黄芪白术汤辨治小儿脾虚型便秘的临床疗效及其机制研究
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摘要
目的:分析黄芪白术汤辨治小儿脾虚型便秘临床疗效,及可能的疗效机制,为小儿脾虚型便秘治疗中医治疗方案选择提供参考。方法:选取2012年1月至2017年1月河南中医药大学第一附属医院收治的脾虚型便秘患儿150例作为研究对象,按照随机数字表法分为对照组与观察组,每组75例。对2组患儿及家长进行健康宣教,日常饮食、生活习惯指导,协助家长建立患儿排便习惯,予以乳果糖口服液治疗。观察组患儿在此基础上,再予以黄芪白术汤加减辨治。2组患儿均连续治疗2周为1个疗程。收集2组患儿治疗过程药物不良反应/不良反应并比较,评估治疗前后临床症状积分(排便次数、排便时间、大便性状、排便难度)变化、检测水通道蛋白-8(AQP-8)、结肠传输试验评分(CTT)、血清淋巴细胞(CD3+、CD4+、CD8+、CD4+/CD8+)变化并比较,完成治疗后,评估患者临床疗效并比较临床总有效率。结果:1)治疗2周后,2组患儿排便次数、排便时间、大便性状、排便难度积分均较治疗前明显降低,且观察组患儿均低于对照组患儿(P <0. 05); 2) 2组患儿AQP-8、CTT分级评分均较治疗前下降,且观察组患儿低于对照组患儿(P <0. 05); 3) 2组患儿淋巴细胞CD3+、CD4+、CD4+/CD8+均较治疗前明显升高,且观察组高于对照组(P <0. 05),CD8+均较治疗前明显下降,且观察组低于对照组(P <0. 05); 4)观察组患儿临床总有效率明显高于对照组(P <0. 05); 5) 2组患儿治疗过程中药物不良反应率比较,差异无统计学意义(P> 0. 05)。结论:黄芪白术汤加减辨治可有效改善脾虚型便秘患儿的免疫功能、AQP-8、CTT评分,改善临床便秘症状,促进临床疗效,且不增加药物不良反应,具有一定的临床价值。
Objective: To analyze the clinical effects and possible mechanism of Huangqi Baizhu Decoction in the treatment of children with constipation of spleen deficiency syndrome,and to provide reference for the selection of TCM treatment schemes in the treatment of children with constipation of spleen deficiency syndrome. Methods: A total of 150 children with spleen deficiency constipation who were treated in The First Affiliated Hospital of Henan University of Chinese Medicine from January 2012 to January2017 were included in the study. The patients were divided into a control group and an observation group with 75 cases in each group. The 2 groups of children and their parents were given health education,daily diet and living habits guidance,to help parents to establish children's defecation habits,to be treated with lactulose oral liquid. On the basis of the observation group,Huangqi Baizhu decoction was added to the treatment. Two groups of children were treated for 2 weeks for a course of treatment. The adverse drug reactions/side effects were collected and compared between the 2 groups. The changes of clinical symptom scores( defecation frequency,defecation time,stool characteristics,defecation difficulty),aquaporin-8( AQP-8),colon transit test score( CTT),serum lymphocyte( CD3~+,CD4~+,CD8~+,CD4~+/CD8~+) were evaluated before and after treatment were evaluated and compared. After completion of treatment,the clinical efficacy was evaluated and the total clinical efficiency was compared. Results: 1) After 2 weeks of treatment,the frequency of defecation,defecation time,stool characteristics and difficulty scores of the 2 groups were significantly decreased than those before treatment,and the observation group was lower than those of the control group( P < 0. 05). 2) AQP-8 and CTT scores of the 2 groups were decreased than those before treatment,and the observation group was lower than the control group( P < 0. 05). 3) Lymphocyte CD3~+、CD4~+、CD4~+/CD8~+of the 2 groups were significantly increased than those before treatment,and the observation group was higher than the control group( P < 0. 05). CD8~+was significantly decreased than before treatment,and the observation group was lower than the control group( P < 0. 05). 4) The total clinical effective rate of the observation group was significantly higher than that of the control group( P < 0. 05). 5) There was no significant difference in the rate of adverse drug reactions between the 2 groups( P > 0. 05). Conclusion: Huangqi Baizhu Decoction can effectively improve the immune function,AQP-8,CTT score of children with constipation of spleen deficiency syndrome,improve clinical constipation symptoms,promote clinical efficacy,and do not increase adverse drug reactions,which has a certain clinical value.
