中药灌肠治疗重症急性胰腺炎患者的临床疗效及对其经肠道微生态调节机制的探讨  

Clinical Value and Mechanism of Enema with Chinese Medicine Decoctionin Treating Severe Acute Pancreatitisvia Regulating Intestinal Microflora

作　　者：古豫 李莹[1] 杨坤[1] 田小雨[1] 王永德 赵景成[1] GU Yu;LI Ying;YANG Kun;TIAN Xiao-yu;WANG Yong-de;ZHAO Jing-cheng(Emergency Department,Huairou District Hospital of Traditional Chinese Medicine,Beijing 101400)

机构地区：[1]北京市怀柔区中医医院急诊科,北京101400

出　　处：《世界中西医结合杂志》2023年第6期1196-1201,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：北京中医药科技发展资金项目(QN2021-06)。

摘　　要：目的 观察通腑清胰方中药灌肠经肠道菌群调控治疗重症急性胰腺炎(Severe acute pancreatitis, SAP)的临床疗效。方法 选取2017年1月—2020年12月期间北京市怀柔区中医医院收治的152例SAP患者,采用随机数字表法分为对照组76例与试验组76例,另选择100例健康体检对象作为参照。对照组给予西医内科综合治疗,共治疗7 d,试验组在西医内科综合治疗基础上联合通腑清胰方中药灌肠,连续灌肠7 d。观察比较SAP患者与健康对象肠道菌群分布情况。观察比较两组患者治疗前后肠道菌群变化及生化指标[二胺氧化酶(Diamine oxidase, DAO)、D-乳酸(D-lactic acid, D-LA)、血清淀粉酶(Amylase, AMY)、内毒素(Lipopolysaccharide, LPS)]变化,并比较两组患者临床疗效(疾病疗效与证候疗效)、病情评分[急性生理学与慢性健康状况Ⅱ(Acute physiology and chronic health conditionsⅡ,APACHEⅡ)评分、Balthazar CT评分]、预后与治疗安全性。结果 SAP患者乳酸杆菌、双歧杆菌水平较健康对象低,肠球菌、肠杆菌、葡萄球菌、产气荚膜梭菌水平较健康对象高,差异有统计学意义(P<0.05)。治疗7 d后两组患者乳酸杆菌、双歧杆菌含量较治疗前升高,肠球菌、肠杆菌、葡萄球菌、产气荚膜梭菌含量较治疗前降低,差异有统计学意义(P<0.05);且试验组乳酸杆菌、双歧杆菌含量明显高于对照组,肠球菌、肠杆菌、葡萄球菌、产气荚膜梭菌含量明显低于对照组,差异有统计学意义(P<0.05)。治疗7 d后两组患者DAO、D-LA、AMY、LPS水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组DAO、D-LA、AMY、LPS水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后试验组疾病总有效率94.67%(71/75)明显高于对照组81.08%(60/74),差异有统计学意义(P<0.05)。治疗后试验组证候总有效率90.67%(68/75)明显高于对照组67.57%(50/74),差异有统计学意义(P<0.05)。治疗后试验组APACHEⅡ评Objective To studythe clinical value and mechanism of enema with Tongfu Qingyi Decoctionin treating severe acute pancreatitis(SAP)via regulating intestinal microflora.Methods A total of 152 SAP patients admitted to Huairou District Hospital of Traditional Chinese Medicine from January 217 to December 2020 were selected and grouped by the random number table method,with 76 patients in the control group and 76 patients in the observation group.Another 100 volunteers confirmed healthy byphysical examination were selected as reference.The control group received comprehensive western medical treatment for 7 days,and the observation group received Tongfu Qingyi Decoction enema in addition to the comprehensive western medical treatment for 7 days.The intestinal microflora structure wascompared between the SAP patients and the healthy volunteers before and after treatment.The biochemical indicators including diamine oxidase(DAO),D-lactic acid(D-LA),amylase(AMY),and lipopolysaccharide(LPS)were compared between the two groups as well as between before and after treatment.The clinical efficacy(for both disease and symptoms),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,Balthazar CT score,prognosis,and treatment safety were compared between the two groups.Results The SAP patients had lower relative abundance of Lactobacillus and Bifidobacterium and higher relative abundance of Enterococcus,Enterobacter,Staphylococcus,and Clostridium perfringens than the healthy volunteers(P<0.05).After 7 days of treatment,the relative abundance of Lactobacillus and Bifidobacteriumincreased,while that of Enterococcus,Enterobacter,Staphylococcus,and Clostridium perfringens decreased compared with that before treatment(P<0.05).Moreover,the changes in the observation group were higher than those in control group(P<0.05).After 7 days of treatment,the levels of DAO,D-LA,AMY,and LPS declined compared with those before treatment(P<0.05),and the observation grouphad lower levels thanthe control groupafte

关 键 词：重症急性胰腺炎 中药灌肠 通腑清胰方 肠道菌群 生化指标 预后 

分 类 号：R576[医药卫生—消化系统]