摘要
目的基于析因设计探讨皮内针联合大承气汤加减灌肠方对恶性肠梗阻(malignant bowel obstruction,MBO)患者肠黏膜屏障功能的影响。方法选取2023年7月~2024年11月中国中医科学院广安门医院南区收治的135例MBO患者作为研究对象,其中15例不符合纳入标准,最终纳入120例患者。采用随机数字法将患者分为4组,A组:甘油灌肠;B组:甘油灌肠+皮内针;C组:中药灌肠;D组:皮内针+中药灌肠,每组各30例。重复测量方差分析比较4组患者治疗前后症状评分、胃肠动力功能指标以及肠黏膜屏障功能指标、卡氏功能状态(Karnofsky performance status,KPS)评分。析因方差设计分析比较各组患者肠黏膜屏障功能指标。线性回归方法分析患者症状评分、胃肠动力功能指标与肠黏膜屏障功能指标的关联。结果4组患者治疗前、治疗7 d后、治疗14 d后的症状评分比较,经重复测量方差分析,结果显示:①不同时间点的症状评分均有差异(P<0.05);②4组患者症状评分均有差异(P<0.05),D组治疗后各评分最低;③4组患者症状评分变化趋势有差异(P<0.05)。4组患者治疗前、治疗7 d后、治疗14 d后的胃肠动力功能指标比较,经重复测量方差分析,结果显示:①不同时间点的胃肠动力功能指标均有差异(P<0.05);②4组患者胃肠动力功能指标均有差异(P<0.05),D组治疗后血管活性肠肽(vasoactive intestinal peptide,VIP)水平最低,胃泌素、胃动素水平最高;③4组患者胃肠动力功能指标变化趋势有差异(P<0.05)。对4组患者治疗前、治疗7 d后、治疗14 d后的肠黏膜屏障功能指标进行比较,经重复测量方差分析,结果显示:①不同时间点的D-乳酸、内毒素(endotoxin,ET)、二胺氧化酶(diamine oxidase,DAO)水平均有差异(P<0.05);②4组患者D-乳酸、ET、DAO水平均有差异(P<0.05),D组治疗后较其他三组水平低;③4组患者D-乳酸、ET、DAO水平的变化趋势有差异(P<0.05)。析因设计方差分析结果显示,中药灌肠与皮内针的交互效应显著,D-乳酸:F=10.317,P<0.001,偏η^(2)=0.376;ET:F=18.025,P<0.001,偏η^(2)=0.599;DAO:F=20.114,P<0.001,偏η^(2)=0.623。线性回归分析结果显示,患者各症状评分、胃肠动力功能指标与肠黏膜屏障功能指标存在相关性(P<0.05)。对4组患者治疗前、治疗7 d后、治疗14 d后的KPS评分进行比较,经重复测量方差分析,结果显示:①不同时间点的KPS评分有差异(P<0.05);②4组患者KPS评分有差异(P<0.05),D组治疗后较其他三组评分高;③4组患者KPS评分变化趋势有差异(P<0.05)。A、B、C、D组患者临床有效率分别为:53.33%、70.00%、80.00%和83.33%,差异具有统计学意义(P<0.05),与其他三组比较,D组表现出较好的临床疗效。结论皮内针联合大承气汤加减灌肠方可以改善患者肠梗阻相关症状,提高MBO患者胃肠动力功能以及肠黏膜屏障功能,从而改善患者健康状况。
Objective To explore the effect of intradermal needle combined with modified Dachengqi Decoction for enema on intestinal mucosal barrier function in patients with malignant bowel obstruction(MBO)based on factorial design.Methods A total of 135 patients with MBO admitted to Southern District,Guang’anmen Hospital,China Academy of Chinese Medical Sciences from July 2023 to November 2024 were selected as research subjects.Among them,15 patients did not meet the inclusion criteria,and 120 patients were finally included.The patients were divided into four groups by random number method,group A:glycerin enema;group B:glycerin enema+intradermal needle;group C:traditional Chinese medicine(TCM)enema;group D:intradermal needle+TCM enema,with 30 cases in each group.Repeated measures analysis of variance was used to compare symptom scores,indicators of gastrointestinal motility function and intestinal mucosal barrier function,and Karnofsky performance status(KPS)scores before and after treatment in four groups of patients.Factorial design analysis of variance was used to compare intestinal mucosal barrier function indicators of patients in each group.The correlation between symptom scores,gastrointestinal motility function indicators and intestinal mucosal barrier function indicators was analyzed by linear regression method.Results Symptom scores of four groups of patients were compared before treatment,after 7 days of treatment,and after 14 days of treatment.The results of repeated measures analysis of variance showed that:①There were differences in symptom scores at different time points(P<0.05);②There were differences in symptom scores among four groups of patients(P<0.05),with group D having the lowest scores after treatment;③There were significant differences in the trend of symptom scores among four groups of patients(P<0.05).Gastrointestinal motility function indicators of four groups of patients were