Effect of Tongfu Huayu Decoction combined with microecological preparation on intestinal mucosal barrier and gastrointestinal motility in patients with severe acute pancreatitis
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摘要: 目的 观察通腑化瘀汤联合微生态制剂对重症急性胰腺炎(severe acute pancreatitis，SAP)患者肠道黏膜屏障及胃肠动力的影响。方法 使用前瞻性随机对照试验的方法，连续纳入2020年3月-2022年2月收治的90例SAP患者作为研究对象，按照随机数字表法分为实验组和对照组，每组各45例。对照组接受一般治疗和微生态制剂治疗，实验组在对照组基础上服用通腑化瘀汤，以治疗7 d为疗效评价时点。观察指标为肠道黏膜屏障(内毒素、二胺氧化酶、乳酸水平)和胃肠动力(胃动素、血管活性肠肽、胆囊收缩素水平)。结果 治疗期间实验组和对照组分别被剔除2例和3例，最终实验组43例、对照组42例完成本研究。两组治疗总有效率比较，差异无统计学意义(P>0.05)；实验组临床痊愈率、显效率高于对照组，差异有统计学意义(P < 0.05)。两组治疗后内毒素、乳酸、二胺氧化酶水平比治疗前均降低，实验组均低于对照组，差异有统计学意义(P < 0.05)。两组治疗后胃动素、胆囊收缩素水平比治疗前升高，血管活性肠肽水平比治疗前降低，实验组胃动素、胆囊收缩素水平高于对照组，血管活性肠肽水平低于对照组，差异有统计学意义(P < 0.05)。结论 通腑化瘀汤联合微生态制剂治疗SAP，能够促进患者肠道黏膜屏障功能恢复，改善胃肠动力，有助于提高疾病治愈率。Abstract: Objective To observe the effect of Tongfu Huayu Decoction combined with microecological preparation on intestinal mucosal barrier and gastrointestinal motility in patients with severe acute pancreatitis(SAP).Methods A prospective randomized controlled trial was used. Ninty patients with SAP who were admitted from March 2020 to February 2022 were enrolled in the study. They were divided into test group and control group according to the random number table, with 45 patients in each group. The control group received general treatment+microecological preparation treatment, and the test group took Tongfu Huayu Decoction on the basis of the control group. The therapeutic effect was evaluated at seven days. The intestinal mucosal barrier(Endotoxin, diamine oxidase[DAO], lactic acid[Lac])and gastrointestinal motility(motilin[MTL], vasoactive intestinal peptide[VIP], cholecystokinin[CCK]) were observed.Results During the treatment, two cases in the test group and three cases in the control group were excluded, 43 cases in the final test group and 42 cases in the control group completed the test. There was no statistical significant difference in the total effective rate between the two groups(P>0.05). The clinical recovery rate and significant effectiveness rate of the test group are higher than those of the control group, with a statistical significant difference(P < 0.05). The levels of Endotoxin, Lac, and DAO in the two groups after treatment were lower than those before treatment, and the level of the test group was lower than that in the control group, with a statistical significant difference(P < 0.05). After treatment, the levels of MTL and CCK in the two groups were higher than those before treatment, and the level of VIP was lower than that before treatment. The levels of MTL and CCK in the test group were higher than those in the control group, and the level of VIP was lower than that in the control group, with a statistical significant difference(P < 0.05).Conclusion Tongfu Huayu Decoction combined with microecological preparation can promote the recovery of intestinal mucosal barrier function, improve gastrointestinal motility and improve the cure rate of SAP patients.
