Page 57 - 2023-05-中国全科医学

·570· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.5

syndrome （IBS-D）. Methods On July 2020，a total of 32 6-week-old SPF male Wistar rats were selected and randomized
into blank group，model group，baishao-fangfeng group （B-F group） and chenpi-baizhu group （C-B group），with 8
rats in each. Except for the blank group，the other three groups were used to establish visceral sensitive IBS-D rat model by use
of colorectal dilatation + chronic restraint stress. At the end of successful model creation，the B-F group received the solution
extracted from both baishao and fangfeng using gavage administration（4 ml/kg），C-B group received the solution extracted
from both chenpi and baizhu using gavage administration（4 ml/kg），and the other two groups received gavage administration
of distilled water. This treatment period was 14 days for all groups. The weight and growth status of weight，stool classification
according to the Bristol Stool Scale（BSS），abdominal withdrawal reflex （AWR） under different pressure gradients，BDNF
and SP expression levels in colon and hippocampus were compared between the four groups at the end of modeling and subsequent
treatment. Results All rats survived when the IBS-D model was successfully created. Blank group had bigger average growth
of weight after modeling period than both B-F and C-B groups（P<0.05）. B-F and C-B groups had bigger average growth of
weight after the treatment than model group （P<0.05）. Compared with model group，blank group had lower average score of
BSS after treatment，and so did both B-F and C-B groups （P<0.05）. After the treatment，the AWR score under 60 mm Hg of
cuff pressure in the model group was higher than that in the blank group （P<0.05），and under both 60 mm Hg or 80 mm Hg of
cuff pressure，the AWR score in the B-F group was lower than that in model group or C-B group （P<0.05）. Model group had
higher average post-treatment expression levels of BDNF and SP in colon tissue than both blank group and B-F group，and so
did C-B group（P<0.05）. Model group had lower average post-treatment expression level of BDNF in hippocampus than blank
group （P<0.05）. B-F group had higher average post-treatment expression level of BDNF in hippocampus than both model group
（P<0.05）. Model group had higher average post-treatment expression level of SP in hippocampus than both blank group and B-F
group（P<0.05）. C-B group had higher expression level of SP in hippocampus than blank group（P<0.05）. Conclusion Both
Tong-Xie-Yao-Fang disassembled recipes could significantly improve weight and diarrhea in rat model of IBS-D. Compared with
chenpi and baizhu，baishao and fangfeng could better alleviate intestinal hypersensitivity，and down-regulate SP expression level
in colon and hippocampus，and BDNF expression level in colon，up-regulate the BDNF expression level in colon，and regulate
the balance of related brain-gut peptides.
【Key words】 Irritable bowel syndrome；Diarrheatype irritable bowel syndrome；Tong-Xie-Yao-Fang；Drugs，
Chinese herbal；Visceral hypersensitivity；Brain-derived neurotrophic factor；Substance P

肠易激综合征（irritable bowel syndrome，IBS）是世 组织中的 BDNF mRNA 表达，呈现双向调节脑肠轴的作
界范围内常见的肠脑互动紊乱的疾病之一，据估计全球 用 ［17］ 。中医认为肝郁脾虚是 IBS-D 基本病机，常用痛
约有 10% 的人受到影响 ［1］ ，其中我国以腹泻型肠易激 泻要方治疗，方中“抑木”组分之白芍防风善于柔肝理
综合征（IBS-D）多见 ［2］ 。临床上 IBS 以腹部不适、排 气止痛，“培土”组分之陈皮白术长于补脾胜湿止泻，
便习惯不良或大便异常为主要特征 ［3］ ，其病程迁延， 四药合用，补脾柔肝，共奏佳效 ［6］ 。然而，目前的临
容易反复发作，严重影响患者身心健康 ［4］ 。IBS 发病 床证据多关注痛泻要方整体药物的疗效及机制。基于中
机制尚未完全明确，但内脏高敏是公认的病理生理基 医理论及前期研究成果，笔者推测“抑木”组分之白芍
础 ［4-5］ ，内脏高敏的发生是一个复杂的病理过程，其作 防风是缓解内脏髙敏、改善腹部不适症状的重要部分。
用机制亦未完全明确，脑肠肽（brain-gut peptide）异常 本研究将痛泻要方拆分为“抑木”组分与“培土”组分，
表达与内脏高敏密切相关 ［6］ ，其中 P 物质（substance P， 以 IBS-D 模型大鼠为研究对象，以 BDNF 和 SP 表达为
SP）、脑源性神经营养因子（brain-derived neurotrophic 切入点，在前期证实痛泻要方有效性的基础上 ［18］ ，深
factor，BDNF）作为相关神经肽参与了 IBS-D 的发展过 入探索痛泻要方治疗 IBS-D 的作用机制。
程，对肠神经系统具有调节作用 ［7-8］ 。关于 IBS-D 的 1 材料与方法
治疗目前指南推荐采用止泻药、解痉药、益生菌、精神 1.1 实验动物与分组 于 2020 年 7 月选取 6 周龄 SPF
药物治疗等方式 ［9］ ，但多数患者使用指南推荐的一线 级雄性 Wistar 大鼠共 32 只，体质量为（190±20）g，
药物后症状仍难以改善 ［10］ ，转而寻求中医药治疗。既 采购于成都达硕生物技术有限公司，动物生产许可证号：
往研究表明痛泻要方可以通过调节脑 - 肠轴 ［11-13］ 、内 SYXK（川）2020-030，饲养于标准Ⅱ级动物房，室温
脏高敏 ［14-15］ 、肠道通透性 ［16］ 、BDNF 表达 ［17］ ，改善 （21±2）℃，相对湿度（50±10）%，明暗比 1∶1。
IBS-D 患者腹痛和腹泻症状。 适应性饲养7 d后，采用抽签法随机分为空白组、模型组、
前期研究发现，痛泻要方可调节大鼠海马及结肠 白芍防风（B-F）组和陈皮白术（C-B）组，每组 8 只