认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征的临床研究  

Clinical studies of cognitive therapy combined with pinaverium bromide and probiotics in the treatment of patients with diarrhea-predominant irritable bowel syndrome

作　　者：董文珠[1] 吴晓青[2] 杨凌辉[1] 王群英[1] 宋健[1] 姚萍[1] 禹华伟[3] 苏国强[4] 

机构地区：[1]解放军第401医院消化内科,山东青岛266071 [2]济南军区青岛第一疗养院 [3]解放军第401医院检验科 [4]解放军第401医院放射科

出　　处：《胃肠病学和肝病学杂志》2012年第9期861-864,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的本研究试图评价应用认知治疗联合益生菌、匹维溴胺治疗腹泻型肠易激综合征(diarrhea-preclomnant irritable bowelsyndrons,D-IBS)的有效性和安全性。方法符合罗马Ⅲ标准的90例D-IBS患者接受认知治疗、匹维溴胺(50 mg/次,3次/d)、双岐三联活菌制剂(粪链球菌、嗜酸乳杆菌、双歧杆菌3种肠道固有菌的活菌制剂)(420 mg/次,3次/d)共8周,分别记录治疗前后患者SF-36生活质量评分和症状积分以评价疗效;治疗前后对粪便菌丛进行记数,对粪便中5种细菌进行培养并对集落形成单位进行记数;治疗前后用不透X线标志物测定全结肠通过时间来评价结肠运输时间的变化;应用SPSS软件对试验数据进行统计学分析。结果有81例患者完成了本研究;试验过程中未发现不良反应;对于D-IBS患者的治疗,认知治疗联合匹维溴胺、益生菌的总有效率达88.9%,症状改善明显尤其是对于腹痛、大便性状的改善;患者生活质量明显改善,躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)和精神健康(MH)维度的积分有显著提高(P<0.05);益生菌能够明显增加肠道双歧杆菌(P<0.01)和乳酸杆菌(P<0.05),明显减少肠球菌(P<0.01)和类杆菌(P<0.05),而肠杆菌无显著变化(P>0.05);结肠运输时间延迟显著(P<0.05)。结论认知治疗联合匹维溴胺和益生菌治疗D-IBS是安全、有效的。Objective To evaluate the efficacy and safety of cognitive therapy combined with pinanerium bromide and probiotics in the treatment of patients with diarrhea-predominant irritable bowel syndrome（D-IBS）.Methods 90 Roma Ⅲ positive D-IBS patients were given cognitive therapy and pinavarium bromide（150 mg/d,tid） plus probiotics live combined Bifidobacterium,Lactobacillus and Enterococcus capsules（1 260 mg/d,tid）.The course of the treatment was 8 weeks.Symptomatic scales,the SF-36 health survey scales and fecal flora were recorded before and after treatment.5 bacterias were cultured and the colony forming units were counted in stool.Pre-and post-treatment colonic transit measurements were performed using radiopaque marks.SPSS was used for data analysis.Results 81 patients finished the follow-up procedure.Side-effect was not founded.The total symptom effective rates were 88.9%.Symptoms was improved,especially in abdominal pain and stool character.The scores of BP,GH,VT,SF,RE and MH scales had significant improved（P〈0.05）.The probiotics could increase bifidobacterium count（P〈0.01） and lactobacillus count（P〈0.05）;decrease bacteroides count（P〈0.05） and enterococci count（P〈0.01）;No obvious changes were observed in enterobacteriaceae（P〉0.05）.Colonic transit was retarded（P〈0.05）.Conclusion Cognitive therapy combined with pinaverium bromide and probiotics can significantly improve symptoms and intestinal bacterial flora,which is safe and effective in the treatment of patients with D-IBS.

关 键 词：肠易激综合征 肠道菌群 益生菌 认知治疗 

分 类 号：R57[医药卫生—消化系统]