疏肝健脾法治疗腹泻型肠易激综合征肝郁脾虚证的临床观察
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摘要
肠易激综合征(IBS)是临床常见病、多发病,本病起病隐匿,症状反复发作或慢性迁延,给患者带来了沉重的经济和心理负担。罗马Ⅲ诊断标准将IBS分为IBS腹泻型(IBS-D)、IBS便秘型(IBS-C)、IBS混合型(IBS-M)及IBS不定型(IBS-U)4型,临床以IBS-D占多数。笔者以中医理论为基础,结合导师及众多临床医家经验,认为肝郁脾虚,肝脾不调是IBS-D的重要病机,临床以肝郁脾虚证最为常见,从而确立疏肝健脾法为IBS-D的治疗大法。
研究目的：观察疏肝健脾法治疗IBS-D肝郁脾虚证的临床疗效,研究结果可作为以后临床参考。
研究方法：采用随机数字表分组法,将60例入选病人随机分为治疗组和对照组,分别用疏肝健脾法和口服洛哌丁胺治疗,疗程为4周,于治疗前后观察并记录2组主要症状、次要症状、不良反应等,对2组的数据进行统计学分析。
研究结果：治疗组有效率96.67%,对照组有效率73.33%,治疗组有效率明显高于对照组(P<0.05)。治疗组和对照组均能明显改善IBS-D患者主要症状(P<0.01)。治疗组在改善患者腹痛上明显优于对照组(P<0.01),在改善大便次数、大便性状上2组无差异(P>0.05)。治疗组在改善患者次要症状上优于对照组。
研究结论：中医疏肝健脾法治疗IBS-D肝郁脾虚证,安全有效,优势明显。
Irritable Bowel Syndrome (IBS) is a clinical common and frequently-occurring disease, which is recurrent or chronic persistent, giving patients a heavy impact on the economic and psychological.By the Rome III diagnostic criteria, IBS is divided into four types:IBS diarrhea (IBS-D), IBS constipation(IBS-C), IBS mixed type (IBS-M), and IBS are not stereotypes (IBS-U) 4-type, with IBS-D is most common in clinical.The author based on the theory of TCM combined with many years of clinical practice of the instructor and clinical physicians suggested that liver depression and spleen deficiency is the most important pathogenesis of IBS-D. In clinical the syndrome of liver depression and spleen deficiency is most common,so as to set Shugan Jianpi Recipe (SJR) for the treatment of IBS-Din the main method. Objective:To verify the SJR in treating syndrome of liver depression and spleen deficiency of IBS-D. The results can be used as clinical reference later.
Research Methods:A random number table grouping method,60 cases were randomly divided into treatment group and the control group, respectively treated with SJR and oral Loperamide for 4 weeks. Before and after the the treatment,observe and record the two groups'main symptoms, secondary symptoms, adverse reactions. The data is statistically analyzed to identify the advantage.
Results:The treatment studies shown that the treatment group's effective rate is 96.67%, when the comparison group's is 73.33%,the treatment group was significantly higher (P<0.05).Both of the two groups,the main symptoms of patients after treatment have markedly improved. Treatment group had a better efficacy in improving abdominal pain than the control group (P<0.01), but no difference in improving stool frequency and character. In some secondary symptoms, the treatment group is better than the control group.
Study Conclusion:SJR of TCM is safe and effective in treating syndrome of liver depression and spleen deficiency of IBS-D.
