痛泻要方加减治疗对腹泻型肠易激综合征肠道微生态的影响
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摘要
研究背景与目的：
肠易激综合征(Irritable Bowel Syndrome, IBS)长期以来都是值得重视的临床与社会问题,因为该病是一种临床常见功能性胃肠病,严重影响患者的学习、生活和工作,对患者的生存质量亦产生不同程度的负面影响。该病患者在消化门诊就诊者中约占25-50%,尤其好发于中青年,是中青年误工和医疗资源消耗的主要原因之一,其中腹泻型肠易激综合征又占据了该病约74.1%。
由于IBS的发病机理尚不明确,目前临床上西医治疗以对症治疗为主,虽然现在的治疗手段多种多样,各有优势,但在减轻症状、缓解病情方面,都不尽如人意；而中医药采取辨证施治的措施,临床上不仅对于改善症状,缩短病程,减轻患者病痛,而且对于减少发作次数都效果显著。
本课题在中医理论的指导下,结合导师劳绍贤教授多年的临床经验,运用痛泻要方加减治疗腹泻型肠易激综合征,观察其对肠道微生态的影响,积极探索该病有效的治疗手段,而且观察肠道微生态对于该病的影响。
研究方法：
本课题选用小样本的对照实验,为同时性前瞻性研究。将符合纳入标准的20例腹泻型肠易激综合征纳入治疗组,予痛泻要方加减治疗前后分别进行症状评分,以评价该疗法的临床疗效；并将治疗组患者在治疗前后留取大便标本进行微生态研究,其结果与10例正常的健康对照组相比较,以揭示微生态变化在该病中的地位。
研究结果：
参与研究的20例治疗组患者和10例对照组的结果显示,两组性别、年龄因素构成比的差异性(P>0.05)无统计学意义,提示治疗组患者和正常健康对照组在性别和年龄构成方面基本均衡；治疗组患者在采用痛泻要方加减治疗后症状评分结果显示共治愈5例,显效6例,有效7例,无效2例,总有效率为90%,提示痛泻要方加减治疗的方法对于肝郁脾虚型的腹泻型肠易激综合征患者取得了良好的疗效；治疗组患者肠道微生态治疗前后与正常对照组相比,其差异性没有统计学意义(P>0.05),而且治疗组在痛泻要方加减治疗前和治疗后自身相比,经统计检验,其变化差异性也没有统计学意义(P>0.05),提示痛泻要方加减对本次研究入组肝郁脾虚型腹泻型肠易激综合征患者肠道双歧杆菌和大肠杆菌变化的影响不明显。
结论：
痛泻要方加减治疗腹泻型肠易激综合征患者在改善症状方面有良好的疗效,虽然直观数据提示治疗后双歧杆菌有上升趋势,而大肠杆菌较治疗前有所下降,但统计结果没有显著性差异,提示肠道双歧杆菌和大肠杆菌在腹泻型肠易激综合征发病中的作用并不明确,其确切机制有待于在以后扩大样本量进一步研究。
Background and purpose:Irritable Bowel Syndrome (IBS) has been note worthy is the clinical and social problems for the disease is a clinical often seen in functional, will seriously affect the study and live and work for the quality of life also produces the negative impact. This sickness patient approximately composes in the digestion outpatient service seeing a doctor 25-50%, especially good sends in the Chinese youth, is the Chinese youth delays work one of with medical resources consumption primary causes, in which diarrhea IBS easy to stir up the synthesis to draft also occupy should get sick approximately 74.1%.
Because the IBS pathogenesis is not still clear about, at present on the clinical doctor practicing western medicine treats by the just right for the illness treatment primarily, although present treatment method many and varied, have the superiority respectively, but is reducing the symptom, the alleviation condition aspect, all not entirely as desired; But the Chinese medicine adopts TCM differential treatment, not only on clinical regarding improvement symptom, reduces the course of an illness, reduces the patient indisposition, moreover is all remarkable regarding the reduced outbreak number of times effect.
This study is under the Chinese medicine theory instruction, unifies teacher to work Lao Shaoxian Professor many years clinical experiences, flows swiftly using Tong Xie Yao Fang addition and subtraction treatment diarrhea IBS easily to stir up the synthesis to draft, observes it to the intestinal tract micro ecology influence, explores positively should get sick the effective treatment method, moreover observes the intestinal tract micro ecology regarding the influence which should get sick.
