1998,15(3):86-87.
[13]王红伟,刘旺根,丁瑞敏.黄芪建中汤对脾虚大鼠血液成分及细胞免疫功能的影响[J].河南中医,2002,17(6):16-17.
[14]陈治水,路遥,聂志伟,等.健脾益气方药治疗脾虚腹泻的临床与实验研究[J].中国中西医结合脾胃杂志,1996,4(1):19-21.
[15]吕冠华,王长洪,孙希良,等.健脾法对腹泻型肠易激综合征食物不耐受患者肠黏膜CD3、MBP表达的影响[J].中国中医药科技,2012,19(3):202-203