研究目的：观察疏肝健脾法治疗IBS-D肝郁脾虚证的临床疗效,研究结果可作为以后临床参考。
研究方法：采用随机数字表分组法,将60例入选病人随机分为治疗组和对照组,分别用疏肝健脾法和口服洛哌丁胺治疗,疗程为4周,于治疗前后观察并记录2组主要症状、次要症状、不良反应等,对2组的数据进行统计学分析。
研究结果：治疗组有效率96.67%,对照组有效率73.33%,治疗组有效率明显高于对照组(P<0.05)。治疗组和对照组均能明显改善IBS-D患者主要症状(P<0.01)。治疗组在改善患者腹痛上明显优于对照组(P<0.01),在改善大便次数、大便性状上2组无差异(P>0.05)。治疗组在改善患者次要症状上优于对照组。
研究结论：中医疏肝健脾法治疗IBS-D肝郁脾虚证,安全有效,优势明显。
Irritable Bowel Syndrome (IBS) is a clinical common and frequently-occurring disease, which is recurrent or chronic persistent, giving patients a heavy impact on the economic and psychological.By the Rome III diagnostic criteria, IBS is divided into four types:IBS diarrhea (IBS-D), IBS constipation(IBS-C), IBS mixed type (IBS-M), and IBS are not stereotypes (IBS-U) 4-type, with IBS-D is most common in clinical.The author based on the theory of TCM combined with many years of clinical practice of the instructor and clinical physicians suggested that liver depression and spleen deficiency is the most important pathogenesis of IBS-D. In clinical the syndrome of liver depression and spleen deficiency is most common,so as to set Shugan Jianpi Recipe (SJR) for the treatment of IBS-Din the main method. Objective:To verify the SJR in treating syndrome of liver depression and spleen deficiency of IBS-D. The results can be used as clinical reference later.
Research Methods:A random number table grouping method,60 cases were randomly divided into treatment group and the control group, respectively treated with SJR and oral Loperamide for 4 weeks. Before and after the the treatment,observe and record the two groups'main symptoms, secondary symptoms, adverse reactions. The data is statistically analyzed to identify the advantage.
Results:The treatment studies shown that the treatment group's effective rate is 96.67%, when the comparison group's is 73.33%,the treatment group was significantly higher (P<0.05).Both of the two groups,the main symptoms of patients after treatment have markedly improved. Treatment group had a better efficacy in improving abdominal pain than the control group (P<0.01), but no difference in improving stool frequency and character. In some secondary symptoms, the treatment group is better than the control group.
Study Conclusion:SJR of TCM is safe and effective in treating syndrome of liver depression and spleen deficiency of IBS-D.
引文
[1]康正祥.肠易激综合征的中医治疗[J].现代中医药,2006,4：24-25.
[2]蒋边生.痛泻要方治疗肠易激综合征36例[J].吉林中医药,2007,27(10)：28.
[3]袁瞳.从肝论治肠易激综合征体会[J].陕西中医,2006,26(9)：24-25.
[4]周福生,吴文江.顺激合剂对肠易激综合征患者结肠动力学影响的研究[J].中医杂志,2004,45(11)：856-859.
[5]刘华.吴鞠通湿病学说与肠易激综合征[J].中国民间疗法2008,7：7.
[6]刘周怀,齐爱珍.肠易激综合征中医病机病理浅析[J].陕西中医,2005,6(9)：975.
[7]巩阳.王长洪教授从肝脾肾论治肠易激综合征的临床经验[J].中国中西医结合消化杂志,2008,17(3)：195-196.
[8]陈文莉.肠易激综合症(IBS)的中医治疗五法[J].山西中医学院学报.2005,6(2)：23-24.
[9]刘同坤,闫书文.从临床特点探讨肠易激综合症的中医辨证思路[J].中国中医药现代远程教育,2008,6(6)：548.
[10]张书生.肠易激综合征从肺论治[J],四川中医,2005,23(3)：17-18.
[11]翟兴红,王和天.赵荣莱教授治疗肠易激综合征(便秘型)经验[J].中华中医药志,2006,21(1)：43-44.
[12]周军丽,张颖.辨证治疗肠易激综合征疗效观察[J].山西中医,2005,4：21.
[13]徐继璞.肠易激综合征的中医辨治[J].中国中医急症,2008,17(7)：1010.
[14]李宏升,李可竹,陈苏宁.理气健脾汤治疗肠易激综合征的疗效[J].实用药物与临床,2009,12(3)：223-224.
[15]甘锋.自拟中药方治疗肠易激综合症81例体会[J].黔南民族医专学报,2007,20(1)：36.
[16]黄沁,许尊贤.痛泻要方加味治疗腹泻型肠易激综合征50例[J].江苏中医药,2008,40(1)：47.
[17]郑柏菁.七位白术散治疗腹泻型肠易激综合征37例[J].福中医药,2005,36(4)：38-39.
[18]桑希河.健脾渗湿止泻汤治疗肠易激综合征30例[J].河北中医,2009,31(1)：37.
[19]吴华清,姚保泰.温补脾肾法治疗腹泻型肠易激综合征疗效观察[J].山东中医药大学学报,2006,30(5)：367-368.
