枳术丸合四逆散治疗肝郁气滞证便秘型肠易激综合征的临床效果及对胃肠激素的影响  

Clinical effect of Zhizhu Pills combined with Sini Powder for the treatment of constipation predominant irritable bowel syndrome in liver qi stagnation and retarded flow type and its influence on gastrointestinal hormones

作　　者：徐逸[1] 庄瑞斐 陈亮[1] 景姗[1] 杨芳[1] XU Yi;ZHUANG Ruifei;CHEN Liang;JING Shan;YANG Fang(Department of Spleen and Stomach Diseases,Nantong Hospital Affiliated to Nanjing University of Chinese Medicine·Nantong Hospital of Traditional Chinese Medicine,Nantong 226000,Jiangsu,China)

机构地区：[1]南京中医药大学南通附属医院·南通市中医院脾胃病科,江苏省南通市226000

出　　处：《广西医学》2023年第24期2972-2976,2989,共6页Guangxi Medical Journal

基　　金：南通市市级科技计划项目(MSZ20206,JCZ20200);南通市卫生健康委员会科研课题(MA2020006)。

摘　　要：目的 探讨枳术丸合四逆散治疗肝郁气滞证便秘型肠易激综合征(IBS-C)的临床效果及对患者胃肠激素的影响。方法 将61例肝郁气滞证IBS-C患者随机分为对照组30例和观察组31例。在常规治疗的基础上,给予对照组口服枸橼酸莫沙必利分散片治疗,给予观察组口服枳术丸合四逆散加减治疗,两组疗程均为6周。比较两组治疗前后的中医证候积分、便秘患者生活质量评估(PAC-QOL)量表评分及血清胃动素、血管活性肠肽(VIP)、P物质水平,以及治疗后的临床疗效和治疗期间不良反应发生情况。结果 治疗后,观察组的腹痛腹胀积分、早饱纳差积分、排便次数减少积分、大便硬结积分、排便困难积分、精神症状积分及中医证候总积分低于治疗前及对照组(P<0.05),而两组的嗳气积分较治疗前降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。治疗后,观察组PAC-QOL量表各维度评分及总分低于治疗前和对照组(P<0.05),对照组PAC-QOL量表的生理评分、满意度评分及总分低于治疗前(P<0.05),但治疗前后PAC-QOL量表的心理评分及担忧度评分差异无统计学意义(P>0.05)。治疗后,观察组血清胃动素、P物质水平较治疗前及对照组升高,血清VIP水平较治疗前及对照组降低(P<0.05);对照组血清胃动素水平较治疗前升高,血清VIP水平较治疗前降低(P<0.05),而治疗前后的血清P物质水平差异无统计学意义(P>0.05)。观察组疗效优于对照组(P<0.05)。治疗期间,观察组患者未出现不良反应,对照组有2例出现轻度口干。结论 枳术丸合四逆散治疗肝郁气滞证IBS-C患者的疗效优于枸橼酸莫沙必利分散片,其可能通过调节患者血清VIP、胃动素、P物质水平来缓解患者临床症状,改善其精神状态,提高其生活质量。Objective To explore the clinical effect of Zhizhu Pills combined with Sini Powder for the treatment of constipation predominant irritable bowel syndrome(IBS-C)in liver qi stagnation and retarded flow type,and its influence on patients′gastrointestinal hormones.Methods A total of 61 patients with IBS-C in liver qi stagnation and retarded flow type were randomly divided into control group(30 cases)or observation group(31 cases).On the basis of routine therapy,the control group was orally administrated Mosapride Citrate Dispersible Tablets,whereas the observation group was orally administrated modified Zhizhu Pills combined with Sini Powder for treatment.Both groups received a 6-week treatment course.The pre-and post-treatment Traditional Chinese Medicine syndromes scores,Patient Assessment of Constipation Quality of Life,(PAC-QOL)scale score,and levels of serum motilin,vasoactive intestinal peptide(VIP),P substance,as well as post-treatment clinical efficacy and occurrence of adverse reactions during treatment were compared between the two groups.Results After treatment,the observation group exhibited lower scores of abdominal pain and distension,early satiety and anorexia,defecation frequency decreasing,hard stool,defecation difficulty,and psychiatric symptoms,as well as a lower total score of Traditional Chinese Medicine syndromes as compared with before treatment and the control group(P<0.05),whereas both groups yielded a lower score of belching as compared with before treatment(P<0.05),but there was no statistically significant difference between the inter-groups(P>0.05).After treatment,the observation group yielded lower scores of various dimensions and total score of PAC-QOL as compared with before treatment and the control group(P<0.05),and the control group interpreted lower physiological score,satisfaction score,and total score of PAC-QOL scale as compared with before treatment(P<0.05),but there was no statistically significant difference in psychiatric score and worry score of PAC-QOL scale between bef

关 键 词：便秘型肠易激综合征 肝郁气滞证 枳术丸 四逆散 临床效果 胃动素 血管活性肠肽 P物质 

分 类 号：R256.35[医药卫生—中医内科学]