Method:This topic selects the small sample the check experiment, for synchrony forward-looking research.will tally integrates the standard 20 example diarrhea IBS easily to stir up the synthesis to draft integrates the treatment group, will give the Tong Xie Yao Fang addition and subtraction treatment to carry on symptom grading separately, will appraise this therapy the clinical curative effect; And will treat the group patients to remain around the treatment takes the bowel movement specimen to conduct the micro ecology research, its result will compare with 10 example normal healthy control groups, will promulgate the micro ecology change in to be supposed to get sick the status.
Result:Participates in the research 20 example treatment group patients and 10 example control group's result showed, two groups of sexes, age factor constitutions compared to the different (P>0.05) non-statistics significance, prompts the treatment group patients and the normal healthy control group in the sex and the age constitution aspect basic balanced; The treatment group patients after use the Tong Xie Yao Fang addition and subtraction treatment the symptom grading result to demonstrate altogether cures 5 examples, shows results 6 examples, the effective 7 examples, the invalid 2 examples, account for 10% invalid, the total effectiveness is 90%, prompted the Tong Xie Yao Fang addition and subtraction treatment easy to stir up the synthesis regarding the liver strongly fragrant spleen weakness diarrhea IBS to draft the patient to obtain the good curative effect; Around the treatment group patient intestinal tract micro ecology treatment compares with the normal control group, its difference does not have statistics significance, moreover the treatment group flows swiftly after the pain wants before the side addition and subtraction treatment and the treatment oneself compares, after the statistical test, its change difference also does not have statistics significance, prompts the pain to flow swiftly must only then add and subtract to this time studies into the group liver strongly fragrant spleen weakness diarrhea IBS easy to stir up the synthesis to draft the influence which the patient intestinal tract micro ecology (a pair of qi bacillus and backwoods coli) change not to be obvious.
Conclusions:The Tong Xie Yao Fang addition and subtraction treat diarrhea IBS easily to stir up the synthesis to draft the patient to have the good curative effect in the improvement symptom aspect, the micro ecology (a pair of qi bacillus and backwoods coli) easy to stir up the synthesis in the diarrhea IBS to commandeer get sick the function not to be clear out. Although visual data hint after treatment was escherichia coli decline, and colon bacillus rising trend after the treatment, but no significant differences in statistical results, it shows intestinal colon bacillus coli in diarrhea and type of irritable bowel syndrome role is not clear, The exact mechanisms expand sample further study in later.
肠易激综合征(Irritable Bowel Syndrome, IBS)长期以来都是值得重视的临床与社会问题,因为该病是一种临床常见功能性胃肠病,严重影响患者的学习、生活和工作,对患者的生存质量亦产生不同程度的负面影响。该病患者在消化门诊就诊者中约占25-50%,尤其好发于中青年,是中青年误工和医疗资源消耗的主要原因之一,其中腹泻型肠易激综合征又占据了该病约74.1%。
由于IBS的发病机理尚不明确,目前临床上西医治疗以对症治疗为主,虽然现在的治疗手段多种多样,各有优势,但在减轻症状、缓解病情方面,都不尽如人意；而中医药采取辨证施治的措施,临床上不仅对于改善症状,缩短病程,减轻患者病痛,而且对于减少发作次数都效果显著。
本课题在中医理论的指导下,结合导师劳绍贤教授多年的临床经验,运用痛泻要方加减治疗腹泻型肠易激综合征,观察其对肠道微生态的影响,积极探索该病有效的治疗手段,而且观察肠道微生态对于该病的影响。
研究方法：
本课题选用小样本的对照实验,为同时性前瞻性研究。将符合纳入标准的20例腹泻型肠易激综合征纳入治疗组,予痛泻要方加减治疗前后分别进行症状评分,以评价该疗法的临床疗效；并将治疗组患者在治疗前后留取大便标本进行微生态研究,其结果与10例正常的健康对照组相比较,以揭示微生态变化在该病中的地位。
研究结果：
参与研究的20例治疗组患者和10例对照组的结果显示,两组性别、年龄因素构成比的差异性(P>0.05)无统计学意义,提示治疗组患者和正常健康对照组在性别和年龄构成方面基本均衡；治疗组患者在采用痛泻要方加减治疗后症状评分结果显示共治愈5例,显效6例,有效7例,无效2例,总有效率为90%,提示痛泻要方加减治疗的方法对于肝郁脾虚型的腹泻型肠易激综合征患者取得了良好的疗效；治疗组患者肠道微生态治疗前后与正常对照组相比,其差异性没有统计学意义(P>0.05),而且治疗组在痛泻要方加减治疗前和治疗后自身相比,经统计检验,其变化差异性也没有统计学意义(P>0.05),提示痛泻要方加减对本次研究入组肝郁脾虚型腹泻型肠易激综合征患者肠道双歧杆菌和大肠杆菌变化的影响不明显。
结论：
痛泻要方加减治疗腹泻型肠易激综合征患者在改善症状方面有良好的疗效,虽然直观数据提示治疗后双歧杆菌有上升趋势,而大肠杆菌较治疗前有所下降,但统计结果没有显著性差异,提示肠道双歧杆菌和大肠杆菌在腹泻型肠易激综合征发病中的作用并不明确,其确切机制有待于在以后扩大样本量进一步研究。
Background and purpose:Irritable Bowel Syndrome (IBS) has been note worthy is the clinical and social problems for the disease is a clinical often seen in functional, will seriously affect the study and live and work for the quality of life also produces the negative impact. This sickness patient approximately composes in the digestion outpatient service seeing a doctor 25-50%, especially good sends in the Chinese youth, is the Chinese youth delays work one of with medical resources consumption primary causes, in which diarrhea IBS easy to stir up the synthesis to draft also occupy should get sick approximately 74.1%.