[20]王长来.养血通腑汤治疗便秘型肠易激综合征50例[J].江西中医药,2008,39(303)：21.
[21]张艳国,张艳红.血府逐瘀汤加味治疗肠易激综合征65例[J].河北中医药学报,2001,16(2)：18-19.
[22]姚景濂,葛秀群,张建中.活血化瘀治疗便秘型肠易激综合征105例[J].中国中西医结合消化杂志,2007,15(4)：266-267.
[23]黄志刚,尤斌,雷震.针灸辨证治疗肠易激综合征172例[J].上海针灸杂志,2006,25(7)：21-22.
[24]储浩然,杨骏.点灸特定穴治疗肠易激综合征(腹泻型)疗效观察[J].中国针灸,2009,29(2)：111.
[25]王雪峰.针药联合治疗肝郁脾虚型肠易激综合征[J].中国民间疗法,2008,9：32.
[26]薛莉萍,刘松.中西医结合治疗肠易激综合征80例观察[J].实用中医药杂志,2007,23(11)：708-709.
[27]左新红.中西医结合治疗腹泻型肠易激综合症32例[J].中医研究,2007,20(11)：34.
[28]张芸.疏肝健脾法联合马来酸曲美布汀治疗腹泻型肠易激综合征疗效观察[J].长春中医药大学学 报,2008,24(5)：503-504.
[29]危北海,张万岱,陈治水.中西医结合消化病学[M].第1版.北京：人民卫生出版社,2003：790-804.
[30]Muller-Lissner SA,Bollani S,Brummer RJ,et al.Epidemi ological aspects of irritable bowel syndrome in Europe and North America[J]. Digesti On,2001,64 (3):200-204.
[31]胡品津,方秀才,袁耀宗,等.肠易激综合征诊断和治疗的共识意见[J].中华消化杂志,2008,28(1)：38-40.
[32]Drossman DA.The functional gastrointestinal disorders and the Rome III process[J].Gastroenterology, 2006,130:1377-1390.
[33]付朝伟,徐飚,陈维清,等.中国人城市肠易激综合征和功能性消化不良患者抑郁、焦虑现状研究[J].中华消化杂志,2006,26(3)：151-154.
[34]Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndromel[J].BMJ,2007,334 (7603):1105-11091.
[35]张志雄,熊汉华,侯晓华.肠易激综合征患者心理评价[J].胃肠病学和肝病学杂志,2004,13(4)：396-399.
[36]Murray CD, Flynn J, Ratcliffe L,et al. Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome[J]. Gastroenterology,2004,127:1695-1703.
[37]Small PK, Loudon MA, Hau CM, et al.Large-scale ambulatory study of postprandial jejunal motility in irritable bowel syndrome[J].Scand J Gastroenterol 1997,32:39-47.
[38]刘新光.肠易激综合征发病机制的研究现状[J].中华消化杂志,2007,21(7)：391-392.
[39]曾民德,范竹萍,李兆申,等.马来酸曲美布汀：肠易激综合征治疗的另一选择[J].胃肠病学,2002,7(4)：206-208.
[40]陈朝元,王岩.曲美布汀治疗肠易激综合征的临床疗效[J].中国新药与临床杂志,2003,22(4)：198-200.
[41]Poynard T, Regimbeau C,Benhamou Y,et al.Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome[J].Alimentpharmacol Ther,2001,15:355-361.
[42]Ringel Y,Droasman DA,Turkington TG, et al. Dysfunction of the motivation affective pain system in patients with IBS:PET brain imaging in response to rectal ballon distention[J]. Gastroenterology,2000, (may suppl):A474
[43]Silverman DH, Munakata JA, Ennes H, et al. Regional cerebral activity in normal and pathological perception of visceral pain [J]. Gastroenterology,1997,112 (1):64-72.
[44]胡品津,潘国宗.中华医学会第一届全国肠易激综合症学术会议纪要[J].中华内科杂志,2003,42(9)：658-659.
[45]胡品津.从脑-肠互动的高度认识肠易激综合征[J].中华消化杂志,2003,23(5)：261-262.
[46]潘国宗,鲁素彩,柯美云,等.北京地区肠易激综合征的流行病学研究：一个整群、分层、随机的调查[J].中华流行病学杂志,2000,61：26-29.