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表 1 两组患者的临床资料比较
X±S，例(%)，M(P25，P75) 临床资料 实验组(n=43) 对照组(n=42) t/Z/χ2 P 年龄/岁 72.44±4.35 71.24±4.14 1.306 0.195 性别 1.423 0.233 男 28(65.12) 22(52.38) 女 15(34.88) 20(47.62) 急性生理慢性健康Ⅱ评分/分 19.42±1.89 20.17±2.11 1.723 0.089 既往史 高血压 11(25.58) 15(35.71) 1.028 0.311 糖尿病 19(44.19) 14(33.33) 1.054 0.305 高脂血症 25(58.14) 30(71.43) 1.317 0.251 胆石症 15(34.88) 19(45.24) 0.949 0.330 改良Marshall评分/分 2.00(2.00，3.00) 2.00(2.00，3.00) 0.395 0.693 
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表 2 两组疗效比较
例(%) 组别 例数 临床痊愈 显效 有效 无效 总有效 实验组 43 8(18.60) 20(46.51) 10(23.26) 5(11.63) 38(88.37) 对照组 42 4(9.52) 14(33.33) 15(35.71) 9(21.43) 33(78.57) Z/χ2 2.076 1.483 P 0.038 0.223
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表 3 两组肠黏膜屏障功能比较
X±S 时间 例数 Endotoxin/(EU/mL) Lac/(mg/L) DAO/(U/L) 治疗前 实验组 43 65.62±8.15 12.25±2.16 20.65±2.66 对照组 42 63.85±8.45 11.83±1.85 21.45±2.25 t 0.977 0.962 1.480 P 0.331 0.339 0.143 治疗后 实验组 43 25.45±3.15 3.85±0.65 7.22±1.54 对照组 42 33.52±4.62 5.16±0.87 10.17±2.33 t 9.387 7.922 6.885 P < 0.001 < 0.001 < 0.001
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表 4 两组胃肠动力比较
X±S 时间 例数 MTL/(ng/L) VIP/(pg/mL) CCK/(ng/L) 治疗前 实验组 43 45.42±5.16 75.66±8.24 112.52±10.25 对照组 42 46.65±6.45 73.82±6.65 115.25±9.92 t 0.969 1.131 1.243 P 0.335 0.261 0.217 治疗后 实验组 43 73.36±8.44 52.55±6.32 180.25±18.42 对照组 42 65.25±8.15 60.17±5.85 161.54±15.53 t 4.505 5.770 5.059 P < 0.001 < 0.001 < 0.001
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[1] Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156(7): 2008-2023. doi: 10.1053/j.gastro.2018.12.041
[2] Agarwala R, Rana SS, Sharma R, et al. Gastrointestinal failure is a predictor of poor outcome in patients with acute pancreatitis[J]. Dig Dis Sci, 2020, 65(8): 2419-2426. doi: 10.1007/s10620-019-05952-5
[3] 郭丹妮, 冯淑兰, 董明国. 电针配合大承气汤灌肠辅治重症急性胰腺炎胃肠功能障碍的临床观察[J]. 中国中西医结合消化杂志, 2022, 30(4): 275-279. doi: 10.3969/j.issn.1671-038X.2022.04.08 https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2022.04.08
[4] Li XY, He C, Zhu Y, et al. Role of gut microbiota on intestinal barrier function in acute pancreatitis[J]. World J Gastroenterol, 2020, 26(18): 2187-2193. doi: 10.3748/wjg.v26.i18.2187
[5] 赵静, 程青, 钟强. 乳果糖序贯微生态制剂对重症急性胰腺炎患者的作用[J]. 中国微生态学杂志, 2022, 34(1): 78-81. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS202201015.htm
[6] 高三明. 超早期肠内营养与微生态制剂联合治疗重症急性胰腺炎患者的效果观察[J]. 山西医药杂志, 2020, 49(7): 786-788. doi: 10.3969/j.issn.0253-9926.2020.07.004
[7] 李君秋, 曹红燕, 肖铁刚, 等. 大承气汤治疗急性胰腺炎患者胃肠功能障碍的临床观察[J]. 中国中西医结合消化杂志, 2021, 29(10): 686-690. doi: 10.3969/j.issn.1671-038X.2021.10.03 https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2021.10.03
[8] 吴珊珊. 通腑化瘀汤内服与灌肠联合芒硝外敷治疗重症急性胰腺炎37例临床观察[J]. 北京中医药, 2020, 39(8): 883-885. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO202008031.htm
[9] 葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018: 429-435.
[10] 张伯礼, 吴勉华, 林子强. 中医内科学[M]. 4版. 北京: 中国中医药出版社, 2019: 530-539.