Objective: To analyze the clinical effects and possible mechanism of Huangqi Baizhu Decoction in the treatment of children with constipation of spleen deficiency syndrome,and to provide reference for the selection of TCM treatment schemes in the treatment of children with constipation of spleen deficiency syndrome. Methods: A total of 150 children with spleen deficiency constipation who were treated in The First Affiliated Hospital of Henan University of Chinese Medicine from January 2012 to January2017 were included in the study. The patients were divided into a control group and an observation group with 75 cases in each group. The 2 groups of children and their parents were given health education,daily diet and living habits guidance,to help parents to establish children's defecation habits,to be treated with lactulose oral liquid. On the basis of the observation group,Huangqi Baizhu decoction was added to the treatment. Two groups of children were treated for 2 weeks for a course of treatment. The adverse drug reactions/side effects were collected and compared between the 2 groups. The changes of clinical symptom scores( defecation frequency,defecation time,stool characteristics,defecation difficulty),aquaporin-8( AQP-8),colon transit test score( CTT),serum lymphocyte( CD3~+,CD4~+,CD8~+,CD4~+/CD8~+) were evaluated before and after treatment were evaluated and compared. After completion of treatment,the clinical efficacy was evaluated and the total clinical efficiency was compared. Results: 1) After 2 weeks of treatment,the frequency of defecation,defecation time,stool characteristics and difficulty scores of the 2 groups were significantly decreased than those before treatment,and the observation group was lower than those of the control group( P < 0. 05). 2) AQP-8 and CTT scores of the 2 groups were decreased than those before treatment,and the observation group was lower than the control group( P < 0. 05). 3) Lymphocyte CD3~+、CD4~+、CD4~+/CD8~+of the 2 groups were significantly increased than those before treatment,and the observation group was higher than the control group( P < 0. 05). CD8~+was significantly decreased than before treatment,and the observation group was lower than the control group( P < 0. 05). 4) The total clinical effective rate of the observation group was significantly higher than that of the control group( P < 0. 05). 5) There was no significant difference in the rate of adverse drug reactions between the 2 groups( P > 0. 05). Conclusion: Huangqi Baizhu Decoction can effectively improve the immune function,AQP-8,CTT score of children with constipation of spleen deficiency syndrome,improve clinical constipation symptoms,promote clinical efficacy,and do not increase adverse drug reactions,which has a certain clinical value.
引文
[1]王海俊,周鸿雲,赵琼,等.泻白散加味治疗小儿肺热型便秘临床疗效观察[J].中国中西医结合儿科学,2018,10(4):330-333.
[2]梁众擎,董盈妹,赵霞.从五脏一体观论治小儿功能性便秘[J].中医杂志,2018,59(12):1066-1068.
[3]武进华,贾林萍,任立中.四君子汤加味对小儿虚秘血液学及肠敏感度的影响[J].世界中医药,2018,13(2):389-392.
[4]中华医学会消化病学分会胃肠动力学组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年,武汉)[J].中华消化杂志,2013,33(5):291-297.
[5]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.
[6]中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002.
[8]张川琳,张春娇.黄芪白术汤联合乳果糖治疗小儿功能性便秘的临床疗效观察[J].中医药学报,2017,45(4):118-120.
[9]汪蕾,蔡朕,江琪.小儿便秘的中医诊治思路[J].中国临床医生杂志,2017,45(2):13-15.
[10]黄志芳,魏志军,张婧茹,等. P物质、血管活性肠肽与脾虚便秘型小鼠肠道之间的关系初探[J].中医临床研究,2016,8(30):69-70.