[47]Neal KR,Hebden J,Spiller R.Prevalence of gastrointestinal symp-toms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome:post survey of patients[J],BMJ,1997,314(7083):779-782.
[48]刘新光.肠易激综合征与肠道感染[J].胃肠病学,2003,8(4)：附8-附9.
[49]Chadwick VS,Chen W,Shu D,et al.Activation of the mucosal immune system in irritable bowel syndrome[J].Gastroenterology,2002,122(7):1778-1783.
[50]王利华,方秀才,潘国宗.肠道感染与肠易激综合征[J].中华内科杂志,2002,41(2)：90-93.
[51]李兆申,詹丽杏,邹多武,等.肠易激综合征患者分泌5-羟色胺的肠嗜铬细胞形态及功能的改变[J].中华消化杂志,2004,24：94-97.
[52]Spiller RC.Postinfectious irritable bowel syndrome[J].Gastroenterology,2003,124(6):1662-1671.
[53]Atkinson W, Lockhart S, Whorwell PJ, et al.Altered 5-hydroxytryptamine signaling in patients with constipation and diarrhea-predominant irritable bowel syndrome[J]. Gastroenterology,2006,130:34-43.
[54]Delvaux M.Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome[J].Gut, 2002,51(Suppl):i67-i71.
[55]Camilleri M, Notthcurr AR,Kong S,et al.Efficacy and safety of alosetron in women with irritable bowel syndrome:arandomized, placebocontrolled trial[J].Lancet,2000,355(9209):1035-1041.
[56]Schoerdeld P,Chey WD,Drossman D,et al. Effectiveness and safety of tegaserod in the treatment of irritable bowel syndrome:a meta-analysis of randomized controlled trials[J].Gastroenterology,2002,122 (4 suppl):A-465.
[57]McAllister F,Henry A,Kreindler J,et al.Role of IL-17A, IL-17F and the IL-17 receptor in regulating growth-related oncogene-alpha and granulocyte colony-stimulationing factor in bronchial epithelium: implications for airway inflammation in cystic fibrosis[J].J Immunol,2005,175(1):404-412.
[58]陈文科,邹益友,李富军,等.肠易激综合征精神心理因素、肠粘膜肥大细胞及5-羟色胺的变化[J].世界华人消化杂志,2007,15(1)：46-50.
[59]李兆申,董文珠,邹多武.肠易激综合征肠黏膜SP、VIP、CGRP变化的研究[J].第二军医大学学报,2003,24(2)：147-151.
[60]梁荣新,蔡联英,郑琴芳,等.肠易激综合征结肠动力与胃肠激素的相关性研究[J].广西医学,2005,27(4)：479-482.
[61]张红杰,林琳,赵志泉,等.胃肠肤类激素与肠易激综合征发病间的关系[J].南京医科大学学报,2003,23(6)：527-529.
[62]Bouin M,Plourde V, Boivin M,et al.Rectal distention testing in patients with irritable bowel syndrome: sensitivity,specificity,and predictive values of pain sensory thresholds[J].Gsatroenterology,2002,122(7): 1771-1777.
[63]Sinhamahapatra P,Saha SP,Chowdhury A,et al.Visceral afferent hypersensitivity in irritable bowel syndrome evaluation by cerebralevoked potential after rectal stimulation[J].Am J Gastroenterol,2001,96(7): 2150-2157.
[64]康明祥,贾红.肠易激综合征内脏高敏感性机制的研究进展[J].世界华人消化杂志2008,16(14)：1554-1558.
[65]汪安江,廖献花,胡品津,等.罗马Ⅲ与罗马Ⅱ标准诊断肠易激综合征的比较[J].中华内科杂志,2007,46(8)：644-647.
[66]Poynard T,Regimbeau C,Benhamou Y.Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome[J].Aliment Pharmacol Ther,2001,15(3):355-361.
[67]颜玉,王艳凤,袁禧先,等.微生态制剂丽珠肠乐治疗肠易激综合征[J].中国微生态学杂志,2003,15：180.
[68]许斌,袁耀宗.肠易激综合征药物治疗进展[J].中华消化杂志.2000,20(4)：261-263.
[69]杜炜,孟环.肠易激综合征药物治疗的现状和进展[J].胃肠病学,2007,12(5)：317-319.
