基于肠肾轴理论的济川煎联合生物反馈疗法治疗功能性便秘阳虚证疗效观察  

Effect of Jichuan Decoction combined with biofeedback therapy for functional constipation of yang-asthenia syndrome:Based on the theory of gut-kidney axis

作　　者：苏静 陆敏 顾海莺 汤智勤 SU Jing;LU Min;GU Haiying;TANG Zhiqin(Department of Gastroenterology,Jiading Nanxiang Hospital,Shanghai 201899;Department of Endocrinology,Jiading Nanxiang Hospital,Shanghai 201899)

机构地区：[1]上海市嘉定区南翔医院消化内科,上海201899 [2]上海市嘉定区南翔医院内分泌科,上海201899

出　　处：《河北中医》2024年第11期1802-1807,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：上海市嘉定区自然科学研究课题(编号:JDKW-2020-0040)。

摘　　要：目的基于肠肾轴理论研究济川煎联合生物反馈疗法治疗功能性便秘阳虚证的效果。方法将126例功能性便秘阳虚证患者按照随机数字表法分为3组,联合组42例予济川煎联合生物反馈疗法治疗,生物反馈组42例予生物反馈疗法治疗,济川煎组42例予济川煎治疗。比较3组治疗前后便秘症状评分、肛门直肠动力学指标[肛管静息压(ARP)、肛管最大收缩压(AMCP)、直肠静息压(RRP)、肛管高压带(HPZ)]、直肠感觉试验指标(初始感觉阈、排便阈值及直肠最大耐受量)、胃肠激素[胃动素(MTL)、生长抑素(SS)、血管活性肠肽(VIP)]、神经递质[5-羟色胺(5-HT)、P物质(SP)]及生活质量变化。比较3组临床疗效,并随访12个月,统计3组复发率。结果治疗2周时,济川煎组、生物反馈组、联合组总有效率分别为73.8%(31/42)、71.4%(30/42)、92.8%(39/42),治疗4周时分别为78.6%(33/42)、80.9%(34/42)、97.6%(41/42),联合组总有效率均高于济川煎组和生物反馈组同期(P<0.05)。治疗后,3组排便时间、排便频率、排便困难、肛门不适、腹胀不适评分均较本组治疗前降低(P<0.05),且联合组低于济川煎组和生物反馈组(P<0.05),济川煎组低于生物反馈组(P<0.05)。治疗后,3组AMCP水平均明显高于本组治疗前(P<0.05),且联合组高于济川煎组和生物反馈组(P<0.05),济川煎组高于生物反馈组(P<0.05);治疗后,3组HPZ、初始感觉阈、排便阈值、最大耐受量及中文版便秘患者生存质量自评量表(PAC-QOL)躯体不适、心理不适、担心焦虑、满意评价评分均明显低于本组治疗前(P<0.05),且联合组低于济川煎组和生物反馈组(P<0.05),济川煎组低于生物反馈组(P<0.05)。治疗后,3组5-HT、MTL、SP水平均明显高于本组治疗前(P<0.05),VIP及SS水平均明显低于本组治疗前(P<0.05),且联合组5-HT、MTL、SP水平高于济川煎组和生物反馈组(P<0.05),VIP、SS水平低于济川煎组和生物反馈组(P<0.05),济�Objective To analyze the effect of Jichuan Decoction(JCD)combined with biofeedback therapy for functional constipation(yang-asthenia syndrome)based on the gut-kidney axis theory.Methods A total of 126 patients with functional constipation(yang-asthenia syndrome)were assigned in a 1∶1∶1 to JCD combined with biofeedback therapy(combined group)or biofeedback therapy(biofeedback group)or JCD(JCD group)using a random number table.The aim was to compare constipation symptoms score,anorectal dynamics indexes(anal resting pressure[ARP],anal maximal contraction pressure[AMCP],rectal resting pressure[RRP],anal high pressure zone[HPZ]),rectal sensation test indexes(initial sensory threshold,defecation threshold,maximum tolerated dose[MTD]),gastrointestinal hormones(motilin[MTL],somatostatin[SS],vasoactive intestinal peptide[VIP]),neurotransmitters(5-hydroxytryptamine[5-HT],substance P[SP]),quality of life,clinical efficacy.A 12-month follow-up was performed to assess recurrence rate.Results The overall effective rate in combined group were significantly higher than those of JCD group and biofeedback group(at week 2 of treatment:92.8%[39/42]vs 73.8%[31/42]vs 71.4%[30/42];at week 4 of treatment:97.6%[41/42]vs 78.6%[33/42]vs 80.9%[34/42];P<0.05).After treatment,the constipation symptoms(including defecation time,defecation frequency,defecation difficulties,anal discomfort,abdominal distension discomfort)scores in the three groups were significantly lower(P<0.05),which in combined group were the lowest among the three group,and with significant differences in pairwise comparisons(all P<0.05).After treatment,AMCP levels in the three groups were significantly higher(P<0.05),which in combined group were the highest relative to JCD group and biofeedback group,and inter-group differences(all P<0.05).HPZ,initial sensory threshold,defecation threshold,MTD,Patient Assessment of Constipation-Quality of Life(PAC-QOL)scores(including body discomfort,psychological discomfort,worry and anxiety,satisfaction estimation)in the three groups

关 键 词：功能性便秘 肠肾轴理论 济川煎 生物反馈 

分 类 号：R256.350.531[医药卫生—中医内科学]