| 摘要: |
| 目的：探讨加味痛泻要方联合穴位埋线治疗腹泻型肠易激综合征（IBS-D）肝郁脾虚证的临床疗效。方法：将60 例IBS-D患者随机分为治疗组和对照组，每组各30 例。治疗组予加味痛泻要方联合穴位埋线治疗，对照组予马来酸曲美布汀片治疗，治疗4周后比较2组患者的临床疗效及治疗前后中医证候积分、肠易激综合征症状严重程度量表（IBS-SSS）评分、肠易激综合征生活质量量表（IBS-QOL）评分、汉密尔顿焦虑量表（HAMA) 及汉密尔顿抑郁量表（HAMD）评分变化，检测2组患者治疗前后5-羟色胺（5-HT）、P物质（SP）、血管活性肠肽（VIP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）及肿瘤坏死因子-α（TNF-α） 水平，以及不良反应发生率和复发率。结果：总有效率治疗组为93.33%（28/30），对照组为63.33%（19/30），2组比较，差异有统计学意义（P＜0.05）。治疗后2组患者中医证候积分，IBS-SSS、HAMA、HAMD评分均低于本组治疗前，IBS-QOL评分高于本组治疗前，且治疗组的改善程度更优（P＜0.05）。治疗后2组患者5-HT、SP、VIP、IL-6、IL-8、TNF-α 水平低于本组治疗前，且治疗后治疗组低于对照组（P＜0.05）。治疗过程中，不良反应发生率治疗组为6.67%（2/30），对照组为3.33%（1/30），2组比较，差异无统计学意义（P>0.05）。停药4周后对2组有效患者进行随访，治疗组的复发率为14.29%（4/28），低于对照组的42.11%（8/19），差异有统计学意义（P＜0.05）。结论：加味痛泻要方联合穴位埋线治疗IBS-D疗效确切，能够显著改善患者临床症状，缓解焦虑、抑郁状态，降低脑肠肽及炎性因子水平，且未见明显不良反应，值得临床推广。 |
| 关键词: 腹泻型肠易激综合征 肝郁脾虚 加味痛泻要方 穴位埋线 |
| DOI： |
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| Clinical effect of modified Tongxieyaofang combined with acupoint thread-embedding therapy in treatment of diarrhea-predominant irritable bowel syndrome：An analysis of 30 cases |
| CHEN Cheng,ZHANG Zhuhui,WANG Yipei |
| (Guangdong Second Provincial Traditional Chinese Medicine Hospital (Huangpu Hospital)，Guangzhou 510530，Guangdong，China;The First Affiliated Hospital of Hunan University of Chinese Medicine，Changsha 410007，Hunan，China;The Second Affiliated Hospital of Hunan University of Chinese Medicine，Changsha 410005，Hunan，China) |
| Abstract: |
| Objective：To investigate the clinical effect of modified Tongxieyaofang combined with acupoint thread-embedding therapy in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) in stagnation of liver Qi and spleen deficiency.Methods：A total of 60 patients with IBS-D were randomly divided into treatment group and control group，with 30 patients in each group.The patients in the treatment group were given modified Tongxieyaofang combined with acupoint thread-embedding therapy，and those in the control group were given trimebutine maleate tablets.After 4 weeks of treatment，the two groups were compared in terms of clinical outcome，traditional Chinese medicine (TCM) syndrome score，Irritable Bowel Syndrome-Severity Scoring System (IBS-SSS) score，Irritable Bowel Syndrome-Quality of Life (IBS-QOL) score，Hamilton Anxiety Scale (HAMA) score，and Hamilton Depression Scale (HAMD) score before and after treatment，and the levels of 5-hydroxytryptamine (5-HT)，substance P (SP)，vasoactive intestinal peptide (VIP)，interleukin-6 (IL-6)，interleukin-8 (IL-8)，and tumor necrosis factor-α (TNF-α) were measured；the incidence rates of adverse reactions and recurrence rate were also compare between the two groups.Results：There was a significant difference in overall response rate between the treatment group and the control group ［93.33% (28/30) vs 63.33% (19/30)，P＜0.05］.After treatment，both groups had significant reductions in TCM syndrome score，IBS-SSS score，HAMA score，and HAMD score and a significant increase in IBS-QOL score，and the treatment group had significantly greater changes than the control group (P＜0.05).After treatment，both groups had significant reductions in the levels of 5-HT，SP，VIP，IL-6，IL-8，and TNF-α，and the treatment group had significantly lower levels than the control group (P＜0.05).There was no significant difference in the incidence rate of adverse reactions between the two groups during treatment ［6.67% (2/30) vs 3.33% (1/30)，P>0.05］.After 4 weeks of drug withdrawal，follow-up was conducted for the patients with response in the two groups，and the treatment group had a significantly lower recurrence rate than the control group ［14.29% (4/28) vs 42.11% (8/19)，P＜0.05］.Conclusion：Modified Tongxieyaofang combined with thread-embedding therapy at acupoints has a marked clinical effect in the treatment of IBS-D and can improve patients’ clinical symptoms，alleviate anxiety and depression，and reduce the levels of brain-gut peptide and inflammatory factors，with little adverse effect，and therefore，it holds promise for clinical application. |
| Key words: diarrhea-predominant irritable bowel syndrome stagnation of liver Qi and spleen deficiency modified Tongxieyaofang acupoint thread-embedding therapy |
