辨证施针对腹泻型肠易激综合征的疗效及血清5-羟色胺的影响  

Therapeutic Effect of Acupuncture Based on Syndrome Differentiation for Diarrhea-predominant Irritable Bowel Syndrome and Its Influence on Serum 5-Hydroxytryptamine

作　　者：李湘力[1,2] 林泳[2] 蔡敬宙[2] 杨路[1] 王升旭[1] 

机构地区：[1]南方医科大学中医药学院,广东广州510515 [2]广州市第一人民医院,广东广州510180

出　　处：《广州中医药大学学报》2015年第2期259-262,266,共4页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广州市科技立项项目(编号:20132A011001)

摘　　要：【目的】观察辨证施针治疗腹泻型肠易激综合征(IBS-D)的临床疗效。【方法】将符合纳入标准的180例IBS-D患者按1∶3比例随机分为对照组45例和治疗组135例(其中肝郁气滞组50例、肠道湿热组43例、脾肾阳虚组42例)。对照组给予酪酸梭菌活菌片和匹维溴铵片治疗,治疗组分别给予辨证施针治疗,2组患者疗程均为4周。观察各组临床疗效及治疗前后主要症状积分变化,并检测血清5-羟色胺(5-HT)水平的变化情况。【结果】(1)治疗组中3种证型组的总有效率分别为92.0%、88.4%、88.1%,均显著高于对照组的68.9%(P<0.05)。(2)治疗后,各组患者腹痛、腹泻、腹胀、大便急迫、肛门坠胀、倦怠乏力等症状均较治疗前显著改善(P<0.05);且治疗组中的3种证型组在腹痛、腹胀、倦怠乏力等症状积分的改善方面优于对照组(P<0.05);肝郁气滞组在改善腹痛、腹胀、肛门坠胀方面优于其他2种证型组(P<0.05)。(3)治疗后,各组患者血清5-HT水平均较治疗前显著降低(P<0.05);3种证型组患者血清5-HT水平均显著低于对照组(P<0.05),3种证型组间比较,肝郁气滞组较肠道湿热组、脾肾阳虚组显著降低(P<0.05)。【结论】辨证施针治疗腹泻型肠易激综合征疗效确切,能有效改善患者的临床症状,并抑制5-HT的过度表达。Objective To investigate the therapeutic effect of acupuncture based on syndrome differentiation for diarrhea-predominant irritable bowel syndrome（IBS-D）. Methods A total of 180 qualified IBS-D patients were randomized into two groups. Control group（ N =45） was given oral use of Clostridium Butyricum Tablets and Pinaverium Bromide Tablets. Treatment group had 135 cases, and were differentiated into liver-qi stagnation（N=50）, intestinal damp-heat（N=43）, and spleen-kidney yang-deficiency（N=42）. Patients in the treatment group were given acupuncture based on syndrome differentiation. The treatment course of both groups lasted for 4weeks. The therapeutic effect was evaluated in both groups after treatment, and scores of present symptoms and serum 5-hydroxytryptamine（ 5-HT） level were monitored before and after treatment. Resutls（ 1） The total effective rate was 92.0%, 88.4%, 88.1% for IBS-D patients with the syndrome of liver-qi stagnation, intestinal damp-heat, and spleen-kidney yang-deficiency, respectively, being higher than that（68.9%） of the control group（ P〈0.05）.（ 2） After treatment, symptoms of abdominal pain, diarrhea, abdominal distention, an urgent desire to defecate, anal pendant expansion, and lassitude were much relieved in both groups（P〈0.05）,and the improvement of symptom scores of abdominal pain, abdominal distention and lassitude in the treatment group was superior to that in the control group（P〈0.05）. The effect on relieving abdominal pain, abdominal distention and anal pendant expansion in liver-qi stagnation IBS-D patients was better than that in IBS-D patients with intestinal damp-heat and spleen-kidney yang-deficiency（P〈0.05）.（3） After treatment, serum5-HT level was decreased in both groups（P〈0.05）, and the decrease in treatment group was more obvious than that in the control group（P〈0.05）. The effect on decreasing 5-HT level of liver-qi stagnation IBS-D patients was better than that of IBS-D patients with intestinal da

关 键 词：肠易激综合征/针灸疗法 肝郁气滞型 肠道湿热型 脾肾阳虚型 5-羟色胺 

分 类 号：R256.34[医药卫生—中医内科学]