标题：健脾理气润肠法治疗STC对患者临床症状及肠神经递质水平的影响

      作者：梁榕钰，邓蓓蕾    上海市静安区中医医院肛肠科，上海 200040

      卷次： 2024年35卷4期

      【摘要】 目的 研究健脾理气润肠法应用于慢传输型便秘(STC)患者中的临床效果。方法 选取2021年8月至2022年12月上海市静安区中医医院肛肠科收治的120例STC患者作为研究对象，采用随机数表法将所有患者分为两组各60例，跟踪随访1个月后，脱落5例，最终115例患者完成研究。其中58例接受乳果糖口服液治疗者设为对照组，57例接受健脾理气润肠汤联合乳果糖口服液治疗者设为观察组。比较两组患者治疗1个月后的治疗效果，以及入院时、治疗7 d、治疗 1个月后的便秘主要性状评分、便秘患者症状自评量表(PAC-SYM)评分、Bristol评分、肠神经递质水平[生长抑素(SS)、血管活性肠肽(VIP)、P物质(SP)]和治疗24 h、48 h、72 h的结肠传输试验标志物残留率。结果 观察组患者的治疗总有效率为98.25%，明显高于对照组的86.21%，差异有统计学意义(P<0.05)；两组患者入院时的便秘主要症状评分比较差异均无统计学意义(P>0.05)；治疗7 d、1个月后，观察组患者的各项便秘主要症状评分明显低于对照组，差异均有统计学意义(P<0.05)；治疗7 d和1个月后，观察组患者的Bristol评分分别为(21.35±5.69)分、(15.63±3.88)分，明显低于对照组的(28.96±4.19)分、(20.20±4.52)分，PAC-SYM评分分别为(5.96±0.88)分、(6.33±0.76)分，明显高于对照组的(4.55±0.87)分、(5.69±0.74)分，差异均有统计学意义(P<0.05)；治疗7 d、1个月后，观察组患者的SS水平分别为(18.52±3.44) ng/mL、(14.20±3.52) ng/mL，明显低于对照组的(21.20±3.69) ng/mL、(18.41±3.66) ng/mL，VIP水平分别为(36.52±5.58) ng/mL、(25.63±7.41) ng/mL，明显低于对照组的(40.10±5.20) ng/mL、(31.20±6.85) ng/mL，SP水平分别为(40.52±6.88) ng/mL、(55.52±7.41) ng/mL，明显高于对照组的(35.63±4.20) ng/mL、(44.52±8.52) ng/mL，差异均有统计学意义(P<0.05)；治疗24 h、48 h、72 h后观察组患者的肠传输实验标志物残留率分别为(60.00±4.20)%、(30.00±5.10)%、(15.00±2.21)%，明显低于对照组的(68.75±5.52)%、(40.00±5.55)%、(20.00±2.55)%，差异均有统计学意义(P<0.05)。结论 健脾理气润肠法应用于STC患者中，可明显改善肠神经递质水平，患者短时间内临床症状得以缓解，且传输实验标志物残留率低，利于减轻不适感。
      【关键词】 慢传输型便秘；健脾理气润肠法；乳果糖；疗效
      【中图分类号】 R574.4 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0486—06

Effects of invigorating spleen, regulating Qi, and moistening intestine therapy on clinical symptoms and intestinalneurotransmitter levels in patients with slow transit constipation.
LIANG Rong-yu, DENG Bei-lei. Department ofProctology, Shanghai Jing'an District Traditional Chinese Medicine Hospital, Shanghai 200040, CHINA
【Abstract】 Objective To study the clinical effect of Jianpi Liqi Runchang decoction (invigorating spleen,regulating Qi, and moistening intestine) in patients with slow transit constipation (STC). Methods A total of 120 STCpatients admitted to Department of Proctology, Shanghai Jing'an District Traditional Chinese Medicine Hospital fromAugust 2021 to December 2022 were selected as the study objects. All patients were divided into two groups by randomnumber table method, with 60 cases in each group. After 1 month of follow-up, 5 cases were lost, and 115 patientsfinally completed the study. Among them, 58 patients receiving lactulose oral liquid treatment were set as control group,and 57 patients receiving Jianpi Liqi Runchang decoction combined with lactulose oral liquid treatment were set asobservation group. The treatment effect of the two groups was compared after 1 month of treatment. At admission, 7days after treatment, and 1 month after treatment, main symptoms score of constipation, Patient Assessment ofConstipation Symptoms (PAC-SYM) score, Bristol score, intestinal neurotransmitter levels [somatostatin (SS),vasoactive intestinal peptide (VIP), substance P (SP)], and residual rate of colon transport test markers at 24 h, 48 h, and72 h after treatment were also compared. Results The total effective rate of observation group was 98.25%, which wassignificantly higher than 86.21% of the control group (P<0.05). There was no significant difference in the scores ofmajor symptoms of constipation between the two groups at admission (P>0.05). After 7 days and 1 month of treatment,the scores of major symptoms of constipation in the observation group were significantly lower than those in the controlgroup, with statistically significant differences (P<0.05). After 7 days and 1 month of treatment, the Bristol scores of theobservation group were (21.35±5.69) points and (15.63±3.88) points, respectively, which were significantly lower than(28.96±4.19) points and (20.20±4.52) points of the control group; the PAC-SYM scores were (5.96±0.88) points and(6.33±0.76) points, respectively, which were significantly higher than (4.55±0.87) points and (5.69±0.74) points in thecontrol group; the differences were statistically significant (P<0.05). After 7 days and 1 month of treatment, SS levels inobservation group were (18.52± 3.44) ng/mL and (14.20±3.52) ng/mL, respectively, significantly lower than (21.20±3.69) ng/mL and (18.41±3.66) ng/mL in the control group, respectively; VIP levels were (36.52±5.58) ng/mL and (25.63±7.41) ng/mL, which were significantly lower than (40.10±5.20) ng/mL and (31.20±6.85) ng/mL of the control group,respectively; SP levels were (40.52±6.88) ng/mL and (55.52±7.41) ng/mL, respectively, which were significantly higherthan (35.63±4.20) ng/mL and (44.52±8.52) ng/mL in the control group; the differences were statistically significant (P<0.05). At 24 h, 48 h, and 72 h after treatment, the residual rates of intestinal transmission test markers in the observationgroup were (60.00±4.20)%, (30.00±5.10)%, and (15.00±2.21)%, respectively. significantly lower than (68.75±5.52)%,(40.00±5.55)%, (20.00±2.55)% in the control group (P<0.05). Conclusion The application of Jianpi Liqi Runchangdecoction in patients with STC can significantly improve the level of intestinal neurotransmitters, relieve the clinicalsymptoms of patients in a short time, and lower the residual rate of transmission test markers, which is conducive toreducing discomfort.
      【Key words】 Slow transit constipation; Invigorating spleen, regulating Qi, and moistening intestine method; Lact-ulose; Curative effect