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张旋,周蒙恩,周薏,李苗华,李勇,阙任烨.十宝润肠方对泻药依赖性便秘气阴两虚证结肠动力的影响及其机制[J].湖南中医药大学学报,2021,41(12):1936-1942[点击复制] |
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| 十宝润肠方对泻药依赖性便秘气阴两虚证结肠动力的影响及其机制 |
| 张旋,周蒙恩,周薏,李苗华,李勇,阙任烨 |
| (上海中医药大学附属上海市中西医结合医院肛肠科, 上海 200082;上海中医药大学附属市中医医院脾胃病科, 上海 200071;上海中医药大学附属上海市中西医结合医院脾胃病科, 上海 200082) |
| 摘要: |
| 目的 观察十宝润肠方治疗泻药依赖性便秘气阴两虚证患者的临床疗效以及其对结肠动力的影响及其机制。方法 采用随机数字表法将60例泻药依赖性便秘气阴两虚证患者分为2组，每组30例，治疗组予十宝润肠方治疗，对照组予乳果糖口服液治疗，两组疗程均为4周。观察并记录两组患者治疗前后的总体临床有效率；比较两组患者Bristol粪便性状分型正常比率、Wexner便秘症状评分、平均每周自发完全排便次数（spontaneous complete bowel movement，SCBM）；通过结肠传输试验观察两组患者结肠动力改变情况；ELISA法检测血清一氧化氮（nitric oxide，NO）、血管活性肠肽（vasoactive intestinal peptide，VIP）、P物质（substance P，SP）、胃动素（motilin，MTL）含量；采用气相色谱-质谱联用技术检测粪便乙酸、丙酸、丁酸及总短链脂肪酸（short-chain fatty acids，SCFAs）含量。结果 治疗组总有效率83.33%，对照组总有效率为53.33%，治疗组总体疗效优于对照组（P<0.05）。治疗后，两组Bristol粪便性状分型正常比率较治疗前明显升高（P<0.05）；治疗组Bristol粪便性状分型正常比率为63.3%，高于对照组的33.3%（P<0.05）。治疗后，两组Wexner评分明显降低（P<0.05），且治疗组Wexner评分低于对照组（P<0.05）。治疗后，治疗组在48、72 h两个时间节点残留标志物比率明显降低（P<0.05）；对照组在72 h节点残留标志物比率明显降低（P<0.05）；治疗组在72 h节点残留标志物比率较对照组明显降低（P<0.05）。治疗时间因素对治疗组SCBM有影响（P<0.05），但对对照组SCBM影响不大（P>0.05）。治疗后，治疗组血清NO、VIP含量较治疗前明显降低（P<0.05），血清SP含量较治疗前明显升高（P<0.05）；对照组血清NO含量较治疗前明显降低（P<0.05），血清SP含量较治疗前明显升高（P<0.05）；治疗组在改善血清NO、VIP、SP含量方面明显优于对照组（P<0.05）。治疗后，治疗组粪便乙酸、丙酸、丁酸及总SCFAs含量较治疗前明显升高（P<0.05）；对照组粪便乙酸、总SCFAs含量较治疗前明显升高（P<0.05）；治疗组在改善粪便丙酸、丁酸及总SCFAs含量方面明显优于对照组（P<0.05）。结论 十宝润肠方对泻药依赖性便秘总体疗效优于乳果糖，对结肠动力具有显著的促进作用，其机制主要与调节胃肠激素或神经递质水平及SCFAs的生成有关。 |
| 关键词: 泻药依赖性便秘 十宝润肠方 胃肠激素 结肠动力 神经递质 短链脂肪酸 |
| DOI：10.3969/j.issn.1674-070X.2021.12.020 |
| 投稿时间：2021-10-13 |
| 基金项目:上海市青年科技英才扬帆计划项目（19YF1445200）；虹口区“国医强优”中医药科研基金项目（HGY-KY-2018-20）；上海市科委引导类项目（18401904000）。 |
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| Effect and Mechanism of Shibao Runchang Recipe on Colonic Motility in Cathartic-dependent Constipation with Qi-Yin Deficiency Syndrome |
| ZHANG Xuan,ZHOU Meng'en,ZHOU Yi,LI Miaohua,LI Yong,QUE Renye |
| (Department of Anorectal, Shanghai TCM-integrated Hospital Affiliated Shanghai University of Traditional Chinese Medicine, Shanghai, 200082, China;Department of Gastroenterology, Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China;Department of Gastroenterology, Shanghai TCM-integrated Hospital Affiliated Shanghai University of Traditional Chinese Medicine, Shanghai, 200082, China) |
| Abstract: |
| Objective To observe the clinical efficacy of Shibao Runchang Recipe in the treatment of cathartic-dependent constipation with Qi-Yin deficiency syndrome and its effect and mechanism on colonic motility. Methods 60 cathartic-dependent constipation with Qi-Yin deficiency syndrome patients were randomly divided into two groups, with 30 cases in each group. The treatment group was treated with Shibao Runchang Recipe, and the control group was treated with lactulose oral liquid. The course of treatment in both groups was 4 weeks. The overall clinical effective rate of the two groups before and after treatment was observed and recorded, and normal rate of Bristol fecal traits typing, Wexner