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| 痛泻要方治疗肝郁脾虚型UCr-IBS的临床疗效和机制研究 |
| Clinical efficacy and mechanism of Tong-Xie-Yao-Fang in the treatment of liver-depression and spleen-deficiency type UCr-IBS |
| 投稿时间：2025-05-16 修订日期：2025-05-16 |
| 中文关键词: 溃疡性结肠炎，肠易激综合征，痛泻要方，低-FODMAP饮食，肝郁脾虚 |
| 英文关键词: Ulcerative Colitis, Irritable Bowel Syndrome, Tong-Xie-Yao-Fang, Low-FODMAP Diet, Liver Depression and Spleen Deficiency |
| 基金项目:浙江省中医药科技计划项目(No.2023ZL464)；浙江省基础公益研究计划项目(No.LQ23H270008)。 |
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| 中文摘要: |
| 目的：观察痛泻要方对肝郁脾虚型缓解期溃疡性结肠炎（UCr）患者肠易激综合征（IBS）样症状（UCr-IBS）的临床疗效并探讨作用机制。
方法：将2023年6月至2024年12月就诊的121例肝郁脾虚型UCr-IBS患者，随机分为低FODMAP饮食组（LFD）及痛泻要方组。LFD组基于UC 基础用药，并遵循LFD饮食。痛泻要方组基于UC 基础用药，遵循常规饮食，并口服痛泻要方治疗，两组患者治疗周期均为8周。比较两组患者治疗前后中医证候疗效评分，IBS症状严重程度量表（IBS-SSS），内脏敏感性指数（VSI），广泛性焦虑障碍7项量表（GAD-7），患者健康问卷-9（PHQ-9）和炎症性肠病简短生活质量量表（SIBDQ）积分。并检测两组患者治疗前后结肠黏膜组织中促肾上腺皮质激素释放因子受体1（CRH-R1）和受体2（CRH-R2）mRNA的相对表达水平。
结果：痛泻要方组患者中医证候疗效有效率明显高于LFD组（P<0.05）。两组患者治疗后IBS-SSS评分和VSI较治疗前均下降，痛泻要方组患者治疗后IBS-SSS评分和VSI均低于LFD组（P<0.05）；痛泻要方组患者治疗后GAD-7，PHQ-9评分较治疗前明显降低（P<0.001），且低于LFD组（P<0.05）。痛泻要方组患者治疗后SIBDQ评分较治疗前明显升高（P<0.001），且高于LFD组（P<0.05）。两组患者治疗后结肠黏膜中CRH-R1 mRNA的相对表达量较治疗前降低，而CRH-R2 mRNA的相对表达量较治疗前升高，且痛泻要方组较LFD组CRH-R1 和CRH-R2 mRNA水平改善更明显，提示痛泻要方可能通过恢复 CRH-R1 和 CRH-R2 的平衡状态，从而治疗UCr-IBS。
结论：痛泻要方可以减轻肝郁脾虚型UCr-IBS患者的IBS样症状，降低内脏敏感性，缓解了焦虑和抑郁水平，并提高了生活质量，其结果优于 LFD。痛泻要方改善UCr-IBS的作用机制可能是通过调控CRH通路，恢复CRH-R1和 CRH-R2 的平衡状态。 |
| 英文摘要: |
| OBJECTIVE: To observe the clinical efficacy of Tong-Xie-Yao-Fang on irritable bowel syndrome (IBS)-like symptoms (UCr-IBS) in patients with remission-phase ulcerative colitis (UCr) with liver-depressing and spleen-deficient type, and to explore the mechanism of action.
METHODS: One hundred and twenty-one patients with UCr-IBS with liver-depression and spleen-deficiency were randomly divided into the low-FODMAP diet group (LFD) and the Tong-Xie-Yao-Fang group from June 2023 to December 2024. The LFD group was administered UC-based medication and followed the LFD diet. In contrast, the Tong-Xie-Yao-Fang group was based on UC-based medication, followed the regular diet, and took the Tong-Xie-Yao-Fang orally, and the treatment period of both groups was 8 weeks. The TCM efficacy scores, IBS Symptom Severity Scale (IBS-SSS), Visceral Sensitivity Index (VSI), Generalised Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Short Inflammatory Bowel Disease Disease Quality of Life (SIBDQ) were compared before and after the treatment in both groups. The relative expression levels of corticotropin-releasing factor receptor 1 (CRH-R1) and receptor 2 (CRH-R2) mRNA in the colonic mucosal tissues before and after treatment were also detected in the two groups of patients.
RESULTS: The effective rate of Chinese medicine evidence of efficacy of patients in the Tong-Xie-Yao-Fang group was significantly higher than that of the LFD group (P<0.05). The IBS-SSS score and VSI of the patients in both groups decreased after treatment compared with those before treatment, and the IBS-SSS score and VSI of the patients in the Tong-Xie-Yao-Fang group were lower than those in the LFD group (P<0.05); the GAD-7 and PHQ-9 scores of the patients in the Tong-Xie-Yao-Fang group decreased significantly after treatment compared with those before treatment (P<0.001) and were lower than those in the LFD group (P<0.05). The SIBDQ scores of patients in the Tong-Xie-Yao-Fang group were significantly higher after treatment than before treatment (P<0.001) and higher than those of the LFD group (P<0.05). The relative expression of CRH-R1 mRNA in the colonic mucosa of the two groups was lower than that before treatment, while the relative expression of CRH-R2 mRNA was higher than that before treatment, and the improvement of CRH-R1 and CRH-R2 mRNA levels in the Tong-Xie-Yao-Fang group was more pronounced than that in the LFD group, which suggested that Tong-Xie-Yao-Fang might be able to treat UCr-IBS by restoring the equilibrium state of CRH-R1 and CRH-R2.
CONCLUSION: The Tong-Xie-Yao-Fang can reduce IBS-like symptoms, decrease visceral sensitivity, alleviate anxiety and depression, and improve quality of life in patients with liver-depression and spleen-deficiency type of UCr-IBS, which is superior to that of LFD. The mechanism of action of the Tong-Xie-Yao-Fang in improving UCr-IBS may be to restore the homeostasis of CRH-R1 and CRH-R2 by modulating the CRH pathway. |
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