平调肝脾、寒热并用法治疗混合型肠易激综合征的临床研究
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摘要
目的本课题主要研究肠易激综合征混合型(IBS-M)的中西医发病机理及治疗,在总结IBS肝脾不调的基础上,提出寒热错杂的病机,结合临床研究,评价中药治疗混合型肠易激综合征的疗效。
方法将56例确诊患者随机分成两组。治疗组30例口服本医院汤药和双歧三联活菌胶囊(商品名培菲康),对照组26例口服双歧三联活菌胶囊。患者就诊前后填写肠易激综合征生活质量表(IBS-QOL)。两组患者均以4周为一个疗程,分别于治疗前、治疗2周及治疗后各记录一次临床症状,并于治疗结束后一月随访,所得数据作统计学分析。比较两组患者的症状积分、生活质量评分的改变,评价两组疗效。
结果1.治疗组总有效率为93.33%,对照组总有效率为61.54%,两组总疗效比较有显著性差异(P<0.05),治疗组优于对照组。
2.IBS临床症状的疗效比较：两组大部分症状在治疗后均有显著改善(P<0.05),特别是在粪便性状、腹痛腹胀及排便不畅三个方面,组间比较显示治疗组在治疗后及随访时都明显优于对照组(P<0.01)。在中医证候疗效评分方面,两组中医证候总积分均较前有明显改善(P<0.01),且治疗组与对照组相比有显著差异(P<0.01)。提示中医中药在改善患者临床症状方面疗效优于对照组。
3.患者生活质量的分析：我们通过患者在治疗前后填写的IBS-QOL所获得的评分,作统计学分析,结果显示在生活质量评分改变上,两组治疗前后均有显著差异(P<0.05)。进一步比较两组治疗前后各维度改善的差值,结果表明在烦躁不安(Q1)、冲突行为(Q2)、身体角色(Q3)、健康忧虑(Q4)四个维度上,治疗组更优于对照组(P<0.05)。
结论两组患者经治疗后,症状积分及生活质量评分均有不同程度的改善,具有统计学显著性差异。其中中药治疗组疗效又优于西药对照组。本研究认为中药不仅可以显著改善IBS患者的腹痛腹胀、排便不畅、大便溏结不调等主要症状,还可以明显改善IBS患者的精神、心理状况、社会角色等生活质量。提示平调肝脾、寒热并用法治疗IBS-M在临床有进一步研究和探讨的价值。
Purpose This issue mainly researches the mechanism and treatment of mixed-predominant Irritable Bowel Syndrome(IBS-M).Based on the pathogenesis the liver and spleen are not adjusted in IBS, we proposed the mechanism of mixed cold and heat, and combined with clinical studies,to evaluate the effect of traditional Chinese medicine in treating IBS-M.
Method 56 patients with IBS were divided into 2 groups at random. The observed group(30 people) took probiotic three times with oral medicine one bag each day, the control group(26 people) took probiotic three times each day. Every patient should be asked for filling out a form before and after the treatment:The Irritable Bowel Syndrome Quality Of Life (IBS-QOL). The course of treatment was 4 weeks. We recorded the patients'clinical symptoms when before treatment, the first 2 weeks and after treatment, then follow-up month later. In the end we analyzed the data.To evaluate the effects by comparing changes of symptom score and quality of life score.
Results 1.The treatment group's total effective rate was 93.33%,while the total group was 61.54%.Compared with the latter, the former was better (P<0.05).2.Comparison of the efficacy of IBS symptoms:most symptoms in both groups improved significantly after treatment(P<0.05),particularly in the stool,abdominal pain, poor bowel movement aspect,the treatment group was prior to the control group(P＜0.01) In the syndromes of Chinease medicine efficacy,both group improved compared with before(P<0.01),and the treatment group was significantly different compared with the control group(P<0.01),which suggested the Chinease medicine is more effective than the control group in improving clinical symptoms of patiens.3.Quality of life of patients:The IBS-QOL scores showed that the two groups were significantly different after treatment(P<0.05).By further comparing the differences of the improvement of dimensions,the results indicated that the treatment group was better than the control group in the following four dimensions: Irritability(Q1), Conflict Behavior(Q2), Physical Role(Q3), Health Concerns(Q4) (P<0.05).
Conclusion After treatment, patients' symptoms scores and quality of life scores all improved in varying degrees, and the treatment group was better than the control group.This study suggests that Chinease medicine can not only significantly improve abdominal pain, poor bowel movement, dry or loose stool and other major symptoms in patients with IBS,but also improve the mental, psychological status, social roles and other quality of life. Reconciliation of the spleen and liver, the method of cold combined with heat have certain advantages in treating IBS-M,and this method is valuable to give further study and exploration.
