理气通便方对气滞型功能性便秘患者的疗效及肠道菌群的影响  

Effect of Liqi Tongbian Decoction on the Efficacy and Intestinal Flora of Patients with Qi-Stagnation Type Functional Constipation

作　　者：胡露楠 刘启鸿[1,2,3] 黄雅滢 许燕城 方文怡 赵培琳[1,2,3] 柯晓 HU Lunan;LIU Qihong;HUANG Yaying;XU Yancheng;FANG Wenyi;ZHAO Peili;KE Xiao(The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350003,China;Fujian Clinical Medical Research Centre of Traditional Chinese Medicine for Spleen and Stomach,Fuzhou,Fujian 350003,China;Famous Chinese Medicine Practitioner Ke Xiao Studio of Fujian Province,Fuzhou,Fujian 350003,China)

机构地区：[1]福建中医药大学附属第二人民医院,福建福州350003 [2]福建省中医脾胃临床医学研究中心,福建福州350003 [3]福建省名中医柯晓工作室,福建福州350003

出　　处：《福建中医药》2025年第1期11-16,共6页Fujian Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82274282);中央引导地方科技发展资金项目(2023L3013);福建省名中医柯晓工作室建设项目(闽卫中医〔2022〕112号)。

摘　　要：目的探讨理气通便方对气滞型功能性便秘(FC)患者的疗效及肠道菌群的影响。方法选取2021年1—12月在福建中医药大学附属第二人民医院确诊的气滞型FC门诊和住院患者34例作为治疗组,采用理气通便方治疗4周后评估患者总的完全自主排便次数(CSBMs)应答率、中医证候疗效、便秘患者生活质量评估量表(PAC-QOL)评分与不良反应发生情况,另招募20名健康人作为正常组。采用16S rDNA测序技术对治疗组治疗前后及正常组肠道菌群进行Alpha多态性分析测定Chao1指数和Simpson指数,测定肠道菌群相对丰度并进行物种组成、产丁酸菌属差异性、特征性微生物群和肠道菌群基因功能预测分析。结果治疗组总的CSBMs应答率为61.76%,中医证候疗效总有效率为88.24%,治疗组治疗后PAC-QOL评分较治疗前改善(P<0.05),且均不良反应。治疗组治疗前后及正常组肠道菌群相对丰度在门水平排名前3的物种为厚壁菌门、拟杆菌门和变形菌门,在属水平排名前3物种为拟杆菌属、栖粪杆菌属和志贺埃希菌属。与正常组比较,治疗组治疗前Chao1指数、Simpson指数升高(P<0.05),产丁酸菌属相对丰度水平降低(P<0.05),以普雷沃氏菌科、戴阿利斯特杆菌属、颤螺旋菌科、乳杆菌属、乳杆菌科、韦荣氏菌科等为特征菌,肠道菌群蔗糖降解Ⅲ(PWY-621)、丙酮酸发酵成乙酸和乳酸(PWY-5100)功能降低(P<0.05)。与治疗前比较,治疗组治疗后Chao1指数、Simpson指数差异无统计学意义(P>0.05),产丁酸菌属相对丰度水平升高(P<0.05),以梭菌纲、毛螺菌科、毛螺菌目、厚壁菌门、布劳特氏菌属为特征菌,肠道菌群蔗糖降解Ⅲ(PWY-621)、丙酮酸发酵成乙酸和乳酸(PWY-5100)功能水平升高(P<0.05)。结论肠道菌群紊乱可能是气滞型FC的重要发病机制,布劳特氏菌属、产丁酸菌属可能是理气通便方治疗气滞型FC患者药物作用的关键菌属。Objective:To explore the effect of Liqi Tongbian Decoction on functional constipation(FC)patients with Qi-stagnation type functional constipation(FC)and its effect on intestinal flora.Methods:A total of 34 outpatients and inpatients with FC of Qi-stagnation type diagnosed in the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January to December 2021 were selected as the treatment group.The response rate of complete spontaneous bowel movements(CSBMs),efficacy of traditional Chinese medicine(TCM)syndromes,the Patients'Assessment of Quality of Life in Constipation(PAC-QOL)score,and the occurrence of adverse reactions were assessed after 4 weeks of treatment with Liqi Tongbian Decoction,and 20 healthy individuals were recruited as the normal group.16S rDNA sequencing technology was used to analyze the Alpha polymorphism of the intestinal flora of the treatment group before and after treatment and the normal group to determine the Chao1 index and Simpson index,and to determine the relative abundance of the intestinal flora for the analysis of the species composition,variability of butyric acid-producing bacterial genera,characteristic microbiota,and the analysis of the prediction of the gene function of the intestinal flora.Results:The total CSBMs response rate of the treatment group was 61.76%,the total effective rate of TCM syndrome was 88.24%,and the PAC-QOL score of the treatment group improved after treatment(P<0.05),and there were no adverse reactions.The top 3 species in terms of relative abundance of intestinal flora at the phylum level in the treatment group before and after treatment and in the normal group were Firmicutes,Bacteroidetes and Proteobacteria,and the top 3 species at the genus level were Bacteroidetes,Faecalibacterium and Escherichia Shigella.Compared with the normal group,the pre-treatment Chao1 index and Simpson's index of the treatment group increased(P<0.05),and the relative abundance level of butyric acid-producing bacterial genera decreased(P<

关 键 词：功能性便秘 理气通便方 肠道菌群 16S rDNA 

分 类 号：R25[医药卫生—中医内科学]