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目的:探讨加味通腑汤治疗腹泻型肠易激综合征(D-IBS)患者的作用机理。方法:将符合罗马Ⅲ诊断标准[1]D-IBS患者60例设为治疗组,并选择健康体检者30例作为健康对照组,治疗组给与加味通腑汤治疗,疗程30天,两组均通过结肠镜取直肠和乙状结肠交界处黏膜,观察直肠和乙状结肠交界处黏膜5-HT含量的变化,血浆中5-HT含量变化并与健康人进行比较。结果:①治疗组治疗后主要症状积分显著降低(P<0.05);②治疗组治疗前后肠黏膜5-HT免疫组化染色强度均显著高于健康对照组,比较差异有高度统计意义(P<0.05);③D-IBS患者与正常人血浆5-HT水平存在明显差异(P<0.01);④治疗组治疗前后比较,治疗后5-HT免疫组化染色强度均显著降低,比较差异有高度统计意义(P<0.05);⑤无论健康人还是D-IBS患者,直肠和乙状结肠交界处黏膜5-HT的含量和血浆中5-HT含量呈正相关性;与患者的病情程度呈正相关性。结论:调节肠壁及血液中5-HT的正常分泌,可能是加味通腑汤治疗D-IBS的作用机制之一。
Objective: To investigate the mechanism of Jiawei Tongfu Decoction in treating patients with diarrhea-predominant irritable bowel syndrome (D-IBS). Methods: Sixty patients with D-IBS meeting the diagnostic criteria of Rome Ⅲ were enrolled as the treatment group and 30 healthy subjects were selected as the healthy control group. The treatment group was treated with Jia Tong Tong Fu Decoction for 30 days. The two groups The colon mucosa at the junction of rectum and sigmoid colon were taken through colonoscopy. The changes of 5-HT content in mucosa at the junction of rectum and sigmoid colon were observed. The content of 5-HT in plasma was compared with that of healthy people. Results: ① The main symptom scores of the treatment group were significantly decreased after treatment (P <0.05); ② The intensity of 5-HT immunohistochemical staining in the treatment group before and after treatment was significantly higher than that in the healthy control group (P < 0.05) .③The level of 5-HT in plasma of patients with D-IBS was significantly different from that of normal people (P <0.01) .④The intensity of 5-HT immunohistochemical staining in the treatment group before and after treatment was significantly lower than that in the control group (P <0.05). (5) The content of 5-HT in the mucosa at the junction of rectum and sigmoid colon was positively correlated with the content of 5-HT in the plasma in both healthy and D-IBS patients, and was positively correlated with the severity of the disease. Conclusion: Regulating the normal secretion of 5-HT in the intestinal wall and blood may be one of the mechanisms of D-IBS in Jia Tong Tong Fu Tang.