compared before treatment,after 7 days of treatment,and after 14 days of treatment.The results of repeated measures analysis of variance showed that:①There were differences in gastrointestinal motility function indicators at different time points(P<0.05);②There were differences in gastrointestinal motility function indicators among four groups of patients(P<0.05).After treatment,the level of vasoactive intestinal peptide(VIP)was the lowest in group D,while levels of gastrin and motilin were the highest;③There were differences in the trend of gastrointestinal motility function indicators among four groups of patients(P<0.05).Intestinal mucosal barrier function indicators of four groups of patients were compared before treatment,after 7 days of treatment,and after 14 days of treatment.The results of repeated measures analysis of variance showed that:①There were differences in the levels of D-lactic acid,endotoxin(ET),and diamine oxidase(DAO)at different time points(P<0.05);②There were differences in the levels of D-lactic acid,ET,and DAO among four groups of patients(P<0.05),with group D showing lower levels after treatment compared with the other three groups;③There were differences in the trend of levels of D-lactate,ET,and DAO among four groups of patients(P<0.05).The results of factorial design analysis of variance showed that the interaction effect between TCM enema and intradermal needle was significant,and D-lactate:F=10.317,P<0.001,partialη^(2)=0.376;ET:F=18.025,P<0.001,partialη^(2)=0.599;DAO:F=20.114,P<0.001,partialη^(2)=0.623.The results of linear regression analysis showed that there was a correlation between the patient’s symptom scores,gastrointestinal motility function indicators and intestinal mucosal barrier function indicators(P<0.05).The KPS scores of four groups of patients were compared before treatment,after 7 days of treatment,and after 14 days of treatment.The results of repeated measures analysis of variance showed that:①There were differences in KPS scores at different time points(P<0.05);②There were differences in KPS scores among four groups of patients(P<0.05),with group D having higher scores after treatment compared with the other three groups.③There was a difference in the trend of KPS scores among four groups of patients(P<0.05).The clinical effective rates of patients in group A,B,C,and D were 53.33%,70.00%,80.00%,and 83.33%,respectively,with statistically significant differences(P<0.05).Compared with the other three groups,group D showed better clinical efficacy.Conclusion Intradermal needle combined with Dachengqi Decoction can improve symptoms related to malignant bowel obstruction,gastrointestinal motility function,and intestinal mucosal barrier function of MBO patients,so as to improve the health status of patients.
作者
修俊青
周雍明
宋学敬
王佳
XIU Junqing;ZHOU Yongming;SONG Xuejing;WANG Jia(Department of Oncology,Southern District,Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 102600,China;Department of Oncology,Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)
出处
《中医肿瘤学杂志》
2025年第1期16-24,共9页
Journal of Oncology in Chinese Medicine
基金
中国中医科学院广安门医院南区所级科研基金(编号:Y2022-08)。
关键词
恶性肠梗阻
大承气汤
皮内针
肠黏膜屏障功能
malignant bowel obstruction
Dachengqi Decoction
intradermal needle
intestinal mucosal barrier function
