加味四磨汤治疗成人功能性便秘及对肠道神经递质的影响
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摘要
目的:观察加味四磨汤对成人功能性便秘(气滞秘)的疗效,探讨其对患者血清肠神经递质一氧化氮合酶(nNOS),一氧化氮(NO),血管活性肠肽(VIP)以及超氧化物歧化酶(SOD)和丙二醛(MDA),谷胱甘肽(GSH)水平的影响。方法:筛选就诊的功能性便秘患者110例,按随机数字表法分为治疗组和对照组各55例。对照组根据常规干预措施,口服促动力药多潘立酮片,1片/次,3次/d;和通便药酚酞片,100 mg/次,2次/d。治疗组采取加味四磨汤内服治疗,每日1剂。两组疗程均连续治疗4周。比较两组患者功能性便秘主要症状、气滞秘症状评分和临床疗效。分析两组患者停药后的便秘复发率。检测血清肠神经递质nNOS,NO,VIP水平以及SOD,MDA,GSH水平。结果:治疗结束后,主要临床症状[排便困难、腹胀、排便时间、排便次数、粪便性状(Bristol)]评分治疗组均明显少于对照组(P <0. 01)。治疗后,气滞秘症状(排便不爽、腹胀、肠鸣、矢气频、胸胁满闷)评分治疗组均明显低于对照组(P <0. 01)。治疗结束后4周,治疗组临床疗效总有效率为98. 04%显著高于对照组的84. 62%(χ2=4. 379,P <0. 05)。停药4和8周时,治疗组便秘复发率分别为3. 92%和8. 16%,均明显低于对照组的18. 18%和27. 78%(P <0. 05)。治疗后,治疗组血清肠神经递质nNOS,NO,VIP水平均明显低于对照组(P <0. 01)。治疗组血清SOD,GSH水平均显著高于对照组,MDA水平低于对照组(P <0. 01)。结论:加味四磨汤治疗成人功能性便秘(气滞秘)可明显改善患者的临床症状和证候症状,提高临床疗效,减少复发率,调节患者体内肠神经递质水平及SOD,MDA,GSH的水平。
Objective: To observe the efficacy of modified Simotang in treatment of adult functional constipation( Qi-stagnancy constipation),and investigate its effects on serum levels of intestinal neurotransmitter nitric oxide synthase( nNOS),nitric oxide( NO),and vasoactive intestinal peptide( VIP),as well as superoxide dismutase( SOD),malonaldehyde( MDA),and glutathione( GSH) levels. Method: One hundred and ten patients with functional constipation were selected and randomly divided into control group( 55 cases) and treatment group( 55 cases) by referring to random number table. The patients in control group were given with routine therapy,Domperidone tablet( 1 tablet/time,tid),and Phenolphthalein tablets( 100 mg/time,bid). The patients in treatment group were treated with modified Simotang,1 dose/day. Both groups were treated for 4 weeks.Then the scores of main clinical symptoms of functional constipation,scores of Qi-stagnancy constipation and clinical efficacy were compared between two groups. Constipation recurrence rate was compared between two groups after stopping medicine. Serum levels of intestinal neurotransmitters nNOS,NO and VIP as well as SOD,MDA,GSH levels were detected in both groups. Result: After treatment,scores for main clinical symptoms( difficult defecation,abdominal distension,defecation time,number of defecation times) and Bristol scores in treatment group were obviously lower than those in control group( P < 0. 01). Scores for symptoms of Qi-stagnancy constipation( ungratifying defecation,abdominal distension, bowel ringing,frequent flatus, chest and flank tightness) in treatment group were obviously lower than those in control group after treatment( P < 0. 01). Total clinical efficacy in treatment group 98. 04% was superior to that in control group 84. 62%( P < 0. 05).Constipation recurrence rate was 3. 92% and 8. 16% in treatment group after 4 and 8 weeks of medication stopping,obviously lower than those in control group 18. 18% and 27. 78%( P < 0. 05). After treatment,serum levels of intestinal neurotransmitters nNOS,NO,VIP in treatment group were remarkably lower than those in control group( P < 0. 01). After treatment,serum levels of SOD and GSH in treatment group were higher while MDA level was lower than those in control group( P < 0. 01). Conclusion: Based on routine therapy,modified Simotang in treatment of adult functional constipation( Qi-stagnancy constipation) can improve clinical symptoms and syndrome symptoms, increase the clinical efficacy, decrease recurrence rate, and regulate levels of intestinal neurotransmitters nNOS,NO and VIP as well as SOD,MDA,GSH levels.
