目的 探讨参倍固肠胶囊联合奥替溴铵治疗腹泻型肠易激综合征的临床效果。方法 选取2014年1月—2018年12月永煤集团总医院收治的120例腹泻型肠易激综合征患者，利用随机数字表法分成对照组（n=60）和治疗组（n=60）。对照组口服奥替溴铵片，40 mg/次，3次/d。治疗组在对照组基础上口服参倍固肠胶囊，1.8 g/次，3次/d。两组均连续治疗4周。对比两组临床疗效，观察两组患者治疗前后主要症状评分、肠易激综合征生活质量（IBS-QOL）量表评分、内脏敏感性指标[内脏敏感指数（VSI）量表评分及直肠感觉功能参数（初始感觉阈值、初始排便冲动阈值、最大耐受阈值）]和血清白细胞介素（IL）-10、肿瘤坏死因子-α（TNF-α）、神经肽Y（NPY）、降钙素相关基因肽（CGRP）、血管活性肠肽（VIP）水平变化情况。结果 治疗后，治疗组总有效率为95.0%，显著高于对照组83.3%（P<0.05）。治疗后，两组大便性状评分、排便频次评分、腹痛评分及IBS-QOL量表评分均较本组治疗前显著降低（P<0.05），且治疗后治疗组主要症状评分和IBS-QOL量表评分显著低于对照组（P<0.05）。两组治疗后VSI量表评分均显著降低，直肠感觉功能各项参数（初始感觉、初始排便冲动及最大耐受的阀值）均显著上升（P<0.05）；且治疗后治疗组患者VSI量表评分、直肠感觉功能各项参数改善优于对照组（P<0.05）。治疗后，两组患者血清IL-10、NPY水平较本组治疗前均显著升高，而血清TNF-α、CGRP和VIP较本组治疗前均显著降低（P<0.05）；且治疗后治疗组血清相关炎症因子和脑肠肽改善优于对照组（P<0.05）。结论 参倍固肠胶囊联合奥替溴铵治疗腹泻型肠易激综合征能安全有效地缓解患者症状，改善生活质量，降低内脏敏感性，减轻机体炎症反应，正性调节体内脑肠肽分泌，整体疗效确切，值得临床推广应用。

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关项目（183055）