Effects of Wenshen Jianpi Decoction combined with Saccharomyces boulardii powder on intestinal microecology in patients with diarrhea irritable bowel syndrome
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摘要: 目的 观察腹泻型肠易激综合征(IBS-D)患者使用温肾健脾汤联合布拉氏酵母菌散治疗效果及其对患者肠道微生态的影响。方法 将宁德师范学院附属宁德市医院消化内科收治的124例IBS-D患者按照随机数字表法分为观察组与对照组，每组62例。2组均接受一般治疗与对症治疗，对照组服用布拉氏酵母菌散治疗，观察组在对照组基础上服用温肾健脾汤治疗，2组连续治疗4周。比较2组患者治疗4周后疗效，比较治疗前、治疗4周后2组患者肠道微生态(双歧杆菌、乳酸杆菌、拟杆菌、肠球菌、肠杆菌)，观察治疗4周内患者不良反应情况。结果 观察组治疗4周后总有效率为93.55%，明显高于对照组的79.03%，差异有统计学意义(P< 0.05)。治疗4周后，2组双歧杆菌、乳酸杆菌、拟杆菌高于治疗前，肠杆菌、肠球菌低于治疗前，且观察组各菌群改善优于对照组，差异有统计学意义(P< 0.05)；2组患者在治疗的4周内未发生严重不良反应；2组过敏反应、便秘、口干总发生率比较差异无统计学意义(P>0.05)。结论 温肾健脾汤联合布拉氏酵母菌散治疗IBS-D的效果显著，可改善患者肠道微生态，且未增加不良反应。Abstract: Objective To observe the therapeutic effect of Wenshen Jianpi Decoction combined with Saccharomyces boulardii powder on patients with diarrhea irritable bowel syndrome(IBS-D), and its effect on intestinal microecology of patients.Methods One hundred and twenty-four patients with IBS-D treated in the Department of Gastroenterology, Ningde Municipal Hospital Affiliated to Ningde Normal University were divided into observation group and control group by the random number table method, with 62 cases in each group; both groups received general treatment and symptomatic treatment. The control group was treated with Saccharomyces boulardii powder, and the observation group was treated with Wenshen Jianpi Decoction based on the control group. The two groups were treated continuously for four weeks; the therapeutic effects of patients in the two groups were compared at four weeks of treatment, and the intestinal microecology(Bifidobacterium,Lactobacillus,Bacteroides,EnterococcusandEnterobacter) was compared to patients in both groups before and after treatment. The adverse reactions of patients within four weeks of treatment were observed.Results The total effective rate in the observation group was 93.55% after four weeks of treatment, which was significantly higher than 79.03% in the control group, with a statistically significant difference(P< 0.05); after four weeks of treatment, Bifidobacterium, Lactobacillus and bacteroides in both groups were higher than those before treatment, Enterobacter and Enterococcus were lower than those before treatment, and the improvement of each flora in the observation group was better than that in the control group, with statistically significant differences(P< 0.05); there were no serious adverse reactions of patients in both groups within four weeks of treatment; compared the total incidence of an allergic reaction, constipation and dry mouth between the two groups, there was no statistically significant difference(P>0.05).Conclusion Wenshen Jianpi Decoction combined with Saccharomyces boulardii powder is effective in treating IBS-D. It can improve the intestinal microecology of patients and will not increase the adverse reaction.
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表 1 2组临床疗效比较
例(%) 组别 例数 治愈 显效 有效 无效 总有效 观察组 62 24(38.71) 19(30.65) 15(24.19) 4(6.45) 58(93.55) 对照组 62 8(12.90) 16(25.81) 25(40.32) 13(20.97) 49(79.03) Z/χ2 3.912 5.522 P < 0.001 0.019 
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表 2 2组治疗前后肠道微生态比较
lgCFU/g，X±S 时间 组别 例数 双歧杆菌 乳杆菌 拟杆菌 肠杆菌 肠球菌 治疗前 观察组 62 7.88±1.35 7.24±1.05 8.76±1.55 9.22±1.76 7.21±0.98 对照组 62 7.75±1.26 7.37±1.17 8.85±1.67 9.14±1.71 7.35±1.09 t 0.550 0.695 0.340 0.232 0.702 P 0.583 0.488 0.734 0.817 0.484 治疗4周 观察组 62 9.62±1.871) 8.85±1.641) 11.84±2.571) 7.65±1.071) 6.17±0.751) 对照组 62 8.43±1.521) 8.02±1.431) 10.83±2.251) 8.32±1.331) 6.88±0.811) t 3.926 2.969 2.331 3.089 5.059 P < 0.001 0.004 0.021 0.003 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 3 2组不良反应比较
例(%) 组别 例数 过敏反应 便秘 口干 合计 观察组 62 1(1.61) 2(3.23) 1(1.61) 4(6.45) 对照组 62 0 1(1.61) 1(1.61) 2(3.23) χ2 0.175 P 0.676
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