【目的】 从胆汁酸-肠道菌群轴失调角度探讨疏肝理脾方对腹泻型肠易激综合征（IBS-D）肝郁脾虚证患者的影响。【方法】 选取2022年5月 ~ 2023年5月西安市第九医院收治的IBS-D肝郁脾虚证患者122例，采用随机数字表法将患者随机分为对照 组和观察组，每组各61例。对照组给予常规西药治疗（口服得舒特+复方地芬诺酯片+双歧杆菌四联片），观察组在对照组的 基础上联合疏肝理脾方治疗。2组均以7 d为1个疗程，共治疗4个疗程。观察2组患者治疗前后肠易激综合征症状严重程度 （IBS-SSS）评分、血清胆汁酸水平及肠道菌群数量（双歧杆菌、乳杆菌、肠球菌）的变化情况，并比较2组患者的临床疗效及 治疗期间的不良反应发生情况。【结果】（1）治疗4个疗程后，观察组的总有效率为96.72%（59/61），对照组为83.61%（51/61）， 组间比较（χ2检验），观察组的疗效明显优于对照组（P < 0.05）。（2）治疗后，2组患者IBS-SSS量表的腹部疼痛程度、腹痛持续 天数、腹胀情况、排便满意程度及生活干扰程度评分均较治疗前降低（P < 0.05），且观察组的降低幅度均明显优于对照组 （P < 0.01）。（3）治疗后，2组患者的血清牛磺脱氧胆酸（TDCA）、牛磺胆酸（TCA）与牛磺石胆酸（TLCA）水平均较治疗前降低 （P < 0.05），且观察组的降低幅度均明显优于对照组（P < 0.01）。（4）治疗后，2 组患者的有害菌肠球菌均较治疗前减少（P < 0.05），有益菌双歧杆菌与乳杆菌均较治疗前增多（P < 0.05），且观察组对肠球菌的减少作用及对双歧杆菌与乳杆菌的增多作 用均明显优于对照组（P < 0.05或P < 0.01）。（5）观察组的不良反应发生率为8.20%（5/61），对照组为6.55%（4/61），组间比较， 差异无统计学意义（P > 0.05）。【结论】 疏肝理脾方对于IBS-D肝郁脾虚证患者具有较好的治疗效果，且安全性高，其作用机 制可能与调控胆汁酸-肠道菌群轴恢复平衡有关。

Objective To investigate the effect of Shugan Lipi Prescription on patients with diarrhea-predominant irritable bowel syndrome（IBS-D）of liver stagnation and spleen deficiency type from the perspective of bile acidintestinal flora axis imbalance. Methods From May 2022 to May 2023，a total of 122 patients with IBS-D of liver stagnation and spleen deficiency type admitted to the Xi􀆳an No. 9 Hospital were enrolled into the investigation. The patients were randomly divided into the control group and the observation group by random number table method， with 61 patients in each group. The control group was given conventional western medicine treatment with oral administration of Dicetel plus Compound Diphenoxylate Tablets and Bifidobacterium Quadruple Viable Tablets， and the observation group was treated with Shugan Lipi Prescription on the basis of treatment for the control group.One course of treatment covered seven days，and both groups were treated for four courses in total. The changes of Irritable Bowel Syndrome Symptom Severity Scale（IBS-SSS）score，levels of serum bile acid and the fecal levels of intestinal flora such as Bifidobacterium，Lactobacillus，and Enterococcus in the two groups of patients before and after treatment were observed. Moreover，the clinical efficacy and the incidence of adverse reactions during the treatment of the two groups were compared. Results（1）After four courses of treatment，the total effective rate of the observation group was 96.72%（59/61）and that of the control group was 83.61%（51/61），and the intergroup comparison（tested by chi-square test）showed that the efficacy of the observation group was significantly superior to that of the control group（P < 0.05）.（2）After treatment，the scores of IBS-SSS items such as abdominal pain， abdominal pain duration， abdominal distension， defecation satisfaction and life interference in the two groups were all decreased when compared with those before treatment（P < 0.05），and the decrease in the observation group was significantly superior to that in the control group（P < 0.01）.（3）After treatment，the levels of serum taurodeoxycholic acid（TDCA），taurocholic acid（TCA）and taurolithocholic acid（TLCA）in the two groups were decreased when compared with those before treatment（P < 0.05），and the decrease in the observation group was significantly superior to that in the control group（P < 0.01）.（4）After treatment，the fecal level of Enterococcus， a kind of pathogenic bacterium， in both groups was decreased when compared with that before treatment（P < 0.05），and the fecal levels of probiotics of Bifidobacterium and Lactobacillus in both groups were increased when compared with those before treatment（P < 0.05）. The effects on the decrease of fecal Enterococcus level and on the increase of fecal Bifidobacterium and Lactobacillus levels in the observation group were significantly superior to those in the control group（P < 0.05 or P < 0.01）.（5）The incidence of adverse reactions in the observation group was 8.20%（5/61）and that in the control group was 6.55%（4/61），and the intergroup comparison showed that the difference was not statistically significant（P > 0.05）. Conclusion Shugan Lipi Prescription exerts certain therapeutic effect for IBS-D patients of liver stagnation and spleen deficiency type，and is with higher safety. Its therapeutic mechanism may be related to the restoration of the function of bile acid-intestinal flora axis.

R259.744

陕西省自然科学基金项目（编号：2021JQ-832）