健脾调肝温肾方对腹泻型肠易激综合征患者肠黏膜肥大细胞及5-HT的影响  

Influence of Jianpi Tiaogan Wenshen Decoction on mast cells and 5-HT in intestinal mucosa of patients with diarrhea-predominant irritable bowel syndrome

作　　者：包永欣[1,2] 吕冠华[3] 邵丽春 孙希良[3] 王丽丹[3] 曹玺[3] 朱成慧[3] 贾金玲[3] 

机构地区：[1]沈阳军区总医院博士后科研工作站,辽宁沈阳110015 [2]解放军第463医院消化科,辽宁沈阳110042 [3]辽宁中医药大学附属二院脾胃病科,辽宁沈阳110034

出　　处：《中国中西医结合消化杂志》2015年第6期385-389,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：辽宁省自然科学基金(No.201102236)

摘　　要：[目的]观察健脾调肝温肾方治疗腹泻型肠易激综合征(D-IBS)的临床疗效,通过检测回盲部肠黏膜肥大细胞(MC)表达及5-HT浓度探讨健脾调肝温肾方治疗D-IBS的作用机制。[方法]选择80例D-IBS患者,随机分为中药治疗组与西药对照组各40例,选取健康体检肠镜检查者10例作为正常对照组,中药治疗组口服健脾调肝温肾方并随症加减,西药对照组口服匹维溴铵片。疗程为4周。应用腹痛视觉模拟评分及症状评分于治疗前及治疗后14d、28d观察并记录腹痛、排便次数及大便性状改变。钳取正常组及治疗前后患者回盲部肠黏膜,应用甲苯胺蓝染色法观察MC数量,应用双抗体夹心法测定5-HT浓度。[结果]治疗组腹痛视觉模拟评分、大便次数及大便性状评分治疗14d及28d均优于治疗前,差异有统计学意义(P<0.01)。各症状评分治疗组均不同程度优于对照组(P<0.05,P<0.01)。中药治疗组与西药对照组治疗前肠黏膜MC数量明显增加,5-HT浓度增高(P<0.01),应用健脾调肝温肾方及匹维溴铵治疗可以明显减少MC表达数目,降低5-HT浓度(P<0.05,P<0.01),其中健脾调肝温肾方治疗组优于匹维溴铵治疗组(P<0.05)。[结论]健脾调肝温肾方可有效控制D-IBS患者的腹痛、腹泻症状,并随着疗程的延长中药的优势更明显。健脾调肝温肾方可能通过降低MC表达及活化,减少5-HT释放,调控神经介质和免疫细胞关系而改善IBS内脏高敏性,减轻或缓解临床症状。[Objective]To observe the clinical effect of Jianpi Tiaogan Wenshen Decoction （JTWD） on the patients with Diarrhea-predominant irritable bowel syndrome, and to investigate its mechanism by detecting the mast cells expression and 5-HT concentration of ileocecal mucosa. [Methods]80 patients with DIBS were assigned randomly equally into two groups respectively received Chinese herbal therapy and western medical treatment. In addition, 10 healthy volunteers were chosen as the normal control. The treatment group was treated with JTWD, and the control group was treated with Pinaverium Bromide tablet （PVB） ,all for four weeks. The abdominal pain visual analogue score（VAS）and defecation were recorded before and 14 days and 28 days after the treatment. The patients and the control were examined through colonoscopy before and after treatment,and ileocecal mucosa were collected. Application of toluidine blue staining was used to observe the number of MC,5-HT concentrations were determined by double antibody sandwich method. EResults3The abdominal pain visual analogue score,defecate frequency and shit character for 14th day and 28th day of treatment group were better than that before treatment（P〈0.01）. The symptom score in treatment group were higher than that in control group（P〈0.05 ,P〈0.01）. The number of MC and 5-HT concentrations of ileocecal mucosa of the treatment group and the control group were higher than that of normal group betfore treatment（P〈0.01）,and significantly lower after treatment（P〈0.05, P〈0.01）. The JTWD treatment group was better than that of pinaverium bromide treatment group（P〈0.05）. EConclusionqThe treatment of JTWD can effectively control the abdominal pain and diarrhea of DIBS patients,and the traditional Chinese medicine is more advantageous in the long run. JTWD alleviates clinical symptoms by reducing the visceral high sensitivity via decreasing the expression of MC and the release of 5-HT and regulating the nerve medium and immune cells.

关 键 词：腹泻型肠易激综合征 健脾调肝温肾方 临床疗效 肥大细胞 5-羟色胺 

分 类 号：R57[医药卫生—消化系统]