Because the IBS pathogenesis is not still clear about, at present on the clinical doctor practicing western medicine treats by the just right for the illness treatment primarily, although present treatment method many and varied, have the superiority respectively, but is reducing the symptom, the alleviation condition aspect, all not entirely as desired; But the Chinese medicine adopts TCM differential treatment, not only on clinical regarding improvement symptom, reduces the course of an illness, reduces the patient indisposition, moreover is all remarkable regarding the reduced outbreak number of times effect.
This study is under the Chinese medicine theory instruction, unifies teacher to work Lao Shaoxian Professor many years clinical experiences, flows swiftly using Tong Xie Yao Fang addition and subtraction treatment diarrhea IBS easily to stir up the synthesis to draft, observes it to the intestinal tract micro ecology influence, explores positively should get sick the effective treatment method, moreover observes the intestinal tract micro ecology regarding the influence which should get sick.
Method:This topic selects the small sample the check experiment, for synchrony forward-looking research.will tally integrates the standard 20 example diarrhea IBS easily to stir up the synthesis to draft integrates the treatment group, will give the Tong Xie Yao Fang addition and subtraction treatment to carry on symptom grading separately, will appraise this therapy the clinical curative effect; And will treat the group patients to remain around the treatment takes the bowel movement specimen to conduct the micro ecology research, its result will compare with 10 example normal healthy control groups, will promulgate the micro ecology change in to be supposed to get sick the status.
Result:Participates in the research 20 example treatment group patients and 10 example control group's result showed, two groups of sexes, age factor constitutions compared to the different (P>0.05) non-statistics significance, prompts the treatment group patients and the normal healthy control group in the sex and the age constitution aspect basic balanced; The treatment group patients after use the Tong Xie Yao Fang addition and subtraction treatment the symptom grading result to demonstrate altogether cures 5 examples, shows results 6 examples, the effective 7 examples, the invalid 2 examples, account for 10% invalid, the total effectiveness is 90%, prompted the Tong Xie Yao Fang addition and subtraction treatment easy to stir up the synthesis regarding the liver strongly fragrant spleen weakness diarrhea IBS to draft the patient to obtain the good curative effect; Around the treatment group patient intestinal tract micro ecology treatment compares with the normal control group, its difference does not have statistics significance, moreover the treatment group flows swiftly after the pain wants before the side addition and subtraction treatment and the treatment oneself compares, after the statistical test, its change difference also does not have statistics significance, prompts the pain to flow swiftly must only then add and subtract to this time studies into the group liver strongly fragrant spleen weakness diarrhea IBS easy to stir up the synthesis to draft the influence which the patient intestinal tract micro ecology (a pair of qi bacillus and backwoods coli) change not to be obvious.
Conclusions:The Tong Xie Yao Fang addition and subtraction treat diarrhea IBS easily to stir up the synthesis to draft the patient to have the good curative effect in the improvement symptom aspect, the micro ecology (a pair of qi bacillus and backwoods coli) easy to stir up the synthesis in the diarrhea IBS to commandeer get sick the function not to be clear out. Although visual data hint after treatment was escherichia coli decline, and colon bacillus rising trend after the treatment, but no significant differences in statistical results, it shows intestinal colon bacillus coli in diarrhea and type of irritable bowel syndrome role is not clear, The exact mechanisms expand sample further study in later.
引文
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