[70]Wegener G,Volke V,Harvey BH.Local,but not systemic, administration of serotonergic antidepressants decreases hippocampa] nitric oxide synthase activity[J].Brain Res,2003,959(1):128-134.
[71]鲍军,单兆伟.抗抑郁药物治疗肠易激综合征[J].江苏医药,2007,33(4)：361-362.
[72]王伟岸.肠易激综合征的治疗[J].胃肠病学和肝病学杂志,2001,10(2)：110-113.
[73]胡品津,潘国宗.中华医学会第一届全国肠易激综合征学术会议纪要[J].中华消化杂志,2003,23(7)：428.
[74]周仲瑛.中医内科学[M].第1版.北京：中国中医药出版社,2003：250.
[75]郑莜萸.中药新药临床研究指导原则[S].北京：中国医药科技出版社,2002：139.
[76]刘学芳,丁国萍.疏肝健脾法治疗慢性结肠炎28例分析[J].社区医学杂志,2007,5(20)：60.
[2]蒋边生.痛泻要方治疗肠易激综合征36例[J].吉林中医药,2007,27(10)：28.
[3]袁瞳.从肝论治肠易激综合征体会[J].陕西中医,2006,26(9)：24-25.
[4]周福生,吴文江.顺激合剂对肠易激综合征患者结肠动力学影响的研究[J].中医杂志,2004,45(11)：856-859.
[5]刘华.吴鞠通湿病学说与肠易激综合征[J].中国民间疗法2008,7：7.
[6]刘周怀,齐爱珍.肠易激综合征中医病机病理浅析[J].陕西中医,2005,6(9)：975.
[7]巩阳.王长洪教授从肝脾肾论治肠易激综合征的临床经验[J].中国中西医结合消化杂志,2008,17(3)：195-196.
[8]陈文莉.肠易激综合症(IBS)的中医治疗五法[J].山西中医学院学报.2005,6(2)：23-24.
[9]刘同坤,闫书文.从临床特点探讨肠易激综合症的中医辨证思路[J].中国中医药现代远程教育,2008,6(6)：548.
[10]张书生.肠易激综合征从肺论治[J],四川中医,2005,23(3)：17-18.
[11]翟兴红,王和天.赵荣莱教授治疗肠易激综合征(便秘型)经验[J].中华中医药志,2006,21(1)：43-44.
[12]周军丽,张颖.辨证治疗肠易激综合征疗效观察[J].山西中医,2005,4：21.
[13]徐继璞.肠易激综合征的中医辨治[J].中国中医急症,2008,17(7)：1010.
[14]李宏升,李可竹,陈苏宁.理气健脾汤治疗肠易激综合征的疗效[J].实用药物与临床,2009,12(3)：223-224.
[15]甘锋.自拟中药方治疗肠易激综合症81例体会[J].黔南民族医专学报,2007,20(1)：36.
[16]黄沁,许尊贤.痛泻要方加味治疗腹泻型肠易激综合征50例[J].江苏中医药,2008,40(1)：47.
[17]郑柏菁.七位白术散治疗腹泻型肠易激综合征37例[J].福中医药,2005,36(4)：38-39.
[18]桑希河.健脾渗湿止泻汤治疗肠易激综合征30例[J].河北中医,2009,31(1)：37.
[19]吴华清,姚保泰.温补脾肾法治疗腹泻型肠易激综合征疗效观察[J].山东中医药大学学报,2006,30(5)：367-368.
[20]王长来.养血通腑汤治疗便秘型肠易激综合征50例[J].江西中医药,2008,39(303)：21.
[21]张艳国,张艳红.血府逐瘀汤加味治疗肠易激综合征65例[J].河北中医药学报,2001,16(2)：18-19.
[22]姚景濂,葛秀群,张建中.活血化瘀治疗便秘型肠易激综合征105例[J].中国中西医结合消化杂志,2007,15(4)：266-267.
[23]黄志刚,尤斌,雷震.针灸辨证治疗肠易激综合征172例[J].上海针灸杂志,2006,25(7)：21-22.
[24]储浩然,杨骏.点灸特定穴治疗肠易激综合征(腹泻型)疗效观察[J].中国针灸,2009,29(2)：111.
[25]王雪峰.针药联合治疗肝郁脾虚型肠易激综合征[J].中国民间疗法,2008,9：32.