constipation symptom score, and the average number of spontaneous complete bowel movement (SCBM) per week were compared. The changes of colonic motility were observed by colonic transit test. The content of serum nitric oxide (NO), vasoactive intestinal peptide (VIP), substance P (SP), motilin (MTL) was detected by ELISA. The content of acetic acid, propionic acid, butyric acid and total short chain fatty acids (SCFAs) in feces was determined by gas chromatography-mass spectrometry. Results The total effective rate of the treatment group was 83.33%, and that of the control group was 53.33%. The overall efficacy of the treatment group was better than that of the control group (P<0.05). After treatment, the normal rate of Bristol fecal traits typing in both groups was significantly higher than before treatment (P<0.05). The normal rate of Bristol fecal traits typing in the treatment group was 63.3%, higher than 33.3% in the control group (P<0.05). After treatment, Wexner score in both groups decreased significantly (P<0.05), and Wexner score in the treatment group was lower than that in the control group (P<0.05). After treatment, the ratio of residual markers in the treatment group was significantly decreased at 48 and 72 hours (P<0.05). The ratio of residual markers at 72 hours in control group was significantly decreased (P<0.05). The ratio of residual markers at 72 hours in the treatment group was significantly lower than that in the control group (P<0.05). Treatment time factor had influence on SCBM of treatment group (P<0.05), but had little influence on SCBM of control group (P>0.05). After treatment, compared with before treatment, the content of serum NO and VIP in the treatment group was significantly decreased (P<0.05), and the content of serum SP was significantly increased (P<0.05). In the control group, the serum NO content was significantly decreased (P<0.05), and the serum SP content was significantly increased (P<0.05). The content of serum NO, VIP and SP in treatment group was significantly better than those in control group (P<0.05). After treatment, the content of acetic acid, propionic acid, butyric acid and total SCFAs in feces of the treatment group was significantly higher than those before treatment (P<0.05); the content of acetic acid and total SCFAs in feces of control group was significantly higher than those before treatment (P<0.05); the content of propionic acid, butyric acid and total SCFAs in the treatment group was significantly better than that in the control group (P<0.05). Conclusion Shibao Runchang Recipe has better effect than lactulose in the treatment of cathartic-dependent constipation, and can significantly promote colonic motility. Its mechanism is mainly related to the regulation of gastrointestinal hormone or neurotransmitter levels and the production of SCFAs. |
| Key words: cathartic-dependent constipation Shibao Runchang Recipe gastrointestinal hormone colonic motility neurotran- smitter short chain fatty acids |
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