通便汤治疗老年泻药性便秘临床观察及对肠道菌群的影响  

Clinical Observation and Effect of Tongbian Decoction on Laxative Constipation and Colon Flora in Elderly Patients

作　　者：颜帅[1] 杨会举[2] 乐音子[1] 钱海华[3] 刘佃温[2] 陈淑君[4] 徐天舒[5] 

机构地区：[1]苏州市中医医院,江苏苏州215009 [2]河南中医药大学第三附属医院,郑州450008 [3]南京中医药大学附属医院,南京210029 [4]河南中医药大学第一附属医院,郑州450000 [5]南京市鼓楼医院,南京210008

出　　处：《中国实验方剂学杂志》2017年第21期166-172,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81573979);江苏省中医药管理局科技项目(YB2017061);苏州市产业技术创新专项(SYS201775;SYSD2016136);苏州市中医医院院级课题项目(YQN2015007)

摘　　要：目的:观察通便汤对老年泻药性便秘(STC)的临床疗效,探讨其可能机制。方法:采用多中心、随机对照、双盲的研究方法,将92例老年STC患者随机分为治疗组(通便汤)和对照组(酪酸梭菌活菌散剂),其中治疗组47例,对照组45例,分别予以药物干预4周。观察两组治疗前后便秘临床症状积分、粪便性状评分以及临床有效率;采用主成分分析(PCA)-QOL评分评价两组患者的生活质量;检测粪便中短链脂肪酸和酪酸含量,并观察两组患者停药后4,8周复发情况及不良反应。结果:治疗组临床总有效率为91.4%,对照组为80.0%,治疗组优于对照组(P<0.05);经通便汤干预后,治疗组可显著提升泻药性便秘患者粪便中短链脂肪酸和酪酸含量(P<0.01),改善粪便性状积分、每次排便时间积分、排便时间间隔积分、排便困难积分及PAC-QOL评分(P<0.05);停药4,8周时治疗组患者复发率均低于对照组,用药期间均无明显不良反应发生。结论:通便汤对老年泻药性便秘临床疗效显著,值得临床推广应用,其作用机制可能与提高便秘患者结肠中短链脂肪酸和酪酸的水平从而改善结肠动力有关。Objective： To observe the clinical effect and safety of Tongbian decoction in the treatment of elderly patients with laxative constipation, and investigate its possible mechanism. Method： A multicenter, large sample, randomized controlled clinical trial was designed. Ninety-two elderly patients with slow transit constipation （STC） were randomly divided into treatment group （Tongbian decoction, 47 cases） and control group （ Clostridium butyricum powder, 45 cases） . The treatment course of each group was 30 days. The clinical symptom score, fecal character score and clinical efficiency of constipation were observed before and after treatment in both groups. PCA- QOL score was used to evaluate the life quality in both groups. Short chain fatty acid and butyric acid contents in feces were detected ; and the recurrence rates and adverse reactions after drug withdrawal for 4, 8 weeks were also observed. Result： The total clinical efficacy was 91.4% in treatment group, superior to 80. 0% in control group, with statistical difference. After treatment by Tongbian decoction, the treatment group could significantly increase the short chain fatty acid and butyric acid contents in feces （ P 〈 0. 01 ） , improve defecation character score, defecation time score, defecation interval score, interval difficulty score and principal components analysis （PCA）- QOL score （P 〈 0.05 ） . The recurrence rates in treatment groups were lower than those in control group after drug withdrawal for 4 weeks and 8 weeks, without significant adverse reactions in both groups. Conclusion： It is worth spreading that Tongbian decoction can decrease the recurrence incidence of laxative constipation with an significant role in clinical effect, and its effect may be relevant to rising short chain fatty acids and acid casein in feces, thus improving colonic motility.

关 键 词：泻药性便秘 通便汤 PCA-QOL评分 短链脂肪酸 

分 类 号：R287[医药卫生—中药学] R574[医药卫生—中医学]