Objective: To observe the efficacy of modified Simotang in treatment of adult functional constipation( Qi-stagnancy constipation),and investigate its effects on serum levels of intestinal neurotransmitter nitric oxide synthase( nNOS),nitric oxide( NO),and vasoactive intestinal peptide( VIP),as well as superoxide dismutase( SOD),malonaldehyde( MDA),and glutathione( GSH) levels. Method: One hundred and ten patients with functional constipation were selected and randomly divided into control group( 55 cases) and treatment group( 55 cases) by referring to random number table. The patients in control group were given with routine therapy,Domperidone tablet( 1 tablet/time,tid),and Phenolphthalein tablets( 100 mg/time,bid). The patients in treatment group were treated with modified Simotang,1 dose/day. Both groups were treated for 4 weeks.Then the scores of main clinical symptoms of functional constipation,scores of Qi-stagnancy constipation and clinical efficacy were compared between two groups. Constipation recurrence rate was compared between two groups after stopping medicine. Serum levels of intestinal neurotransmitters nNOS,NO and VIP as well as SOD,MDA,GSH levels were detected in both groups. Result: After treatment,scores for main clinical symptoms( difficult defecation,abdominal distension,defecation time,number of defecation times) and Bristol scores in treatment group were obviously lower than those in control group( P < 0. 01). Scores for symptoms of Qi-stagnancy constipation( ungratifying defecation,abdominal distension, bowel ringing,frequent flatus, chest and flank tightness) in treatment group were obviously lower than those in control group after treatment( P < 0. 01). Total clinical efficacy in treatment group 98. 04% was superior to that in control group 84. 62%( P < 0. 05).Constipation recurrence rate was 3. 92% and 8. 16% in treatment group after 4 and 8 weeks of medication stopping,obviously lower than those in control group 18. 18% and 27. 78%( P < 0. 05). After treatment,serum levels of intestinal neurotransmitters nNOS,NO,VIP in treatment group were remarkably lower than those in control group( P < 0. 01). After treatment,serum levels of SOD and GSH in treatment group were higher while MDA level was lower than those in control group( P < 0. 01). Conclusion: Based on routine therapy,modified Simotang in treatment of adult functional constipation( Qi-stagnancy constipation) can improve clinical symptoms and syndrome symptoms, increase the clinical efficacy, decrease recurrence rate, and regulate levels of intestinal neurotransmitters nNOS,NO and VIP as well as SOD,MDA,GSH levels.
引文
[1]黄林生,祝琦,高仁元,等.合生元治疗慢性功能性便秘的疗效及对肠道菌群结构的影响研究[J].中国全科医学,2018,21(8):908-913.
[2]黄仁燕,陈勇,彭云花,等.黄杏润肠片治疗轻中度慢传输型便秘45例临床观察[J].中医杂志,2016,57(24):2121-2123.
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[10]中华医学会外科学分会肛肠外科学组.便秘症状及疗效评估[J].中华胃肠外科杂志,2005,8(4):355.
[11]中华中医药学会脾胃病分会.慢性便秘中医诊疗共识意见(2009,深圳)[J].中国中西医结合消化杂志,2010,18(2):136-139.
[12]赵蕾,廖秀军,杨关根,等.慢性功能性便秘基本证型分布特点及相关因素分析[J].中国中西医结合杂志,2014,34(10):1173-1177.
[13]张晓,牛学恩.从调畅气机论治功能性便秘[J].中国中医药现代运程教育,2018,16(4):6 3-64.
[14]龚明,叶丽芝,糜亚男.乌药不同提取液对小鼠肠推进功能影响的实验研究[J].中医药导报,2015,21(2):36-37.
[15]李红念,梅全喜,林焕泽,等.沉香的化学成分、药理作用和临床应用研究进展[J].中国药房,2011,22(35):3349-3351.
[16]孙娟,曹立幸,陈其城,等.槟榔对健康人胃电图及胃动素、促肾上腺皮质激素释放激素的影响[J].中药新药与临床药理,2016,27(2):281-285.
[17]胡源祥,陈海芳,宋玉鹏,等.枳实及其主要活性成分促进脾虚模型大鼠胃肠运动的机制研究[J].中国药房,2017,28(13):1747-1750.
[18]杨滢.大黄药效成分及其药理活性研究进展[J].中医临床研究,2018,10(35):142-144.
[19]苟杰,胥潇,李木瑶,等.木香茎叶提取物成分类别的初步检识及其对小鼠肠推进和胃排空的影响[J].药物评价研究,2017,40(9):1259-1264.
[20]阙任烨,方慧琪,沈艳婷,等. NO及NOS与气阴两虚型功能性便秘相关性及芪榔方的干预作用[J].世界中西医结合杂志,2017,12(4):520-523.
[21]贾蕊,邢海娇,张选平,等.不同刺灸法对功能性便秘大鼠血浆一氧化氮、一氧化氮合酶及结肠血管活性肠肽的影响[J].针刺研究,2017,42(1):50-55.
