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平调肝脾法治疗腹泻型肠易激综合征肝郁脾虚型的临床研究
The Clinic Study of Reconcile the Liver and Spleen Method in Treating the Type of Liver Stagnation and Spleen Deficiency of Diarrhea-predominant Irritable Bowel Syndrome
【作者】 谢彬；
【导师】 徐进康；
【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 硕士
【摘要】 目的观察平调肝脾法治疗腹泻型肠易激综合征(IBS-D)肝郁脾虚型的临床疗效及其改善腹泻型肠易激综合征患者生活质量的实际意义；并从理论和临床研究两个方面系统探讨其作用机制。方法采用随机对照研究,将符合研究标准的64例IBS-D肝郁脾虚型患者随机分为治疗组和对照组。治疗组服用平调肝脾汤加减,水煎日一剂,分两次服,辅以饮食调理、心理治疗。对照组服用匹维溴铵片,每次50mg,每日3次；双歧三联活菌胶囊,每次2粒,每日2次；辅以饮食调理、心理治疗。两组均以4周为1个疗程,分别于治疗前、治疗第2周、治疗后各观察一次,共观察1个疗程,治疗结束一个月后随访。主要观察两组患者相关症状及生活质量在不同时期的治疗改善情况,以评定平调肝脾汤的临床疗效。采用SPSS13.0统计软件对相关数据进行处理,得出结论。结果在改善各临床症状方面：两组各临床症状均能得到较大改善(P<0.05),特别是在治疗2周以及治疗后(P<0.01),组间比较治疗组在随访时明显优于对照组(P<0.05)；在中医证侯疗效方面：两组中医证侯总积分均有明显改善(P<0.01),组间比较治疗组疗效优于对照组(P<0.05)；两组证候综合疗效比较,治疗组总有效率为90.63%,对照组总有效率为81.25%,两组比较有显著性差异(P<0.05)；在改善生活质量方面：两组多个维度的量表得分较治疗前有提高(P<0.05),而组间各维度量表得分无明显差异(P>0.05),治疗组在VT、SF、MCS三个维度的症状积分改善与生活质量提高之间有线性相关(P<0.05)。结论两组均能显著地改善IBS-D患者各临床症状、中医证侯及生活质量；两组间比较,治疗组的治疗效果稍优于对照组,尤其是在提高远期疗效方面；治疗组的症状改善与生活质量提高之间存在线性关系。平调肝脾法在治疗IBS-D肝郁脾虚型患者方面具有良好的临床疗效,其突出疗效与其组方严谨、切中病机有关。提示中医药在本病的治疗上有一定的优势,有进一步研究和探讨的价值。
【Abstract】 Objective To observe the clinical curative effect of treating the type of Liver stagnation and Spleen deficiency of diarrhea-predominant irritable bowel syndrome with reconcile the Liver and spleen method, evaluate the relevance to improve the quality of life with this method, and explore the mechanism from theoretical and clinical aspects.Methods 64 cases with IBS-D are divided into two groups at random. Ping-Tiao-Gan-Pi Decoction was given to the treatment group. The control group was given Pi-Wei-Xiu-An and Shuang-Qi-San-Lian-Huo-Jun. Two groups are supplemented by dietary conditioning and psychological treatment. Four weeks for a course of treatment, to observe the related symptoms and quality of life at respectively time when before treatment、the first 2 weeks、after treatment, then follow-up one month later in order to assess the clinical curative effect of this method. SPSS13.0 statistical software will be used for processing data and drawing conclusions.Results In improving the clinical symptoms:two groups were greatly improved, particularly in the 2 weeks and after treatment, in the follow-up, treatment group was superior to control group; In the syndromes of Chinese medicine efficacy:Two groups’ total scores were significantly improved, and the treatment group was superior to the control group; A comprehensive comparative efficacy of two groups of syndromes, treatment group, the total effective rate was 90.63%, in the control group, it was 81.25%, the two groups was significantly different; In improving the quality of life:more than two-dimensional degree of scale scores has been improved compared with before treatment, while the scores for each dimension between two groups were no significant, treatment group in the VT、SF、MCS dimensions, the symptom improvement and improved quality of life have the linear correlation.Conclusion Two groups are significantly improve patients’ clinical symptoms、syndromes in Chinese Medicine and the quality of life; compared the clinical curative effect, the treatment group is slightly better than the control group, especially in improving the long-term efficacy; The treatment group’s symptom improvement and the improved quality of life exist a linear correlation. This method has a good clinical efficacy, its outstanding efficacy is related to its rigorous structure and stringent hit the pathogenesis. Chinese medicine have certain advantages in treating this disease, and it is valuable to give further study and exploration.