目的 探討參倍固腸膠囊聯(lián)合奧替溴銨治療腹瀉型腸易激綜合征的臨床效果。方法 選取2014年1月—2018年12月永煤集團總醫(yī)院收治的120例腹瀉型腸易激綜合征患者，利用隨機數(shù)字表法分成對照組（n=60）和治療組（n=60）。對照組口服奧替溴銨片，40 mg/次，3次/d。治療組在對照組基礎上口服參倍固腸膠囊，1.8 g/次，3次/d。兩組均連續(xù)治療4周。對比兩組臨床療效，觀察兩組患者治療前后主要癥狀評分、腸易激綜合征生活質(zhì)量（IBS-QOL）量表評分、內(nèi)臟敏感性指標[內(nèi)臟敏感指數(shù)（VSI）量表評分及直腸感覺功能參數(shù)（初始感覺閾值、初始排便沖動閾值、最大耐受閾值）]和血清白細胞介素（IL）-10、腫瘤壞死因子-α（TNF-α）、神經(jīng)肽Y（NPY）、降鈣素相關基因肽（CGRP）、血管活性腸肽（VIP）水平變化情況。結(jié)果 治療后，治療組總有效率為95.0%，顯著高于對照組83.3%（P<0.05）。治療后，兩組大便性狀評分、排便頻次評分、腹痛評分及IBS-QOL量表評分均較本組治療前顯著降低（P<0.05），且治療后治療組主要癥狀評分和IBS-QOL量表評分顯著低于對照組（P<0.05）。兩組治療后VSI量表評分均顯著降低，直腸感覺功能各項參數(shù)（初始感覺、初始排便沖動及最大耐受的閥值）均顯著上升（P<0.05）；且治療后治療組患者VSI量表評分、直腸感覺功能各項參數(shù)改善優(yōu)于對照組（P<0.05）。治療后，兩組患者血清IL-10、NPY水平較本組治療前均顯著升高，而血清TNF-α、CGRP和VIP較本組治療前均顯著降低（P<0.05）；且治療后治療組血清相關炎癥因子和腦腸肽改善優(yōu)于對照組（P<0.05）。結(jié)論 參倍固腸膠囊聯(lián)合奧替溴銨治療腹瀉型腸易激綜合征能安全有效地緩解患者癥狀，改善生活質(zhì)量，降低內(nèi)臟敏感性，減輕機體炎癥反應，正性調(diào)節(jié)體內(nèi)腦腸肽分泌，整體療效確切，值得臨床推廣應用。

Objective To investigate the clinical effect of Shenbei Guchang Capsules combined with otilonium bromide in treatment of diarrheal irritable bowel syndrome. Methods A total of 120 patients with diarrhoeal irritable bowel syndrome admitted to Yongmei Group General Hospital from January 2014 to December 2018 were selected and divided into control group (n=60) and treatment group (n=60) by random number table method. Patients in the control group were po administered with Otilonium Bromide Tablets, 40 mg/time, three times daily. Patients in the treatment group were po administered with Shenbei Guchang Capsules on the basis of the control group, 1.8 g/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, the scores of main symptoms, irritable bowel syndrome quality of life (IBS-QOL) scale, visceral sensitivity index [visceral sensitivity index (VSI) scale score and rectal sensory function parameters before and after treatment. (initial sensory threshold, initial bowel impulse threshold, maximum tolerance threshold)] and serum interleukin (IL)-10, tumor necrosis factor-α (TNF-α), neuropeptide Y (NPY), calcitonin-related gene peptide (CGRP), and vasoactive intestinal peptide (VIP) in two groups were observed. Results After treatment, the total effective rate (95.0%) in treatment group, which was significantly higher than that in control group (83.3%) (P<0.05). After treatment, stool trait score, defecation frequency score, abdominal pain score and IBS-QOL score in two>groups were significantly lower than those before treatment (P<0.05). After treatment, major symptom score and IBS-QOL score in treatment group were significantly lower than those in control group (P<0.05). After treatment, VSI scores in both groups were significantly decreased, but all parameters of rectal sensory function (initial sensation, initial impulse to defecate and threshold of maximum tolerance) were significantly increased (P<0.05). After treatment, the improvement of VSI scale score and rectal sensory function parameters in the treatment group was better than that in the control group (P<0.05). After treatment, serum IL-10 and NPY levels in two groups were significantly increased compared with before treatment, but serum TNF-α, CGRP and VIP were significantly decreased compared with before treatment (P<0.05). After treatment, the improvement of serum inflammatory cytokines and brain-intestinal peptides in treatment group was better than that in control group (P<0.05). Conclusion Shenbei Guchang Capsules combined with otilonium bromide can safely and effectively alleviate the symptoms of patients in treatment of diarrheal irritable bowel syndrome, and can improve the life quality, reduce visceral sensitivity and the inflammatory response of the body, positively regulate the secretion of brain-intestinal peptide in the body, and the overall efficacy is definite, which is worthy of clinical application.

R975

商丘市科技局科技攻關項目（183055）