[26]薛莉萍,刘松.中西医结合治疗肠易激综合征80例观察[J].实用中医药杂志,2007,23(11)：708-709.
[27]左新红.中西医结合治疗腹泻型肠易激综合症32例[J].中医研究,2007,20(11)：34.
[28]张芸.疏肝健脾法联合马来酸曲美布汀治疗腹泻型肠易激综合征疗效观察[J].长春中医药大学学 报,2008,24(5)：503-504.
[29]危北海,张万岱,陈治水.中西医结合消化病学[M].第1版.北京：人民卫生出版社,2003：790-804.
[30]Muller-Lissner SA,Bollani S,Brummer RJ,et al.Epidemi ological aspects of irritable bowel syndrome in Europe and North America[J]. Digesti On,2001,64 (3):200-204.
[31]胡品津,方秀才,袁耀宗,等.肠易激综合征诊断和治疗的共识意见[J].中华消化杂志,2008,28(1)：38-40.
[32]Drossman DA.The functional gastrointestinal disorders and the Rome III process[J].Gastroenterology, 2006,130:1377-1390.
[33]付朝伟,徐飚,陈维清,等.中国人城市肠易激综合征和功能性消化不良患者抑郁、焦虑现状研究[J].中华消化杂志,2006,26(3)：151-154.
[34]Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndromel[J].BMJ,2007,334 (7603):1105-11091.
[35]张志雄,熊汉华,侯晓华.肠易激综合征患者心理评价[J].胃肠病学和肝病学杂志,2004,13(4)：396-399.
[36]Murray CD, Flynn J, Ratcliffe L,et al. Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome[J]. Gastroenterology,2004,127:1695-1703.
[37]Small PK, Loudon MA, Hau CM, et al.Large-scale ambulatory study of postprandial jejunal motility in irritable bowel syndrome[J].Scand J Gastroenterol 1997,32:39-47.
[38]刘新光.肠易激综合征发病机制的研究现状[J].中华消化杂志,2007,21(7)：391-392.
[39]曾民德,范竹萍,李兆申,等.马来酸曲美布汀：肠易激综合征治疗的另一选择[J].胃肠病学,2002,7(4)：206-208.
[40]陈朝元,王岩.曲美布汀治疗肠易激综合征的临床疗效[J].中国新药与临床杂志,2003,22(4)：198-200.
[41]Poynard T, Regimbeau C,Benhamou Y,et al.Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome[J].Alimentpharmacol Ther,2001,15:355-361.
[42]Ringel Y,Droasman DA,Turkington TG, et al. Dysfunction of the motivation affective pain system in patients with IBS:PET brain imaging in response to rectal ballon distention[J]. Gastroenterology,2000, (may suppl):A474
[43]Silverman DH, Munakata JA, Ennes H, et al. Regional cerebral activity in normal and pathological perception of visceral pain [J]. Gastroenterology,1997,112 (1):64-72.
[44]胡品津,潘国宗.中华医学会第一届全国肠易激综合症学术会议纪要[J].中华内科杂志,2003,42(9)：658-659.
[45]胡品津.从脑-肠互动的高度认识肠易激综合征[J].中华消化杂志,2003,23(5)：261-262.
[46]潘国宗,鲁素彩,柯美云,等.北京地区肠易激综合征的流行病学研究：一个整群、分层、随机的调查[J].中华流行病学杂志,2000,61：26-29.
[47]Neal KR,Hebden J,Spiller R.Prevalence of gastrointestinal symp-toms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome:post survey of patients[J],BMJ,1997,314(7083):779-782.
[48]刘新光.肠易激综合征与肠道感染[J].胃肠病学,2003,8(4)：附8-附9.
[49]Chadwick VS,Chen W,Shu D,et al.Activation of the mucosal immune system in irritable bowel syndrome[J].Gastroenterology,2002,122(7):1778-1783.
[50]王利华,方秀才,潘国宗.肠道感染与肠易激综合征[J].中华内科杂志,2002,41(2)：90-93.
[51]李兆申,詹丽杏,邹多武,等.肠易激综合征患者分泌5-羟色胺的肠嗜铬细胞形态及功能的改变[J].中华消化杂志,2004,24：94-97.
[52]Spiller RC.Postinfectious irritable bowel syndrome[J].Gastroenterology,2003,124(6):1662-1671.