[11]王晓艾.小儿便秘的中医证型及分布规律研究[D].杭州:浙江中医药大学,2013.
[12]张雁雁,郝巧茸,程燕.小儿功能性便秘的中医药治疗进展[J].湖南中医杂志,2015,31(12):202-204.
[13]周德富.李柏年教授学术思想总结及益气润肠汤治疗脾虚气弱型便秘的临床观察[D].南京:南京中医药大学,2015.
[14]张莉,陈磊.小儿便秘临床治疗研究进展[J].深圳中西医结合杂志,2015,25(14):191-192.
[15]张欣.基于文献研究小儿便秘中医证型及用药规律[D].沈阳:辽宁中医药大学,2015.
[16]段升萍,崔瑞琴,王文刚.“黄芪白术汤”治疗小儿脾虚气弱型便秘60例临床观察[J].江苏中医药,2014,46(11):37-38.
[17]郑志勇.补中益气汤加味治疗小儿便秘临床研究[J].河南中医,2014,34(5):977-978.
[18]王晓艾.中医辨证治疗小儿功能性便秘研究进展[J].实用中医药杂志,2016,32(6):635-637.
[19]葛国岚,金玉晶.穴位埋线治疗小儿脾虚气弱型便秘疗效观察[J].新中医,2018,50(1):123-125.
[20]何荣兰.中医辨证治疗小儿功能性便秘的临床研究[J].中医临床研究,2017,9(25):76-77.
[2]梁众擎,董盈妹,赵霞.从五脏一体观论治小儿功能性便秘[J].中医杂志,2018,59(12):1066-1068.
[3]武进华,贾林萍,任立中.四君子汤加味对小儿虚秘血液学及肠敏感度的影响[J].世界中医药,2018,13(2):389-392.
[4]中华医学会消化病学分会胃肠动力学组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年,武汉)[J].中华消化杂志,2013,33(5):291-297.
[5]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.
[6]中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002.
[8]张川琳,张春娇.黄芪白术汤联合乳果糖治疗小儿功能性便秘的临床疗效观察[J].中医药学报,2017,45(4):118-120.
[9]汪蕾,蔡朕,江琪.小儿便秘的中医诊治思路[J].中国临床医生杂志,2017,45(2):13-15.
[10]黄志芳,魏志军,张婧茹,等. P物质、血管活性肠肽与脾虚便秘型小鼠肠道之间的关系初探[J].中医临床研究,2016,8(30):69-70.
[11]王晓艾.小儿便秘的中医证型及分布规律研究[D].杭州:浙江中医药大学,2013.
[12]张雁雁,郝巧茸,程燕.小儿功能性便秘的中医药治疗进展[J].湖南中医杂志,2015,31(12):202-204.
[13]周德富.李柏年教授学术思想总结及益气润肠汤治疗脾虚气弱型便秘的临床观察[D].南京:南京中医药大学,2015.
[14]张莉,陈磊.小儿便秘临床治疗研究进展[J].深圳中西医结合杂志,2015,25(14):191-192.
[15]张欣.基于文献研究小儿便秘中医证型及用药规律[D].沈阳:辽宁中医药大学,2015.
[16]段升萍,崔瑞琴,王文刚.“黄芪白术汤”治疗小儿脾虚气弱型便秘60例临床观察[J].江苏中医药,2014,46(11):37-38.
[17]郑志勇.补中益气汤加味治疗小儿便秘临床研究[J].河南中医,2014,34(5):977-978.
[18]王晓艾.中医辨证治疗小儿功能性便秘研究进展[J].实用中医药杂志,2016,32(6):635-637.
[19]葛国岚,金玉晶.穴位埋线治疗小儿脾虚气弱型便秘疗效观察[J].新中医,2018,50(1):123-125.
[20]何荣兰.中医辨证治疗小儿功能性便秘的临床研究[J].中医临床研究,2017,9(25):76-77.