2023 年第 7 期 第 18 卷

四神丸合理中汤治疗大肠癌术后脾肾阳虚证患者基于肠道菌群的临床效果分析

Clinical effect of Sishen pill combined with Lizhong decoction in the treatment of patients with spleen-kidney Yang deficiency syndrome after colorectal cancer surgery based on intestinal flora

作者：谭雅彬1蒋璐剑2廖子静3周琴4

英文作者：Tan Yabin1 Jiang Lujian2 Liao Zijing3 Zhou Qin4

单位：1浙江中医药大学附属第一医院（浙江省中医院）肿瘤内科，杭州310006；2天津市中医药研究院附属医院消化二科，天津300120；3北京中医药大学东方医院肿瘤科，北京100078；4北京中医药大学，北京100029

英文单位：1Department of  Oncology The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine) Hangzhou 310006 China; 2Second Department of Gastroenterology Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital Tianjin 300120 China; 3Department of  Oncology Dongfang Hospital Beijing University of Chinese Medicine Beijing 100078 China; 4Beijing University of Chinese Medicine Beijing 100029 China

关键词：大肠癌；四神丸；理中汤；肠道菌群；临床效果

英文关键词：Colorectalcancer;Sishenpill;Lizhongdecoction;Intestinalflora;Clinicaleffect

• 摘要：

• 目的  分析四神丸合理中汤治疗大肠癌术后脾肾阳虚证患者的临床效果，探讨患者临床症状的改善与肠道菌群之间的关系。方法  选取北京中医药大学东方医院肿瘤科门诊或住院部2018年1月至2020年12月收治的40例大肠癌术后脾肾阳虚证患者作为观察组，选取同期10例年满18岁、体重指数18～25 kg/m2且生活于北京、健康状况良好的志愿者为对照组。患者通过14 d的四神丸合理中汤中药口服治疗，对照组不给药。记录治疗有效率，比较方药治疗前1 d及治疗7、14 d后患者中医症状积分的变化，了解临床治疗效果；同时观察治疗期间有无药物相关不良反应。另外分别收集对照组和观察组治疗前及治疗14 d后的粪便样本进行Alpha多样性指数分析和主成分分析，对比分析健康人和患者治疗前后的肠道菌群结构。结果  观察组治疗有效率为100%（40/40），且所有患者未出现药物相关不良反应。观察组治疗前及治疗7、14 d后的中医症状总积分分别为（13.6±2.6）、（9.0±2.2）、（4.6±2.3）分，两两比较差异均有统计学意义（均P<0.001）。Alpha多样性指数分析结果显示大肠癌术后脾肾阳虚证患者粪便标本中肠道菌群的丰富度和多样性低于健康人，且组内差异较大，治疗后患者肠道菌群的丰富度和多样性提高，组内差异也变小，趋向于健康人。主成分分析结果显示观察组治疗后与对照组在转换后的二维坐标系中的位置较观察组治疗前接近，说明四神丸合理中汤治疗改善了患者的肠道菌群。结论  大肠癌术后脾肾阳虚证患者临床症状经过四神丸合理中汤干预后得到明显好转，且患者的肠道菌群丰富度和多样性也得到改善，接近于健康受试者。临床症状的改善与提高了肠道微生物的丰富度和多样性有关。

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  Objective  To analyze the clinical effect of Sishen pill combined with Lizhong decoction in the treatment of patients with spleen-kidney Yang deficiency syndrome after colorectal cancer surgery, and to explore the relationship between the improvement of clinical symptoms and intestinal flora. Methods  Totally Forty patients with spleen-kidney Yang deficiency syndrome after colorectal cancer surgery admitted to the Oncology outpatient or inpatient Department of Dongfang Hospital, Beijing University of Chinese Medicine from January 2018 to December 2020 were selected as the observation group. At the same time, 10 volunteers aged 18 years or above, with body mass index of 18-25 kg/m2, living in Beijing and in good health were selected as the control group. The patients were treated with Sishen pill combined with Lizhong decoction for 14 d, and the control group was not given drugs. At the same time, the drug-related adverse reactions during the treatment were observed. In addition, fecal samples were collected from the control group and the observation group before treatment and 14 d after treatment for Alpha diversity index analysis and principal component analysis to compare and analyze the structure of intestinal flora in healthy people and patients before and after treatment. Results  The effective rate of treatment in the observation group was 100%(40/40), and all patients did not experience any adverse reactions to the medication. The total traditional Chinese medicine symptom scores of the observation group before treatment and 7 and 14 d after treatment were (13.6±2.6), (9.0±2.2), and (4.6±2.3), respectively (all P<0.001). The results of Alpha diversity index analysis showed that the richness and diversity of intestinal flora in stool samples of patients with spleen-kidney Yang deficiency after colorectal cancer surgery were lower than those of healthy people, and the difference within the group was large. After treatment, the richness and diversity of intestinal flora in patients increased, and the difference within the group decreased, which tended to be healthy people. The results of principal component analysis showed that the positions of the observation group and the control group in the converted two-dimensional coordinate system after treatment were closer than that of the observation group before treatment, indicating that the treatment of Sishen pill combined with Lizhong decoction improved the intestinal flora of the patients. Conclusions    The clinical symptoms of patients with spleen-kidney Yang deficiency syndrome after colorectal cancer surgery are significantly improved after the intervention of Sishen pill combined with Lizhong decoction, and the richness and diversity of intestinal flora of patients are also improved, close to that of healthy subjects. The improvement of clinical symptoms is associated with increased gut microbial richness and diversity.