Effect of the Xinkai Kujiang compound on proximal gastric accommodation and serum 5-HT and NO in patients with functional dyspepsia
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摘要: 目的 探索辛开苦降法对功能性消化不良(functional dyspepsia，FD)寒热错杂证患者近端胃容受性、感觉高敏和血清5-HT、NO水平的影响。方法 将符合纳入和排除标准的60例FD寒热错杂证患者随机分为治疗组(30例)和对照组(30例)，分别接受辛开苦降法和安慰剂治疗共4周；采用液体营养餐负荷试验联合二维超声成像，分别采集并计算阈值饮入量(初始饱感)、最大饮入量(最大饱感)、空腹近端胃面积和容积、最大饱感近端胃面积和容积，并在空腹和最大饱感时采集外周血，测量血清5-HT、NO水平。结果 ①治疗组初始饱感入量较对照组及治疗前均显著升高(P < 0.05)，但治疗组最大饱感入量、近端胃面积及近端胃容积变化与治疗前及对照组比较均差异无统计学意义(P > 0.05)；②治疗4周后，治疗组空腹及餐后5-HT、NO水平均显著降低(P > 0.05)，对照组空腹5-HT、NO水平与治疗前比较差异无统计学意义(P > 0.05)，餐后5-HT、NO比治疗前显著降低(P < 0.05)。结论 辛开苦降法可提高患者的初始饱感水平，对降低患者的内脏敏感性有益，其作用机制可能是通过调节空腹及餐后5-HT、NO等血清胃肠激素水平的变化来实现的。Abstract: Objective To investigate the effects of the Xinkai Kujiang compound on proximal gastric accommodation and plasma gastrointestinal hormone levels(5-HT and NO) in functional dyspepsia(FD) patients with cold heat complicated syndrome.Methods Sixty FD patients with cold heat complicated syndrome, who met inclusion and exclusion criteria were assigned equally into the treatment group or placebo group, treated with Xinkai Kujiang compound or placebo for a total of four weeks randomly. The intake volume and proximal gastric volume at initial satiety and maximum satiety were collected and calculated using NLT combined with 2DUS, respectively. Peripheral blood samples were collected at fasting and maximum satiety, and serum 5-HT and NO levels were measured.Results ①After four weeks of treatment, the intake volume at initial satiety in the treatment group was significantly increased than base line, as well as the placebo group(P < 0.05), but no significant difference was found in intake volume at maximum satiety. Compared with the placebo group, there was no significant chang in proximal gastric volume at base line and after four weeks of treatment(P > 0.05).② After four weeks of treatment, the fasting and postprandial levels of 5-HT and NO in the treatment group were significantly reduced(P > 0.05). The postprandial levels of 5-HT and NO in the placebo group were significantly reduced compared to base line(P < 0.05), but no significant changes were found in the fasting levels of 5-HT and NO(P > 0.05). No significant difference was found in inter-group comparison.Conclusion Xinkai Kujiang compound can improve the initial satiety level in FD patients, which means beneficial for reducing visceral sensitivity. The mechanism may be achieved by regulating changes in serum gastrointestinal hormone levels such as 5-HT or NO on fasting and after meals.
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Key words:
- Xinkai Kujiang compound /
- functional dyspepsia /
- proximal gastric accommodation /
- 5-HT /
- NO
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表 1 治疗组及对照组治疗前后近端胃容受性的比较
X ± S，M(P25，P75) 胃容受性 治疗前 治疗后 t/Z P 治疗组(n=29) 对照组(n=29) 治疗组(n=29) 对照组(n=29) 初始饱感入量/mL 275.0±22.2 303.1±26.9 341.6±25.911)2) 283.3±25.8 -1.931 0.044 最大饱感入量/mL 644.4±65.2 657.8±57.8 600.0±59.0 600.0±51.1 0.475 0.638 近端胃面积变化/cm2 15.60 (10.50，19.40) 16.60 (12.30，20.50) 14.01 (8.60，17.90) 18.80 (11.40，25.40) -1.566 0.124 近端胃容积变化/cm3 89.56 (50.39，122.20) 82.06 (69.69，133.56) 83.59 (57.02，120.20) 91.05 (55.50，148.88) -0.081 0.952 与治疗组治疗前比较，1)P < 0.05；与对照组治疗后比较，2)P < 0.05。 
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表 2 治疗组及对照组治疗前后血清5-HT水平的比较
ng/mL，X ± S 时间 治疗组(n=29) 对照组(n=29) 空腹 餐后 空腹 餐后 治疗前 1 174.2±183.0 1 123.6±658.7 1 006.2±666.9 1 002.5±650.4 治疗后 656.0±250.31) 523.2±200.31) 692.4±390.8 449.2±231.31) 与治疗前比较, 1)P < 0. 05。
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表 3 治疗组及对照组治疗前后血清NO水平的比较
μmol/L，X ± S 时间 治疗组(n=29) 对照组(n=29) 空腹 餐后 空腹 餐后 治疗前 246.8±143.7 229.6±150.0 219.5±132.8 195.3±101.4 治疗后 144.8±54.21) 117.3±45.21) 142.7±40.1 94.0±25.51) 与治疗前比较，1)P < 0.05。
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