认知行为疗法联合药物治疗腹泻型肠易激综合征患者的疗效研究  

Clinical efficacy of cognitive behavioral therapy combined with drugs in the treatment of patients with diarrhea-predominant irritable bowel syndrome

作　　者：季永胜[1] 沈雪辉 梁枫[1] 蔡爱博 陈茜 潘菊花 杨瑾[1] JI Yong-sheng;SHEN Xue-hui;LIANG Feng;CAI Ai-bo;CHEN Qian;PAN Ju-hua;YANG Jin(Department of Digestive Medicine,Qidong Hospital of TCM,Qidong 226200,Jiangsu,CHINA)

机构地区：[1]启东市中医院消化内科,江苏启东226200

出　　处：《海南医学》2024年第19期2758-2763,共6页Hainan Medical Journal

基　　金：2023年度江苏省启东市社会发展科技项目(编号:2023-21-8)。

摘　　要：目的探讨认知行为疗法(CBT)联合药物治疗腹泻型肠易激综合征(IBS-D)的临床疗效及对患者内脏敏感性、脑肠肽表达的影响。方法前瞻性选取2022年10月至2024年1月于启东市中医院消化内科门诊接受治疗的90例IBS-D患者为研究对象,按照随机数表法将其分为对照组和观察组,每组45例。对照组患者给予口服匹维溴铵片及双歧杆菌三联活菌胶囊治疗,观察组患者在对照组治疗的基础上给予CBT治疗,疗程均为8周。比较两组患者治疗前后的主要症状评分、内脏敏感性指标[内脏压力阈值(初始感觉阈值、排便紧迫感阈值、最大耐受阈值)及内脏敏感指数(VSI)评分]和血清脑肠肽[5-羟色胺(5-HT)、P物质(SP)、胃动素(MTL)、神经肽Y(NPY)]水平。结果治疗前,两组患者的主要症状评分、内脏敏感性指标、脑肠肽水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的主要症状评分均低于治疗前,且观察组患者的腹痛评分、粪便性状评分、腹泻频度评分和症状总评分分别为(2.31±1.46)分、(4.16±0.60)分、(1.78±1.22)分、(8.24±2.22)分,明显低于对照组的(3.36±1.61)分、(4.53±0.73)分、(2.62±1.40)分、(10.51±2.38)分,差异均有统计学意义(P<0.05);治疗后,两组患者的内脏压力阈值各项指标均高于治疗前,VSI评分均低于治疗前,且观察组患者的初始感觉阈值、排便紧迫感阈值和最大耐受阈值分别为(46.33±6.47)mL、(80.58±6.91)m L、(136.42±8.97)m L,明显高于对照组的(40.16±5.77)m L、(71.29±5.13)mL、(131.64±8.83)m L,VSI评分为(18.36±4.58)分,明显低于对照组的(29.42±7.08)分,差异均有统计学意义(P<0.05);治疗后,两组患者的血清5-HT、SP、MTL水平均低于治疗前,血清NPY水平均高于治疗前,且观察组患者的血清5-HT、SP、MTL水平分别为(192.31±30.21)μg/L、(36.42±17.61)ng/L、(218.36±21.70)ng/L,明显低于对照组的(258.76±23.82)μg/L、(55.58±15.96)ng/L、(253.89±29Objective To explore the clinical efficacy of cognitive behavioral therapy(CBT)combined with drugs in the treatment of patients with diarrhea-predominant irritable bowel syndrome(IBS-D)and its influences on visceral sensitivity and brain-gut peptides.Methods A total of 90 patients with IBS-D were prospectively selected from the Outpatient Department of Gastroenterology,Qidong Hospital of TCM from October 2022 to January 2024.They were divided into a control group and an observation group according to the random number table method,with 45 patients in each group.Patients in the control group were treated with pinaverium bromide tablets and bifidobacterium triple viable capsules,and those in the observation group were treated with CBT on the basis of the treatment in the control group,all for 8 weeks.The scores of main symptoms,visceral sensitivity parameters(visceral pressure threshold[first sensation threshold,defecation urgency threshold,maximum tolerance threshold]and visceral sensitivity index[VSI]score)and brain-gut peptides(5-hydroxytryptamine,5-HT;substance P,SP;motilin,MTL;neuropeptide Y,NPY)levels in the serum were compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in the scores of main symptoms,visceral sensitivity parameters,and brain-gut peptides levels between the two groups(P>0.05).After treatment,the scores of main symptoms in two groups were significantly lower than those before treatment;the scores of abdominal pain,stool character,diarrhea frequency,and total symptom in the observation group were(2.31±1.46)points,(4.16±0.60)points,(1.78±1.22)points,and(8.24±2.22)points,respectively,which were significantly lower than(3.36±1.61)points,(4.53±0.73)points,(2.62±1.40)points,and(10.51±2.38)points in the control group;the differences were statistically significant(P<0.05).After treatment,the parameters of visceral pressure threshold in the two groups were significantly higher than those before treatment,and the visceral sensi

关 键 词：腹泻型肠易激综合征 认知行为疗法 匹维溴铵片 双歧杆菌三联活菌胶囊 内脏敏感性 脑肠肽 

分 类 号：R574.4[医药卫生—消化系统]