[22] YIN J,LIANG Y,WANG D,et al. Naringenin induces laxative effects by upregulating the expression levels of c-Kit and SCF,as well as those of aquaporin 3 in mice with loperamide-induced constipation[J]. Int J Mol Med,2018,41(2):649-658.
[23]牛明了,甄欢欢,周晓丽.秦艽提取物对便秘大鼠血清及结肠组织NO,SOD,MDA,GSH水平的影响[J].山东医药,2016,56(5):27-29.
[24]唐洪波,陈宝国,付倩雨,等.右归丸治疗脾肾阳虚型老年功能性便秘的临床观察[J].中国实验方剂学杂志,2015,21(23):168-171.
[2]黄仁燕,陈勇,彭云花,等.黄杏润肠片治疗轻中度慢传输型便秘45例临床观察[J].中医杂志,2016,57(24):2121-2123.
[3]吴胜智,郑卫方,卢中华.四磨汤加减联合莫沙必利治疗气滞型慢性功能性便秘疗效观察[J].新中医,2015,47(4):99-100.
[4]苏兆田,王真.加味四磨汤治疗化疗相关性便秘30例临床观察[J].云南中医中药杂志,2011,32(7):46-47.
[5]赵先平,李丹丹,李湘玉,等.四磨汤治疗便秘概况[J].湖南中医杂志,2015,31(8):196-197.
[6]谢昌营,吴成成,肖慧荣.麻元通便止痛汤对慢传输型便秘大鼠肠道推进功能的影响[J].中国实验方剂学杂志,2018,24(7):154-158.
[7]贺敏,秦建设,吕武宾,等.柚皮苷对胃溃疡大鼠血清及胃黏膜组织中SOD和NO水平的影响[J].重庆医学,2017,46(2):230-232.
[8]中华医学会消化病学分会胃肠动力组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南[J].胃肠病学,2013,18(10):605-612.
[9]中华中医药学会脾胃病分会.便秘中医诊疗专家共识意见(2017)[J].中医杂志,2017,58(15):1345-1349.
[10]中华医学会外科学分会肛肠外科学组.便秘症状及疗效评估[J].中华胃肠外科杂志,2005,8(4):355.
[11]中华中医药学会脾胃病分会.慢性便秘中医诊疗共识意见(2009,深圳)[J].中国中西医结合消化杂志,2010,18(2):136-139.
[12]赵蕾,廖秀军,杨关根,等.慢性功能性便秘基本证型分布特点及相关因素分析[J].中国中西医结合杂志,2014,34(10):1173-1177.
[13]张晓,牛学恩.从调畅气机论治功能性便秘[J].中国中医药现代运程教育,2018,16(4):6 3-64.
[14]龚明,叶丽芝,糜亚男.乌药不同提取液对小鼠肠推进功能影响的实验研究[J].中医药导报,2015,21(2):36-37.
[15]李红念,梅全喜,林焕泽,等.沉香的化学成分、药理作用和临床应用研究进展[J].中国药房,2011,22(35):3349-3351.
[16]孙娟,曹立幸,陈其城,等.槟榔对健康人胃电图及胃动素、促肾上腺皮质激素释放激素的影响[J].中药新药与临床药理,2016,27(2):281-285.
[17]胡源祥,陈海芳,宋玉鹏,等.枳实及其主要活性成分促进脾虚模型大鼠胃肠运动的机制研究[J].中国药房,2017,28(13):1747-1750.
[18]杨滢.大黄药效成分及其药理活性研究进展[J].中医临床研究,2018,10(35):142-144.
[19]苟杰,胥潇,李木瑶,等.木香茎叶提取物成分类别的初步检识及其对小鼠肠推进和胃排空的影响[J].药物评价研究,2017,40(9):1259-1264.
[20]阙任烨,方慧琪,沈艳婷,等. NO及NOS与气阴两虚型功能性便秘相关性及芪榔方的干预作用[J].世界中西医结合杂志,2017,12(4):520-523.
[21]贾蕊,邢海娇,张选平,等.不同刺灸法对功能性便秘大鼠血浆一氧化氮、一氧化氮合酶及结肠血管活性肠肽的影响[J].针刺研究,2017,42(1):50-55.
[22] YIN J,LIANG Y,WANG D,et al. Naringenin induces laxative effects by upregulating the expression levels of c-Kit and SCF,as well as those of aquaporin 3 in mice with loperamide-induced constipation[J]. Int J Mol Med,2018,41(2):649-658.
[23]牛明了,甄欢欢,周晓丽.秦艽提取物对便秘大鼠血清及结肠组织NO,SOD,MDA,GSH水平的影响[J].山东医药,2016,56(5):27-29.
[24]唐洪波,陈宝国,付倩雨,等.右归丸治疗脾肾阳虚型老年功能性便秘的临床观察[J].中国实验方剂学杂志,2015,21(23):168-171.