IBS-D中医证候分型特点及膳食纤维对IBS-D症状影响的临床研究

发布时间：2018-01-11 01:15

  本文关键词：IBS-D中医证候分型特点及膳食纤维对IBS-D症状影响的临床研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 腹泻型肠易激综合征 高膳食纤维 中医证型 影响

【摘要】：背景:肠易激综合征(irritable bowel syndrome,IBS)是功能性胃肠病(functional gastrointestinal disorders FGIDs)中,最常见的下消化道疾病;IBS发病机制尚未完全阐明,对于IBS的治疗也没有一种彻底有效的治疗药物。研究表明IBS需要采取饮食干预改善症状;目前指南明确的是高膳食纤维食物可能对肠易激综合征便秘型(IBS with constipation,IBS-C)有效,对腹痛及腹泻不利。很少有研究报道高膳食纤维食物与IBS腹泻型(IBS with diarrhea,IBS-D)的关系,有研究报道,不溶性纤维会加重部分IBS患者的症状。本研究运用中西医结合的思想,以祖国医学"饮食有节"的观点,观察通过饮食节制后临床症状和中医证候积分有无改善。目的:在中医理论指导下,对IBS-D进行中医证候分型,并观察膳食纤维干预后中医证候积分的情况。了解患者对膳食纤维知晓情况,探索经膳食纤维干预后IBS-D患者症状、生活质量情况。方法:对于符合纳入标准的患者,随机分为干预组和对照组,两组患者均进行饮食知识普及,干预组进行膳食纤维宣教及干预,对照组进行普通饮食干预;在患者入组时,分别采取肠易激综合征症状量表(IBS-SSS)、膳食纤维表、医院焦虑抑郁自评量表(HAD)、肠易激综合征生活质量量表(IBS-QOL)、中医证候评分表对患者进行问卷调查;在1个月观察期后,予IBS-SSS、IBS-QOL及中医证候积分表对两组患者再次进行问卷调查;采用统计学方法,对治疗前后进行比较。结果:1.根据IBS-SSS的积分,78.69%患者属于中度IBS-D,21.31%属于重度IBS-D,1个月后两组患者程度均有所下降,73.77%的IBS-D患者属于轻度及以下;干预组治疗后IBS-SSS总积分在130.66±51.30,对照组治疗后总积分在163.28±55.62;膳食纤维干预后干预组IBS-SSS总积分的改善明显优于对照组。2.根据IBS-SSS临床疗效改善等级,总体有效率占83.61%,干预组总体有效率为93.75%,对照组总体有效率为72.41%,干预组IBS-SSS疗效的改善明显优于对照组。根据IBS-SSS的腹胀及腹痛积分,两组在治疗前后腹胀腹痛均有明显改善,干预组与对照组比较,在腹痛、腹胀临床症状上,干预组积分改善明显优于对照组。3.91.80%的患者认为食物与IBS有关系,IBS-D患者认为与食物温度(冷食)占70.49%、食物佐料(辣味和辛味)占59.02%、奶制品(牛奶)占45.90%、水果(西瓜和梨)占27.87%、饮料(咖啡和酒)占24.59%、肉蛋类食物(虾、螃蟹及贝壳类)占23.23%、蔬菜类(辣椒、木耳、竹笋)占22.95%;食物是诱发加重IBS症状的重要因素之一。4.虽然88.52%的患者认可膳食纤维并非多多益善,但是81.97%的患者完全不知道膳食纤维,83.61%的患者不知晓膳食纤维与IBS的关系。经干预后,干预组81.25%患者知道一点高膳食纤维食物,18.75%患者完全知道膳食纤维食物;90.63%患者认为膳食纤维与IBS-D有关系,78.13%患者认为膳食纤维食物是加重IBS-D的症状。5.有37.70%IBS-D患者存在明显的焦虑和(或)抑郁,焦虑合并抑郁占3.28%,焦虑或抑郁的患者占34.43%;6.在生活质量上,IBS-D患者在饮食限制、焦虑不安、行为障碍、健康忧虑4个维度表现突出,焦虑不安、行为障碍、躯体意念、健康忧虑、社会反应、人际关系的评分均较治疗前有所下降,饮食限制维度在治疗后均有所升高。一个月治疗后,两组评分无明显差异。表明单纯的膳食纤维干预在患者的生活质量上影响较少。7.JBS-D患者,脾虚湿阻证型(36.99%),肝郁脾虚证型(27.40%),脾胃湿热证型(20.55%),脾肾阳虚证型(12.33%),以脾虚湿阻证型最多,一个月治疗后,两组病例中医证候总积分比治疗前均有改善,干预组治疗后总积分5.19±2.96,对照组治疗后总积分6.41±3.09。干预组与对照组疗效无明显差异,膳食纤维干预在中医证候改善中,无明显疗效。
[Abstract]:Background: irritable bowel syndrome (irritable bowel, syndrome, IBS) is a functional gastrointestinal disease (functional gastrointestinal disorders FGIDs), the most common digestive tract disease; the pathogenesis of IBS has not been fully elucidated, nor a thorough and effective therapy for the treatment of IBS. The results show that IBS needs to take to improve the diet intervention the guide is clear symptoms; high dietary fiber food on constipation type irritable bowel syndrome (IBS with, constipation, IBS-C) is effective against abdominal pain and diarrhea. Few studies have reported high dietary fiber food and diarrhea (IBS with diarrhea IBS, IBS-D) relationship, studies have reported that insoluble fiber will aggravate some of the symptoms of the IBS patients. This study uses the ideas of combining traditional Chinese and Western medicine, Chinese medicine to "diet" point of view, through the observation of diet after clinical symptoms and TCM syndromes have no Objective: to improve. Under the guidance of TCM theory, IBS-D syndromes, and to observe the prognosis of TCM syndrome integral of the dietary fiber. To understand the patient awareness of dietary fiber, dietary fiber and explore the intervention of patients with IBS-D symptoms and quality of life. Methods: the patients who met the criteria were randomized. Divided into intervention group and control group, two groups of patients were treated with dietary knowledge popularization, intervention group, dietary fiber education and intervention, the control group with normal diet intervention; patients in group, respectively take the symptoms of irritable bowel syndrome scale (IBS-SSS), dietary fiber, hospital anxiety and Depression Scale (HAD), irritable bowel syndrome, quality of life scale (IBS-QOL), TCM Syndrome Score questionnaire for patients; 1 months after the observation period, with IBS-SSS, IBS-QOL and TCM syndromes scale of two