摘要
目的观察久泻方联合火龙灸治疗脾肾阳虚型腹泻型肠易激综合征(IBS-D)的疗效及对肠黏膜屏障、炎症因子、脑肠轴的影响。方法选取2019年10月-2021年3月就诊于潍坊市中医院的脾肾阳虚型IBS-D患者120例,随机分为4组:内治组30例采用久泻方口服治疗,外治组30例采用火龙灸治疗,联合组30例采用久泻方口服联合火龙灸治疗,对照组30例采用马来酸曲美布汀片治疗,疗程均为2周。观察4组治疗前后中医症状积分(4项主症、3项次症)、肠易激综合征症状严重程度量表(IBS-SSS)积分及血清D-乳酸、二胺氧化酶(DAO)、白细胞介素-1β(IL-1β)、P物质(SP)、血管活性肠肽(VIP)、5-羟色胺(5-HT)水平变化,比较4组中医证候疗效、IBS-SSS量表疗效及不良反应发生情况。结果治疗后4组4项主症积分、IBS-SSS积分及内治组、外治组、联合组3项次症积分均较治疗前明显降低(P均<0.05),联合组各项主症积分、IBS-SSS积分均明显低于其他3组(P均<0.05),内治组、外治组各项主症积分、IBS-SSS积分均明显低于对照组(P均<0.05),内治组、外治组治疗后的腹痛、腹泻、腹胀积分及IBS-SSS积分比较差异均无统计学意义(P均>0.05);联合组3项次症积分、内治组倦怠乏力积分、外治组腰膝酸软积分均明显低于对照组(P均<0.05)。治疗后4组血清D-乳酸、DAO、IL-1β、SP、VIP、5-HT水平均较治疗前明显降低(P均<0.05),且联合组各指标水平均明显低于其他3组(P均<0.05),内治组、外治组各指标水平均明显低于对照组(P均<0.05);内治组血清D-乳酸、DAO、SP、VIP水平均明显低于外治组(P均<0.05),血清IL-1β水平明显高于外治组(P<0.05),血清5-HT水平与外治组比较差异无统计学意义(P>0.05)。内治组、外治组、联合组中医证候总有效率及内治组、联合组IBS-SSS量表总有效率均明显高于对照组(P均<0.05)。4组均未见不良反应发生。结论久泻方、火龙灸单用和联用均可明显缓解脾肾阳虚型IBS-D患者的症状及病情程度,提高生活质量,明显改善肠黏膜屏障,抑制炎症因子表达,调节脑肠轴功能,且联用效果更好。
Objective It is to observe the curative effect of Jiuxie decoctioni combined with fire dragon moxibustion in the treatment of irritable bowel syndrome with diarrhea(IBS-D)of spleen-kidney Yang deficiency and its effects on intestinal mucosal barrier,inflammatory factors and brain-gut axis.Methods A total of 120 patients with IBS-D of spleen-kidney Yang deficiency treated in Weifang Hospital of Traditional Chinese Medicine from October 2019 to March 2021 were selected and randomly divided into 4 groups:30 cases in the internal treatment group were treated with Jiuxie decoction orally,and the external treatment group was treated with fire dragon moxibustion,30 cases in the combination group were treated with Jiuxie decoction orally combined with fire dragon moxibustion,and 30 cases in the control group were treated with trimebutine maleate tablets,all the course of treatment was 2 weeks.The changes in the scores of traditional Chinese medicine(TCM)symptoms(4 main symptoms and 3 sub-symptoms),scores of irritable bowel syndrome symptom severity scale(IBS-SSS)and the levels of serum D-lactate,diamine oxidase(DAO),interleukin-1β(IL-1β),substance P(SP),vasoactive intestinal peptide(VIP),and 5-hydroxytryptamine(5-HT)before and after treatment were observed in the four groups,and the efficacy of TCM syndromes and IBS-SSS scale and adverse reactions occurred among the four groups were compared.Results After treatment,the scores of 4 main symptoms and IBS-SSS scores of the 4 groups and the scores of 3 sub-symptoms of the internal treatment group,external treatment group and combination group were significantly lower than those before treatment(all P<0.05),the scores of every main symptom and IBS-SSS scores of the combination group were significantly lower than those of the other three groups(all P<0.05),and the scores of main symptoms and IBS-SSS scores of the internal treatment group and external treatment group were significantly lower than those of the control group(all P<0.05),there was no significant difference in the scores of abdominal pain,diarrhea,abdominal distension and IBS-SSS scores between the internal treatment group and external treatment group after treatment(all P>0.05),the scores of 3 sub-symptoms in the combination group,the scores of lassitude,asthenia in the internal treatment group,and the soreness of waist and knee weakness in the external treatment group were significantly lower than those in the control group(all P<0.05).After treatment,the levels of serum D-lactic acid,DAO,IL-1β,SP,VIP,and 5-HT in the four groups were significantly lower than those before treatment(all P<0.05),and the levels of each index in the combination group were significantly lower than those in the other three groups(all P<0.05),the levels of each index in the internal treatment group and external treatment group were significantly lower than those in the control group(all P<0.05);the levels of serum D-lactic acid,DAO,SP,and VIP in the internal treatment group were significantly lower than those in the external treatment group(all P<0.05),and the level of serum IL-1βwas significantly higher than that in the external treatment group(P<0.05),there was no significant difference in the level of serum 5-HT between the the external treatment group and internal treatment group(P>0.05).The total effective rate of TCM syndromes in the internal treatment group,external treatment group and combination group and and the total effective rate of IBS-SSS in the internal treatment group and combination group were significantly higher than those in the control group(all P<0.05).There was no adverse reaction occurred in the four groups.Conclusion Jiuxie decoction and fire dragon moxibustion alone or in combination can significantly relieve the symptoms and severity of IBS-D patients with spleen and kidney Yang deficiency,improve the quality of life,significantly improve the intestinal mucosal barrier,inhibit the expression of inflammatory factors,and regulate the brain-gut axis function,and the combined effect is better.
作者
郑薇薇
赵耀
刘兴山
ZHENG Weiwei;ZHAO Yao;LIU Xingshan(Weifang Hospital of Traditional Chinese Medicine,Weifang 261000,Shandong,China)
出处
《现代中西医结合杂志》
CAS
2022年第16期2191-2196,2204,共7页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
山东省中医药科技发展计划项目(2019-0708)。
关键词
肠易激综合征
腹泻型
脾肾阳虚型
火龙灸
肠道屏障
irritable bowel syndrome
diarrhea type
spleen and kidney Yang deficiency
fire dragon moxibustion
intestinal barrier
