加味济川煎治疗脾肾阳虚型老年慢传输型便秘患者的疗效评价及对血清脑肠肽的影响  

Clinical Effect of Modified Jichuanjian on Senile Patients with Slow Transit Constipation of Spleen-kidney Yang Deficiency Syndrome and Effect on Brain-gut Peptide

作　　者：牛明了 甄欢欢 唐诚馨 梁伟涛 NIU Mingliao;ZHEN Huanhuan;TANG Chengxin;LIANG Weitao(Henan Province Hospital of Traditional Chinese Medicine/Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450002,China;The Second Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450008,China)

机构地区：[1]河南省中医院/河南中医药大学第二附属医院,郑州450002 [2]河南中医药大学第二临床医学院,郑州450008

出　　处：《中国实验方剂学杂志》2023年第11期126-132,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药科学研究专项(20-21ZY2069)。

摘　　要：目的:观察加味济川煎治疗脾肾阳虚型老年慢传输型便秘患者的临床疗效及对血清脑肠肽的影响。方法:将150例老年慢传输型便秘患者随机按数字表法分为对照组和观察组各75例。观察组口服加味济川煎,1剂/d。对照组口服便通胶囊,3粒/次,2次/d。2组疗程均为4周。记录治疗前后患者便秘主要症状评分、便秘患者生存质量自评量表(PAC-QOL)评分、中医证候积分、平均每周自发完全排便次数(SCBM)、结肠传输试验情况及血清5-羟色胺(5-HT)、5-HT 4受体(5-HT4R)、生长抑素(SS)、血管活性肠肽(VIP)水平和复发情况。结果:治疗后观察组总有效率为93.06%(67/72),对照组总有效率为74.65%(53/71),观察组总有效率显著高于对照组,差异有统计学意义(χ^(2)=8.974 6,P<0.01)。与本组治疗前比较,2组患者治疗后便秘主要症状评分、PAC-QOL 4个维度评分、PAC-QOL总评分、中医证候积分均显著降低(P<0.01)。与对照组治疗后比较,观察组患者便秘主要症状评分、PAC-QOL 4个维度评分、PAC-QOL总评分、中医证候积分均低于对照组(P<0.01)。观察组患者在治疗后2、3、4周的SCBM次数均多于对照组(P<0.01),与本组治疗前比较,2组患者治疗后24、48、72 h残留标志物比例均较治疗前显著降低(P<0.01)。与对照组治疗后比较,观察组患者结肠传输试验24、48、72 h残留标志物比例低于对照组(P<0.01)。与本组治疗前比较,2组患者治疗后血清5-HT、5-HT4R水平均显著升高(P<0.01),血清SS、VIP水平均显著降低(P<0.01)。与对照组治疗后比较,观察组患者血清5-HT、5-HT4R水平均显著升高(P<0.01),血清SS、VIP水平均显著降低(P<0.01)。且观察组复发率29.85%(20/67),对照组58.49%(31/53),观察组复发率明显低于对照组,差异有统计学意义(χ^(2)=9.9324,P<0.01)。结论:用加味济川煎治疗脾肾阳虚型老年慢传输型便秘患者有着较好的临床疗效,可有效减轻患者临床症状,调�Objective:To observe the clinical effect of modified Jichuanjian on senile patients with slow transit constipation of spleen-kidney yang deficiency syndrome and the influence on brain-gut peptide.Method:A total of 150 senile patients with slow transit constipation were randomized into control group(75 cases)and observation group(75 cases)with the random number table method.The observation group was given modified Jichuanjian(oral,1 dose/day,4 weeks),and the control group was treated with Biantong Capsules(oral,3 capsules/time,twice/day,4 weeks).Data before and after treatment were recorded,including the score of major constipation symptoms,score of Patient Assessment of Constipation Quality of Life(PACQOL),TCM syndrome score,spontaneous complete bowel movements(SCBM),colonic transit test,serum 5-hydroxytryptamine(5-HT),5-HT 4 receptor(5-HT4R),somatostatin(SS),and vasoactive intestinal peptide(VIP),and recurrence.Result:The total effective rate of the observation group was 93.06%(67/72),as compared with the 74.65%(53/71)in the control group(χ^(2)=8.9746,P<0.01).After treatment,the scores of major constipation symptoms,scores of four dimensions of PAC-QOL,total score of PAC-QOL,and TCM syndrome score were lower than those before treatment in the two groups(P<0.01),and lower in the observation group than in the control group(P<0.01).The SCBM in the observation group were more than those in the control group at the 2nd,3rd,4th weeks after treatment(P<0.01).The proportions of residual markers at 24,48,72 h after treatment were smaller than those before treatment in the two groups(P<0.01),and smaller in the observation group than in the control group(P<0.01).After treatment,the levels of serum 5-HT and 5-HT4R were higher(P<0.01)and the levels of serum SS and VIP were lower(P<0.01)than those before treatment in the two groups.In addition,the levels of serum 5-HT and 5-HT4R in the observation group were higher(P<0.01)and the levels of serum SS and VIP were lower(P<0.01)in the observation group than in the control group.

关 键 词：慢传输型便秘 脑肠肽 加味济川煎 脾肾阳虚 5-羟色胺(5-HT) 5-羟色胺4受体(5-HT4R) 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R442.2R256.35