基于胆汁酸代谢及肠道微生态异常探讨加味交泰丸治疗腹泻型肠易激惹综合征的临床研究  

Clinical Research on Jiawei Jiaotai Pill(加味交泰丸)in Treatment of Irritable Bowel Syndrome Based on Bile Acid Metabolism and Intestinal Microecological Abnormalities

作　　者：许琰杰[1] 冯娟[1] 蒋洁 季雁浩[1] 邵荣世[1] 杨芳[1] 严晶[2] XU Yanjie;FENG Juan;JIANG Jie;JI Yanhao;SHAO Rongshi;YANG Fang;YAN Jing(Nantong Hospital of Traditional Chinese Medicine,Nantong 226006,Jiangsu,China;The First Clinical School of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南通市中医院,江苏南通226006 [2]南京中医药大学第一临床医学院,江苏南京210029

出　　处：《中华中医药学刊》2025年第2期29-33,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81503536);南通市市级科技计划项目(MS22022052)。

摘　　要：目的基于胆汁酸代谢及肠道微生态异常探讨加味交泰丸治疗腹泻型肠易激惹综合征(irritable bowel syndrome,IBS)的临床效果。方法将2022年8月—2023年6月南京中医药大学南通附属中医院脾胃病科门诊诊治的96例腹泻型肠易激惹综合征患者作为研究对象,根据随机、对照原则分为试验组和对照组,每组48例。两组患者均进行调畅情志、合理饮食作息、烟酒控制等常规治疗措施,同时对照组给予地衣芽孢杆菌治疗,试验组给予加味交泰丸治疗,以28 d为1个疗程,两组治疗时间均为1个疗程。比较两组患者的中医证候疗效,IBS症状严重程度量表(IBS Symptom Severity Scale,IBS-SSS)评分,汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分,胆汁酸水平、肠道菌群分布,治疗安全性。结果试验组总有效率97.92%(47/48),显著高于对照组的83.33%(40/48),(P<0.05)。治疗前两组IBS-SSS评分以及HAMA、HAMD评分差异均无统计学意义(P>0.05),治疗后两组以上各项评分均显著下降,并且试验组显著低于对照组(P<0.05)。治疗前两组胆酸(CA)、鹅脱氧胆酸(CDCA)、熊脱氧胆酸(UDCA)、脱氢胆酸(HDCA)、石胆酸(LCA)差异无统计学意义(P>0.05),治疗后两组患者CA、CDCA、HDCA显著降低,UDCA、LCA显著升高,且试验组改善情况优于对照组(P<0.05)。治疗前两组肠道菌群分布差异无统计学意义(P>0.05),治疗后两组双歧杆菌及乳酸杆菌水平升高,大肠杆菌、肠球菌水平降低,且试验组改变更显著(P<0.05)。两组均无严重不良反应发生,治疗安全性佳。结论加味交泰丸治疗腹泻型肠易激惹综合征的临床效果满意,能够显著改善患者的胆汁酸代谢及肠道微生态异常状况,从而缓解其证候,促进患者康复。Objective To study the effect of Jiawei Jiaotai Pill(加味交泰丸)in the treatment of irritable bowel syndrome based on bile acid metabolism and intestinal microecological abnormalities.Methods From August 2022 to June 2023,96 patients with diarrhea-predominant irritable bowel syndrome diagnosed and treated in the outpatient department of spleen and stomach disease department of nantong affiliated hospital of traditional Chinese medicine of Nanjing university of Chinese medicine were selected as the research objects.According to the random and control principle,they were divided into experimental group and control group,with 48 cases in each group.The patients of two groups were treated with routine treatment measures such as regulating emotions,reasonable diet and rest,and tobacco and alcohol control.At the same time,the control group was treated with Bacillus licheniformis and the experimental group was treated with Jiawei Jiaotai Pill.The course of treatment was 28 days and the treatment time of both groups was 1 course.The efficacy of TCM syndromes,irritable bowel syndrome symptom severity scale(IBS-SSS)score,Hamilton anxiety scale(HAMA)score,Hamilton depression scale(HAMD)score,bile acid level,intestinal flora distribution and treatment safety were compared between the two groups.Results The total effective rate of the experimental group was 97.92%,which was significantly higher than that(83.33%)of the control group(P<0.05).After treatment,the scores of IBS-SSS,HAMA and HAMD of the two groups were significantly decreased and the scores of the experimental group were significantly lower than those of the control group(P<0.05).There was no significant difference in cholic acid(CA),chenodeoxycholic acid(CDCA),ursodeoxycholic acid(UDCA),dehydrocholic acid(HDCA)or lithocholic acid(LCA)between the two groups before treatment(P>0.05).After treatment,the levels of CA,CDCA and HDCA were significantly reduced,and the levels of UDCA and LCA were significantly increased.The improvement of the experimental group was b

关 键 词：腹泻型肠易激惹综合征 交泰丸 地衣芽孢杆菌 胆汁酸代谢 肠道微生态 

分 类 号：R259.74[医药卫生—中西医结合]