[53]Atkinson W, Lockhart S, Whorwell PJ, et al.Altered 5-hydroxytryptamine signaling in patients with constipation and diarrhea-predominant irritable bowel syndrome[J]. Gastroenterology,2006,130:34-43.
[54]Delvaux M.Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome[J].Gut, 2002,51(Suppl):i67-i71.
[55]Camilleri M, Notthcurr AR,Kong S,et al.Efficacy and safety of alosetron in women with irritable bowel syndrome:arandomized, placebocontrolled trial[J].Lancet,2000,355(9209):1035-1041.
[56]Schoerdeld P,Chey WD,Drossman D,et al. Effectiveness and safety of tegaserod in the treatment of irritable bowel syndrome:a meta-analysis of randomized controlled trials[J].Gastroenterology,2002,122 (4 suppl):A-465.
[57]McAllister F,Henry A,Kreindler J,et al.Role of IL-17A, IL-17F and the IL-17 receptor in regulating growth-related oncogene-alpha and granulocyte colony-stimulationing factor in bronchial epithelium: implications for airway inflammation in cystic fibrosis[J].J Immunol,2005,175(1):404-412.
[58]陈文科,邹益友,李富军,等.肠易激综合征精神心理因素、肠粘膜肥大细胞及5-羟色胺的变化[J].世界华人消化杂志,2007,15(1)：46-50.
[59]李兆申,董文珠,邹多武.肠易激综合征肠黏膜SP、VIP、CGRP变化的研究[J].第二军医大学学报,2003,24(2)：147-151.
[60]梁荣新,蔡联英,郑琴芳,等.肠易激综合征结肠动力与胃肠激素的相关性研究[J].广西医学,2005,27(4)：479-482.
[61]张红杰,林琳,赵志泉,等.胃肠肤类激素与肠易激综合征发病间的关系[J].南京医科大学学报,2003,23(6)：527-529.
[62]Bouin M,Plourde V, Boivin M,et al.Rectal distention testing in patients with irritable bowel syndrome: sensitivity,specificity,and predictive values of pain sensory thresholds[J].Gsatroenterology,2002,122(7): 1771-1777.
[63]Sinhamahapatra P,Saha SP,Chowdhury A,et al.Visceral afferent hypersensitivity in irritable bowel syndrome evaluation by cerebralevoked potential after rectal stimulation[J].Am J Gastroenterol,2001,96(7): 2150-2157.
[64]康明祥,贾红.肠易激综合征内脏高敏感性机制的研究进展[J].世界华人消化杂志2008,16(14)：1554-1558.
[65]汪安江,廖献花,胡品津,等.罗马Ⅲ与罗马Ⅱ标准诊断肠易激综合征的比较[J].中华内科杂志,2007,46(8)：644-647.
[66]Poynard T,Regimbeau C,Benhamou Y.Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome[J].Aliment Pharmacol Ther,2001,15(3):355-361.
[67]颜玉,王艳凤,袁禧先,等.微生态制剂丽珠肠乐治疗肠易激综合征[J].中国微生态学杂志,2003,15：180.
[68]许斌,袁耀宗.肠易激综合征药物治疗进展[J].中华消化杂志.2000,20(4)：261-263.
[69]杜炜,孟环.肠易激综合征药物治疗的现状和进展[J].胃肠病学,2007,12(5)：317-319.
[70]Wegener G,Volke V,Harvey BH.Local,but not systemic, administration of serotonergic antidepressants decreases hippocampa] nitric oxide synthase activity[J].Brain Res,2003,959(1):128-134.
[71]鲍军,单兆伟.抗抑郁药物治疗肠易激综合征[J].江苏医药,2007,33(4)：361-362.
[72]王伟岸.肠易激综合征的治疗[J].胃肠病学和肝病学杂志,2001,10(2)：110-113.
[73]胡品津,潘国宗.中华医学会第一届全国肠易激综合征学术会议纪要[J].中华消化杂志,2003,23(7)：428.
[74]周仲瑛.中医内科学[M].第1版.北京：中国中医药出版社,2003：250.
[75]郑莜萸.中药新药临床研究指导原则[S].北京：中国医药科技出版社,2002：139.
[76]刘学芳,丁国萍.疏肝健脾法治疗慢性结肠炎28例分析[J].社区医学杂志,2007,5(20)：60.