基于“脑-肠-菌”轴探讨健脾益气自拟方对老年慢传输型便秘的影响  

Effects of self-drafted Jianpi Yiqi Formula on senile slow transit constipation based on"brain-gut-microbiota"axis

作　　者：陈念[1] 王永恒[1] 黄湘俊[1] 刘欢[1] 倪志强[1] CHEN Nian;WANG Yongheng;HUANG Xiangjun;LIU Huan;NI Zhiqiang(The First Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410007,China)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《湖南中医药大学学报》2024年第12期2216-2221,共6页Journal of Hunan University of Chinese Medicine

基　　金：湖南省卫生健康委员会重点指导课题(202304019709);湖南中医药大学级科研基金项目(ZYYDX201734)。

摘　　要：目的基于“脑-肠-菌”轴理论,探究健脾益气自拟方对老年慢传输型便秘的临床疗效及作用机制。方法回顾性选取湖南中医药大学第一附属医院胃肠外科门诊2021年1月至2023年12月的128例气虚型老年慢传输型便秘患者,随机分为空白组(17例)、对照组(48例)和观察组(63例)。空白组仅进行饮食、生活调整;对照组在空白组基础上口服枸橼酸莫沙必利分散片(5 mg/次,3次/d);观察组在空白组基础上予健脾益气自拟方干预,每日1剂,水煎服,分两次服用。3组均干预6周,对比各组血清脑肠肽[血管活性肠肽(vasoactive intestinal peptide,VIP)、血清5-羟色胺(5-hydroxytryptamine,5-HT)、P物质(substance P,SP)]水平、肠道菌群丰度、结肠传输功能、完全自主排便次数(complete spontaneous bowel movements,CSBM)、便秘患者生存质量自评量表(Patient Assessment of Constipation-Quality of Life,PAC-QOL)评分及临床疗效。结果与治疗前比较,治疗后3组乳酸杆菌菌群数量均升高(P<0.05,P<0.01),血清VIP水平及PAC-QOL评分降低(P<0.05,P<0.01)。与空白组比较,对照组和观察组双歧杆菌、类杆菌数量、血清5-HT、血清SP水平均升高(P<0.01),肠杆菌、梭杆菌数量、血清VIP水平、PAC-QOL评分均降低(P<0.05,P<0.01)。与对照组比较,观察组双歧杆菌、乳酸杆菌、类杆菌数量、血清5-HT、血清SP、CSBM水平均升高(P<0.01);肠杆菌、梭杆菌数量、血清VIP水平、PAC-QOL评分均降低(P<0.05,P<0.01),72 h标记物残留粒数减少(P<0.01)。与空白组比较,对照组和观察组总有效率升高(P<0.05,P<0.01);与对照组比较,观察组总有效率升高(P<0.01)。结论健脾益气自拟方可通过调节“脑-肠-菌”轴,有效改善老年气虚慢传输型便秘患者血清脑肠肽水平,促进肠道菌群平衡,增强结肠传输功能,缓解临床症状,具有临床推广价值。Objective To explore the clinical efficacy and mechanism of action of self-draft Jianpi Yiqi Formula in treating senile slow transit constipation(STC)based on the"brain-gut-microbiota"axis theory.Methods A retrospective study was conducted on 128 elderly patients with STC of qi deficiency pattern who present the gastrointestinal surgery outpatient departmen of the First Hospital of Hunan University of Chinese Medicine from January 2021 to December 2023.The patients were randomized into blank group(n=17),control group(n=48),and observation group(n=63).All three groups were subjected to dietary and lifestyle adjustments.Additionally,the control group was administered mosapride citrate tablets orally(5 mg per time,three times a day);the observation group received a water decoction of self-draft Jianpi Yiqi Formula,administered at one dose per day and divided into two administrations.All intervention lasted for six weeks.The levels of serum brain-gut peptides[vasoactive intestinal peptide(VIP),5-hydroxytryptamine(5-HT),and substance P(SP)],gut microbiota abundance,colonic transit function,complete spontaneous bowel movements(CSBM),scores of the Patient Assessment of Constipation-Quality of Life(PAC-QOL),and clinical efficacy were compared among the groups.Results Compared with before treatment,the number of Lactobacillus flora increased in all three groups after treatment(P<0.05,P<0.01),while serum VIP level and PAC-QOL scores decreased(P<0.05,P<0.01).Compared with the blank group,the control and observation groups showed increased numbers of Bifidobacterium and Bacteroides,higher serum levels of 5-HT and SP(P<0.01),decreased numbers of Enterobacter and Fusobacterium,and lower serum VIP level and PAC-QOL scores(P<0.05,P<0.01).Compared with the control group,the observation group exhibited increased numbers of Bifidobacteria,Lactobacillus,and Bacteroides,higher serum levels of 5-HT,SP,and CSBM(P<0.01),decreased numbers of Enterobacter and Fusobacterium,lower serum VIP level and PAC-QOL scores(P<0.05),as well as a redu

关 键 词：健脾益气自拟方 老年气虚型 “脑-肠-菌轴” 肠道菌群 脑钠肽 慢传输型便秘 结肠传输试验 

分 类 号：R256.35[医药卫生—中医内科学]