加味异功散辅助马来酸曲美布汀治疗腹泻型肠易激综合征疗效及对结肠组织酪酪肽和密封蛋白1表达的影响  

Clinical Efficacy of Modified Yigong Powder Assisting Trimebutine Maleate for Diarrhea-predominant Irritable Bowel Syndrome and Its Effects on the Expression of Peptide YY and Claudin-1 in Colonic Mucosal Tissues of the Patients

作　　者：黄礼 韦祎[2] 刘英莲[2] HUANG Li;WEI Yi;LIU Ying-Lian(Dept.of Traditional Chinese Medicine,the Third People’s Hospital of Haikou City,Haikou 571100 Hainan,China;College of Traditional Chinese Medicine,Hainan Medical University,Haikou 571199 Hainan,China)

机构地区：[1]海口市第三人民医院中医科,海南海口571100 [2]海南医学院中医学院,海南海口571199

出　　处：《广州中医药大学学报》2022年第3期508-515,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(编号:81860816)。

摘　　要：【目的】研究加味异功散辅助马来酸曲美布汀治疗腹泻型肠易激综合征(IBS-D)的临床疗效及对患者结肠组织中酪酪肽(PYY)和密封蛋白1(claudin-1)的影响。【方法】将160例脾胃虚弱型IBS-D患者随机分为观察组和对照组,每组各80例。对照组给予马来酸曲美布汀治疗,观察组在对照组的基础上联合加味异功散治疗,疗程为2周。观察2组患者治疗前后中医症状积分、血清胃肠激素和T淋巴细胞亚群水平,以及结肠黏膜组织PYY和claudin-1阳性表达率的变化情况,评价2组的中医证候疗效。【结果】(1)治疗2周后,观察组的总有效率为93.75%(75/80),对照组为75.00%(60/80),观察组的中医证候疗效明显优于对照组(P<0.01)。(2)治疗后,2组患者的中医症状总积分均较治疗前下降(P<0.05),且观察组对中医症状总积分的下降作用明显优于对照组(P<0.01)。(3)治疗后,2组患者血清5-羟色胺(5-HT),γ-干扰素(INF-γ)、神经肽Y(NPY)水平均较治疗前明显降低(P<0.05),且观察组对血清5-HT、IFN-γ、NPY水平的降低作用均明显优于对照组(P<0.01)。(4)治疗后,2组患者血清胃动素(MTL)、血管活性肠肽(VIP)水平均较治疗前明显降低(P<0.05),P物质(SP)水平均较治疗前明显升高(P<0.05),且观察组对血清VIP、MTL水平的降低作用和对血清SP水平的升高作用均明显优于对照组(P<0.01)。(5)治疗后,2组患者外周血CD3^(+)和CD4^(+)T淋巴细胞水平均较治疗前升高(P<0.05),CD8^(+)T淋巴细胞水平均较治疗前降低(P<0.05),且观察组对外周血CD3^(+)和CD4^(+)T淋巴细胞水平的升高作用和对CD8^(+)T淋巴细胞水平的降低作用均明显优于对照组(P<0.01)。(6)治疗后,2组患者结肠黏膜组织PYY的阳性表达率均较治疗前降低(P<0.05),而claudin-1的阳性表达率均较治疗前有所升高(P<0.05),且观察组对结肠黏膜组织PYY阳性表达率的降低作用和对claudin-1阳性表达率的升高作用均明显优于对照组(P<0.Objective To investigate the clinical efficacy of modified Yigong Powder assisting trimebutine maleate in treating diarrhea-predominant irritable bowel syndrome(IBS-D)and its effect on the expression of peptide YY(PYY)and claudin-1 in the colonic mucosal tissues of the patients.Methods A total of 160 IBS-D patients with spleen and stomach deficiency syndrome were randomly divided into observation group and control group,with 80 cases in each group.Both groups were treated with trimebutin maleate orally,and additionally the observation group was treated with oral use of modified Yigong Powder.The course of treatment lasting two weeks.The traditional Chinese medicine(TCM)symptom scores,serum gastrointestinal hormone levels and T lymphocyte subgroup levels,as well as the positive expression rates of PYY and claudin-1 in colonic mucosal tissues in the two groups were observed before and after treatment,and the TCM syndrome efficacy of the two groups was also evaluated.Results(1)After 2 weeks of treatment,the overall effective rate of the observation group was93.75%(75/80)and that of the control group was 75.00%(60/80),and the TCM syndrome efficacy in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the total TCM symptom scores in both groups were decreased compared with those before treatment(P<0.05),and the effect on lowering TCM symptom scores in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the serum levels of 5-hydroxytryptamine(5-HT),interferon gamma(INF-γ)and neuropeptide Y(NPY)in both groups were significantly decreased compared with those before treatment(P<0.05),and the effect on lowering the serum 5-HT,IFN-γand NPY levels in the observation group was significantly superior to that in the control group(P<0.01).(4)After treatment,the serum motilin(MTL)and vasoactive intestinal peptide(VIP)levels in both groups were significantly lowered(P<0.05)and the substance P(SP)level was significantly incr

关 键 词：加味异功散 腹泻型肠易激综合征(IBS-D) 脾胃虚弱型 炎症反应 胃肠道激素 免疫功能 酪酪肽(PYY) 密封蛋白1(claudin-1) 

分 类 号：R259.744[医药卫生—中西医结合]