groups of patients to carry out the questionnaire again Check; by statistical method, were compared before and after treatment. Results: 1. according to IBS-SSS score, 78.69% patients with moderate IBS-D, 21.31% belong to severe IBS-D, 1 months after the two groups of patients were decreased, 73.77% patients with IBS-D and mild; the intervention group after treatment IBS-SSS total score in 130.66 + 51.30 the control group, the total score after treatment in the 163.28 + 55.62; improve the total score of IBS-SSS of intervention group after the intervention of dietary fiber was better than the control group improved.2. grade according to the clinical efficacy of IBS-SSS, the overall efficiency accounted for 83.61%, the effective rate of intervention group was 93.75% overall, the control group total effective rate was 72.41%, the efficacy of IBS-SSS intervention group significantly better than the control group. According to the IBS-SSS integral of abdominal distension and abdominal pain, abdominal distension and pain before and after treatment in the two groups were significantly improved, the intervention group compared with the control group, the clinical symptoms of abdominal pain, abdominal distension, the intervention group integral Improved significantly better than the control group.3.91.80% were thought to be related to food and IBS, IBS-D and patients that food temperature (cold) accounted for 70.49%, food seasoning (spicy and pungent) accounted for 59.02%, accounted for 45.90% of dairy products (milk), fruits (watermelon and pear) accounted for 27.87%, drinks (coffee and wine) accounted for 24.59%, meat and eggs food (shrimp, crabs and shellfish) accounted for 23.23%, vegetables (pepper, mushrooms, bamboo shoots) accounted for 22.95%; food is one of the important factors inducing aggravated symptoms of IBS.4. while 88.52% patients accepted dietary fiber is not The more, the better. 81.97% patients fully, but do not know the relationship between dietary fiber, 83.61% of the patients were unaware of dietary fiber and IBS. After the intervention, the intervention group of 81.25% patients knew a little high dietary fiber food, 18.75% patients fully aware of dietary fiber food; 90.63% patients that have the relationship between dietary fiber and IBS-D, 78.13% of patients believed that the dietary fiber food .5. IBS-D had symptoms of 37.70%IBS-D patients have obvious anxiety and depression (or) anxiety with depression, anxiety or depression accounted for 3.28%, accounted for 34.43% of patients; 6. in the quality of life in patients with IBS-D, dietary restriction, anxiety, behavioral disorders, health concerns 4 dimensions of outstanding performance, anxiety, behavior disorders, physical health concerns, ideas, social response, interpersonal relationship scores were decreased after treatment, dietary restriction dimension have increased. After treatment one month after treatment, no significant difference between the scores of the two groups. Show that dietary fiber intervention is less affected in patients with.7.JBS-D in the quality of life of patients. Spleen deficiency and dampness syndrome (36.99%), liver stagnation and spleen deficiency type (27.40%), DHSS (20.55%), spleen kidney yang deficiency type (12.33%), with spleen deficiency and dampness syndromes most, one month after treatment, two cases of TCM syndrome total score than before the treatment After improvement, the total score of the intervention group was 5.19 + 2.96 after treatment. The total score of the control group was 6.41 + 3.09. after treatment. There was no significant difference between the intervention group and the control group. Dietary fiber intervention had no obvious effect in the improvement of TCM syndromes.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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