[11] 中华中医药学会脾胃病分会. 急性胰腺炎中医诊疗专家共识意见(2017)[J]. 临床肝胆病杂志, 2017, 33(11): 2052-2057. doi: 10.3969/j.issn.1001-5256.2017.11.002
[12] 宋冰, 汪永锋, 张延英, 等. 中医辨证诊治急性胰腺炎方法研究[J]. 中华中医药学刊, 2020, 38(2): 88-91. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202002024.htm
[13] 林娟, 韩晨霞, 姜坤, 等. 从"不通则痛"探讨急性胰腺炎中西医病机认识[J]. 现代中医临床, 2022, 29(6): 20-25. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYL202206005.htm
[14] 卢丽珠, 崔金玲, 黄秋萍, 等. 中医综合特色疗法在急性胰腺炎中的应用[J]. 中国中医急症, 2020, 29(6): 1076-1078. doi: 10.3969/j.issn.1004-745X.2020.06.037
[15] 赵亮, 尚东, 张桂信, 等. 从"痈"论治急性胰腺炎[J]. 中医杂志, 2020, 61(18): 1639-1642. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202018019.htm
[16] 刘嘉斌. 通腑逐瘀汤保留灌肠温度对急性重症胰腺炎患者腹胀腹痛, 排便改善效果及血清AMS, LPS的影响[J]. 四川中医, 2022, 40(12): 219-221. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202212066.htm
[17] Ding L, Chen HY, Wang JY, et al. Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis[J]. World J Gastroenterol, 2020, 26(5): 514-523.
[18] Carballo-Folgoso L, Rodriguez-Pelaez M, Suarez A. Diffuse hemorrhagic gastropathy as an infrequent complication of necrotizing acute pancreatitis[J]. Rev Esp Enferm Dig, 2021, 113(8): 620.
[19] 郑冰峰, 马刚, 王少渊, 等. 早期肠内营养联合微生态制剂治疗重症急性胰腺炎疗效的荟萃分析[J]. 中华肝胆外科杂志, 2021, 27(2): 128-134.
[20] 代宇, 叶勇, 林影, 等. 微生态制剂对重症急性胰腺炎病人的炎症指标、降钙素原、尿胰蛋白酶原激活肽水平及肠道菌群的影响研究[J]. 安徽医药, 2020, 24(4): 826-830. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY202004049.htm
[21] 曹强, 郭亚菲, 叶蕾蕾, 等. 大黄及其活性成分抗炎作用及机制的研究进展[J]. 中草药, 2022, 53(22): 7285-7294. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202222031.htm
[22] 尹家乐, 张爱香, 王毓炜, 等. 大黄酸精氨酸预防大鼠实验性肠粘连抗炎机制的研究[J]. 中药新药与临床药理, 2010, 21(1): 18-21. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXY201001008.htm
[23] 高飞, 钟辉云, 陈可禧, 等. 大黄有效组分"大黄酸-大黄素"联合治疗溃疡性结肠炎作用机制研究[J]. 中国中药杂志, 2022, 47(15): 4148-4155. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY202215020.htm
[24] 张立辉, 张超, 时霞, 等. 枳实总黄酮苷对胆汁反流性胃炎大鼠的胃黏膜保护作用[J]. 中国临床药理学杂志, 2020, 36(22): 3760-3763. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ202022044.htm
[25] 王煜姣, 贾庆玲, 郭丽坤, 等. 枳实治疗功能性消化不良作用机制的网络药理学分析[J]. 中药新药与临床药理, 2022, 33(5): 666-673. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXY202205013.htm
[26] 陈妤, 吴春松, 江军兵. 肠内营养联合微生态制剂对重症胰腺炎患者的疗效[J]. 中国微生态学杂志, 2021, 33(1): 66-70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS202101013.htm
[27] 李锦春, 钱传云, 蔡乙明, 等. 微生态制剂联合肠内营养对急性重症胰腺炎患者全身炎症反应、细菌移位以及免疫功能的影响[J]. 中国现代医学杂志, 2018, 28(6): 85-89. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY201806018.htm
[28] 赵旭龙, 王超, 李燕. 基于系统药理学方法探究中药大黄治疗胃肠系统疾病及抗炎机制[J]. 沈阳药科大学学报, 2020, 37(11): 1022-1036. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYD202011011.htm
[29] 乐音子, 丁天雯, 谢金, 等. 大黄-桃仁鼻饲联合足三里穴位注射治疗术后粘连性肠梗阻的临床研究[J]. 中国中医急症, 2021, 30(2): 238-240. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202102013.htm
[30] 乐音子, 王晓鹏, 宗阳, 等. "大黄-桃仁"药对防治粘连性肠梗阻物质基础及作用机制研究[J]. 中华中医药学刊, 2019, 37(10): 2349-2353. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201910011.htm
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