Clinical observation and mechanism exploration of Jianchang Zhixie mixture combined with acupoint application for the treatment of diarrhea-predominant irritable bowel syndrome
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摘要: 目的 采用随机单盲法研究健肠止泻合剂联合穴位贴敷治疗腹泻型肠易激综合征的疗效，并观察治疗前后消化道症状评分及血清脑肠肽水平。方法 将门诊收治的90例腹泻型肠易激综合征患者随机分为对照组、治疗A组和治疗B组，每组各30例。其中对照组予以匹维溴铵治疗，治疗A组予以健肠止泻合剂治疗，治疗B组在健肠止泻合剂基础上给予穴位贴敷治疗，观察3组有效率、消化道症状评分、血清5羟色胺、P物质、降钙激素基因相关肽变化及不良反应。结果 治疗B组(96.55%)和治疗A组(86.67%)的总有效率均明显高于对照组(63.33%)(均P < 0.05)；治疗4周后，3组消化道症状评分较治疗前均明显改善(P < 0.05)，以治疗B组改善最为显著。3组治疗前脑肠肽水平差异无统计学意义(P>0.05)，而治疗后均明显下降(P < 0.05)，且以治疗B组下降最为显著。治疗A组和治疗B组的不良反应发生率均明显低于对照组(P < 0.05)。结论 健肠止泻合剂治疗腹泻型肠易激综合征的疗效优于西药匹维溴铵，联合穴位贴敷治疗后效果更佳，无明显不良反应，值得临床推广应用，其机制可能与干预患者体内5羟色胺、P物质、降钙激素基因相关肽等脑肠肽信号相关。Abstract: Objective To study the efficacy of the newly developed Jianchang Zhixie mixture combined with acupoint application in the treatment of diarrhea-predominant irritable bowel syndrome(IBS-D) by the randomized single-blind method.The digestive tract symptom score and brain-gut peptide were also observed or determined before and after the medicinal intervention.Methods Ninety outpatient IBS-D patients were randomized into control group, treatment group A and treatment group B, each group includes 30 volunteers. The control group was treated with piveronium bromide, the Group A was treated with Jianchang Zhixie mixture, the Group B was given acupoint application plus with Jianchang Zhixie mixture. Then the response rate, gastrointestinal symptom score, serum serotonin, substance P and CGRP changes and adverse reactions were observed.Results The total response rate of treatment group B(96.55%) and treatment A(86.67%) was significantly higher than that of the control group(63.33%)(P < 0.05); The gastrointestinal symptom score of the three groups improved significantly than 4 weeks ago(P < 0.05), and the group B is most significant. The pretreatment brain-gut peptide levels in the 3 groups were comparable(P>0.05), while all decreased significantly after treatment(P < 0.05), and the most significant was in group B. The incidence of adverse effects in both treatment groups was significantly lower than that in the control group(P < 0.05).Conclusion The Jianchang Zhixie mixture has an advantage over western medicine perigonium bromide, and the effect is much better when combined with acupoint application. There are no obvious adverse reactions, The therapy is worthy of clinical promotion and application. The mechanism may be related to the intervention of serotonin, substance P, and CGRP in IBS-D in the intervention patients.
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表 1 3组治疗前后总体疗效比较
例 组别 例数 痊愈 好转 显效 无效 总有效率/% 对照组 30 13 3 3 11 63.33 治疗A组 30 16 5 5 4 86.671) 治疗B组 29 17 6 5 1 96.552) 与对照组比较，1)P < 0.05，2)P < 0.01。 
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表 2 3组患者治疗前后消化道症状评分的比较
分，X±S 组别 例数 时间 腹痛 腹胀 排便次数 粪便性状 黏液便 对照组 30 治疗前 2.13±0.39 2.10±0.57 1.87±0.58 1.90±0.67 1.94±0.59 治疗4周后 1.12±0.521) 1.19±0.471) 1.59±0.57 1.61±0.60 1.61±0.55 治疗A组 30 治疗前 2.17±0.51 2.14±0.65 1.77±0.59 1.87±0.53 2.03±0.71 治疗4周后 0.85±0.571)2) 0.89±0.551)2) 0.85±0.521)2) 0.79±0.581)2) 0.90±0.571)2) 治疗B组 29 治疗前 2.08±0.75 2.17±0.69 1.95±0.65 1.96±0.58 2.11±0.46 治疗4周后 0.39±0.521)2) 0.55±0.471)2) 0.45±0.531)2) 0.53±0.641)2) 0.50±0.591)2) 与本组治疗前比较，1)P < 0.05；与对照组比较，2)P < 0.05。
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表 3 3组患者治疗前后血清学指标变化
pg/mL，X±S 组别 例数 时间 5-HT SP CGRP 对照组 30 治疗前 28.11±2.58 88.05±16.97 27.31±20.61 治疗4周后 19.97±2.401) 68.63±13.391) 18.01±10.03 治疗A组 30 治疗前 27.84±5.25 90.85±16.95 27.83±25.52 治疗4周后 14.37±2.021)2) 61.53±11.021)2) 13.17±8.941)2) 治疗B组 29 治疗前 28.45±4.59 89.91±17.15 28.35±21.95 治疗4周后 10.63±1.931)2)3) 50.34±10.391)2) 10.64±8.311)2) 与本组治疗前比较，1)P < 0.05；与对照组比较，2)P < 0.05；与治疗A组比较，3)P < 0.05。
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