加味逍遥散治疗肝郁气滞型慢传输型便秘的临床研究  

Clinical Study on Modified Xiaoyao San in Treating Slow Transit Constipation of Liver-qi Stagnation

作　　者：孔鹏飞[1] 王秋晓 王邦林[2] 唐学贵[1] 张贤良 KONG Pengfei;WANG Qiuxiao;WANG Banglin;TANG Xuegui;ZHANG Xianliang(Affiliated Hospital of North Sichuan Medical College,Nanchong 637001 Sichuan,China;The People's Hospital of Yanting City,Mianyang 621601 Sichuan,China;Nanchong Mental Health Center of Sichuan Province,Nanchong 637001 Sichuan,China)

机构地区：[1]川北医学院附属医院,四川南充637001 [2]盐亭县人民医院,四川绵阳621601 [3]四川省南充市精神卫生中心,四川南充637001

出　　处：《中药新药与临床药理》2021年第10期1531-1536,共6页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：国家自然科学基金项目(81573990)。

摘　　要：目的评价加味逍遥散治疗肝郁气滞型慢传输型便秘(STC)的疗效及对胃肠神经递质和胃肠动力的影响。方法将160例患者随机分为对照组和观察组,每组各80例。2组患者均行生活方式调整,对照组口服四磨汤口服液治疗;观察组口服加味逍遥散治疗,疗程均为8周。观察2组患者治疗前后每周完全自发排便次数(CSBMs)、便秘主要症状积分、便秘患者生存质量自评量表(PAC-QOL)评分、肝郁气滞证积分、结肠传输排空率和胃肠神经递质[5-羟色胺(5-HT)、P物质(SP)、血管活性肠肽(VIP)、生长抑素(SS)和一氧化氮(NO)]水平变化,并评价2组患者的临床疗效。结果(1)对照组脱失6例,剔除2例,完成研究72例;观察组脱失5例,剔除4例,完成研究71例。(2)治疗后,2组患者周平均CSBMs较治疗前增加,便秘主要症状积分、肝郁气滞证积分和PAC-QOL评分较治疗前下降(P<0.01),且治疗后观察组周平均CSBMs高于对照组,便秘主要症状积分、肝郁气滞证积分和PAC-QOL评分均低于对照组(P<0.01)。(3)治疗后,2组患者48 h和72 h标记物的排出率均较治疗前明显增加(P<0.01),且治疗后观察组48 h和72 h标记物的排出率均明显高于对照组(P<0.01)。(4)治疗后,2组患者SP水平较治疗前明显升高(P<0.01),5-HT、SS、NO和VIP水平明显下降(P<0.01),且治疗后观察组SP水平高于对照组(P<0.01),5-HT、SS、NO和VIP水平低于对照组(P<0.01)。(5)治疗后,观察组临床疗效总有效率为92.96%(66/71),高于对照组的77.78%(56/72),差异有统计学意义(χ^(2)=6.574,P<0.05)。(6)治疗后,观察组排便正常率(每周SCBM≥3次)为57.75%(41/71),高于对照组的38.89%(28/72)(χ^(2)=5.091,P<0.05)。结论加味逍遥散内服治疗肝郁气滞型STC的临床疗效优于四磨汤口服液,其作用机制可能与调节肠神经递质,改善胃肠动力有关。Objective To evaluate the curative effect of modified Xiaoyao san in the treatment of slow transit constipation(STC)of liver-qi stagnation and its influence on gastrointestinal neurotransmitter and gastrointestinal motility.Methods One hundred and sixty patients were randomly divided into a control group and an observation group,80 cases in each group.Lifestyle adjustments were performed in both groups.Patients in the control group took Simo decoction oral liquid.Patients in the observation group took modified Xiaoyao san.The course of treatment for both groups were 8 weeks.We observed the number of complete spontaneous bowel movements(CSBMs)per week,main symptom scores of constipation,patient assessment constipation-quality of life(PAC-QOL)scores,liver-qi stagnation scores,colonic transit emptying rate and gastrointestinal neurotransmitter(5-HT,SP,VIP,SS and NO)levels before and after treatment in both groups.The clinical efficacy of the 2 groups of patients was evaluated.Results(1)In the control group,6 cases were lost,2 cases were eliminated,and 72 cases were completed.In the observation group,5 cases were lost,4 cases were eliminated,and 71 study cases were completed.(2)After treatment,the average weekly CSBMs of the two groups increased compared to those before treatment.The main symptom scores of constipation,the scores of liver-qi stagnation syndrome and PAC-QOL score decreased obviously(P<0.01).After treatment,the average weekly CSBMs of the observation group were higher than those of the control group and the main symptom scores of constipation,the scores of liver-qi stagnation and PAC-QOL score were lower than those of the control group(P<0.01).(3)After treatment,48-h and 72-h marker excretion rates of the two groups increased significantly(P<0.01).Besides,48-h and 72-h marker excretion rates of patients in the observation group were significantly higher than those in the control group after treatment(P<0.01).(4)After the therapy,the levels of SP in the two groups were significantly higher than those be

关 键 词：慢传输型便秘 加味逍遥散 肝郁气滞 胃肠神经递质 胃肠道动力 

分 类 号：R285.6[医药卫生—中药学]