方法将56例确诊患者随机分成两组。治疗组30例口服本医院汤药和双歧三联活菌胶囊(商品名培菲康),对照组26例口服双歧三联活菌胶囊。患者就诊前后填写肠易激综合征生活质量表(IBS-QOL)。两组患者均以4周为一个疗程,分别于治疗前、治疗2周及治疗后各记录一次临床症状,并于治疗结束后一月随访,所得数据作统计学分析。比较两组患者的症状积分、生活质量评分的改变,评价两组疗效。
结果1.治疗组总有效率为93.33%,对照组总有效率为61.54%,两组总疗效比较有显著性差异(P<0.05),治疗组优于对照组。
2.IBS临床症状的疗效比较：两组大部分症状在治疗后均有显著改善(P<0.05),特别是在粪便性状、腹痛腹胀及排便不畅三个方面,组间比较显示治疗组在治疗后及随访时都明显优于对照组(P<0.01)。在中医证候疗效评分方面,两组中医证候总积分均较前有明显改善(P<0.01),且治疗组与对照组相比有显著差异(P<0.01)。提示中医中药在改善患者临床症状方面疗效优于对照组。
3.患者生活质量的分析：我们通过患者在治疗前后填写的IBS-QOL所获得的评分,作统计学分析,结果显示在生活质量评分改变上,两组治疗前后均有显著差异(P<0.05)。进一步比较两组治疗前后各维度改善的差值,结果表明在烦躁不安(Q1)、冲突行为(Q2)、身体角色(Q3)、健康忧虑(Q4)四个维度上,治疗组更优于对照组(P<0.05)。
结论两组患者经治疗后,症状积分及生活质量评分均有不同程度的改善,具有统计学显著性差异。其中中药治疗组疗效又优于西药对照组。本研究认为中药不仅可以显著改善IBS患者的腹痛腹胀、排便不畅、大便溏结不调等主要症状,还可以明显改善IBS患者的精神、心理状况、社会角色等生活质量。提示平调肝脾、寒热并用法治疗IBS-M在临床有进一步研究和探讨的价值。
Purpose This issue mainly researches the mechanism and treatment of mixed-predominant Irritable Bowel Syndrome(IBS-M).Based on the pathogenesis the liver and spleen are not adjusted in IBS, we proposed the mechanism of mixed cold and heat, and combined with clinical studies,to evaluate the effect of traditional Chinese medicine in treating IBS-M.
Method 56 patients with IBS were divided into 2 groups at random. The observed group(30 people) took probiotic three times with oral medicine one bag each day, the control group(26 people) took probiotic three times each day. Every patient should be asked for filling out a form before and after the treatment:The Irritable Bowel Syndrome Quality Of Life (IBS-QOL). The course of treatment was 4 weeks. We recorded the patients'clinical symptoms when before treatment, the first 2 weeks and after treatment, then follow-up month later. In the end we analyzed the data.To evaluate the effects by comparing changes of symptom score and quality of life score.
Results 1.The treatment group's total effective rate was 93.33%,while the total group was 61.54%.Compared with the latter, the former was better (P<0.05).2.Comparison of the efficacy of IBS symptoms:most symptoms in both groups improved significantly after treatment(P<0.05),particularly in the stool,abdominal pain, poor bowel movement aspect,the treatment group was prior to the control group(P＜0.01) In the syndromes of Chinease medicine efficacy,both group improved compared with before(P<0.01),and the treatment group was significantly different compared with the control group(P<0.01),which suggested the Chinease medicine is more effective than the control group in improving clinical symptoms of patiens.3.Quality of life of patients:The IBS-QOL scores showed that the two groups were significantly different after treatment(P<0.05).By further comparing the differences of the improvement of dimensions,the results indicated that the treatment group was better than the control group in the following four dimensions: Irritability(Q1), Conflict Behavior(Q2), Physical Role(Q3), Health Concerns(Q4) (P<0.05).
Conclusion After treatment, patients' symptoms scores and quality of life scores all improved in varying degrees, and the treatment group was better than the control group.This study suggests that Chinease medicine can not only significantly improve abdominal pain, poor bowel movement, dry or loose stool and other major symptoms in patients with IBS,but also improve the mental, psychological status, social roles and other quality of life. Reconciliation of the spleen and liver, the method of cold combined with heat have certain advantages in treating IBS-M,and this method is valuable to give further study and exploration.
引文
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[3]王景杰,高峰等.IBS患者胃肠运动功能的临床研究[J],西安交通大学学报(医学版).2002,23(4)：423-4.
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