四磨汤口服液联合复方谷氨酰胺肠溶胶囊治疗腹泻型肠易激综合征临床研究

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摘要：目的 观察四磨汤口服液联合复方谷氨酰胺肠溶胶囊治疗腹泻型肠易激综合征(IBS-D)肝郁脾虚证临床疗效,并探讨其作用机制。方法 将60例IBS-D患者随机分为2组,治疗组30例给予四磨汤口服液、复方谷氨酰胺肠溶胶囊口服,对照组30例给予马来酸曲美布汀片、枯草杆菌二联活菌肠溶胶囊口服,疗程4周。比较2组治疗前后临床症状及5-羟色胺(5-HT)、P物质(SP)水平变化,记录复发率、不良反应。结果 治疗1、2、4周总有效率2组间比较差异无统计学意义(P＞0.05)；治疗4周后治疗组症状总积分及腹胀、排便急迫感积分明显低于对照组(P＜0.05)；治疗后2组患者血清5-HT、SP水平均较治疗前明显下降(P＜0.05)；治疗组、对照组停药4周后复发率分别为10.7%(3/28)、32.1%(9/28),差异无统计学意义(P＞0.05)。2组均未见明显不良反应。结论 四磨汤口服液联合复方谷氨酰胺肠溶胶囊治疗IBS-D肝郁脾虚证疗效显著,尤善于缓解腹胀、排便急迫感症状,其作用机制可能与降低血清5-HT、SP水平有关。

关键词：腹泻型肠易激综合征；肝郁脾虚证；四磨汤口服液；复方谷氨酰胺肠溶胶囊

DOI：10.3969/j.issn.1005-5304.2013.08.005

中图分类号：R259.744

文献标识码：A

文章编号：1005-5304(2013)08-0011-04Clinical Research of Simotang Oral Liquid and Compound Glutamine Enteric Capsules for Treating Diarrhea-predominant Irritable Bowel Syndrome WU Yong-hong, ZHENG Guo-rong (Department of Digestive System, Wuhan General Hospital of Guangzhou Military Region of PLA, Wuhan 430070, China)

Abstract：Objective To observe the clinical efficacy of Simotang oral liquid combined with compound glutamine enteric capsules in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) belonging to liver depression and spleen deficiency pattern, and to explore its possible mechanism. Methods Sixty patients were randomly divided into two groups. The treatment goup (30 cases) took Simotang oral liquid and compound glutamine enteric capsules, the control group took Cerekinon and Medilac-S. The treatment course was 4 weeks. Clinical symptoms, 5-hydroxytryptamine (5-HT) and substance P (SP) of both groups were evaluated respectively before and after treatment. Recurrence rate and adverse reactions were recorded. Results The total effective rate after treating 1, 2, 4 weeks between the two groups had no significant difference (P＞0.05). Four weeks later, in the treatment group, total score of the symptoms, abdominal distension and defecation urgency were apparently lower than that of control group (P＜0.05). The levels of 5-HT and SP of the two groups significantly decreased after treatment (P＜0.05). The recurrence rate at 4 weeks after drug withdrawal of treatment group and control group was 10.7% (3/28) and 32.1% (9/28) respectively. The difference between the two groups wasn’t significant (P＞0.05). Obvious side effects were not found in the two groups. Conclusion Simotang oral liquid combined with compound glutamine enteric capsules has evident therapeutic effect on IBS-D of liver depression and spleen deficiency pattern, especially good at releasing abdominal distension and defecation urgency. The mechanism may be related with decreasing the levels of 5-HT and SP.

Key words：diarrhea-predominant irritable bowel syndrome；liver depression and spleen deficiency syndrome；Simotang oral liquid；compound glutamine enteric capsules

肠易激综合征(irritable bowel syndrome,IBS)是临床常见的一种功能性肠病,以腹痛(或腹部不适)伴大便次数、性状改变为特征,临床上可分为腹泻型、便秘型、混合型及不确定型4种亚型,其中腹泻型IBS(IBS-D)最常见。IBS病程长,与情绪、饮食密切相关,易反复发作,目前尚无单一药物或单一疗法对IBS完全有效[1]。中医药治疗IBS-D具有一定优势[2]。笔者采用四磨汤口服液联合复方谷氨酰胺肠溶胶囊治疗IBS-D肝郁脾虚证患者29例,观察其临床疗效及患者5-羟色胺(5-HT)、P物质(SP)水平的变化,现总结报道如下。