Abstract: PENG Zhuoyu，Chief physician，Professor；E-mail：penazy@163.com
Background　Diarrhea-predominant irritable bowel syndrome（IBS-D） is one of the common diseases and frequently-occurring diseases of digestive system.Western medicine treatments have no significant therapeutic effects on such patients，especially in improving their visceral sensitivity.Moreover，after such treatment，the disease is easily recur.Therefore，it is particularly important to find a more effective treatment for IBS-D.Objective　To explore clinical response and changes in serum 5-HT in patients with IBS-D treated with Anchang Decoction from the perspective of visceral sensitivity.Methods　A total of 80 IBS-D gastroenterology inpatients and outpatients were enrolled from Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from January 2017 to January 2018.They were equally divided into control group and observation group by use of a random number table，receiving a 8-week oral administration of Trimebutine Maleate Capsule，Trimebutine Maleate Capsule with Anchang Decoction，respectively.The severity of clinical symptoms〔evaluated by Irritable Bowel Syndrome Severity Scale（IBS-SSS）〕，visceral sensitivity〔evaluated by Visceral Sensitivity Index（VSI）〕，parameters of rectal motility〔anal resting pressure（ARP），anal systolic pressure（ASP），anal maximal contraction pressure（AMCP），rectal resting pressure（RRP），inside rectal pressure（IRP）〕，visceral sensory parameters（first sensation threshold，first desire to defecate threshold，rectal maximum tolerable volume），and serum 5-HT levels were compared between the two groups before and after treatment.Results　After treatment，mean IBS-SSS and VSI scores of the observation group were significantly lower than those of the control group（P<0.05）．Posttreatment mean scores of IBS-SSS and VSI decreased in both groups compared with pretreatment（P<0.05）．After treatment，mean values of ARP，first sensation threshold，first desire to defecate threshold，and rectal maximum tolerable volume in，the observation group were significantly higher than those of the control group（P<0.05）．And the posttreatment values of these 4 parameters increased in both groups compared with pretreatment（P<0.05），After treatment，mean serum 5-HT level of the observation group was significantly lower than that of the control group（P<0.05）．Posttreatment mean serum 5-HT level declined in both groups compared with pretreatment（P<0.05）．Conclusion　From the perspective of visceral sensitivity，Anchang Decoction can improve the symptoms and visceral hypersensitivity of IBS-D patients as a whole.It may alleviate the symptoms of abdominal pain，diarrhea and abdominal distension and so on by lowering the serum 5-HT level，increasing ARP，first sensation threshold，first desire to defecate threshold，and rectal maximum tolerable volume，and relieving the visceral hypersensitivity.

Key words: Irritable bowel syndrome, Diarrhea-predominant irritable bowel syndrome, Visceral sensitivity, Anchang Decoction, 5-hydroxytryptamine, Treatment outcome

摘要： 背景　腹泻型肠易激综合征（IBS-D）作为消化系统的常见病和多发病之一，目前单纯应用西医治疗方案对于IBS-D患者的诊疗特别是内脏敏感性的调节治疗效果不够显著，且容易复发，因此寻找一种更为有效的治疗IBS-D的方法显得尤为重要。目的　从内脏敏感性角度，探讨安肠汤治疗IBS-D的临床疗效及其对血清5-羟色胺（5-HT）水平的影响。方法　选取2017年1月—2018年1月在广西中医药大学附属瑞康医院消化内科住院及门诊就诊的IBS-D患者80例。采用随机数字表法将患者分为对照组40例和观察组40例。对照组给予口服马来酸曲美布汀胶囊治疗，观察组在对照组的基础上加口服安肠汤治疗，两组均治疗8周。比较两组治疗开始前与治疗结束后的临床症状严重程度〔肠易激综合征症状严重程度量表（IBS-SSS）得分〕、内脏敏感性〔内脏敏感指数量表（VSI）得分〕、直肠动力指标〔肛管静息压（ARP）、肛管收缩压（ASP）、肛管最大收缩压（AMCP）、直肠静息压（RRP）、直肠排便压（IRP）〕、内脏感觉指标〔初始感觉阈值、初始排便冲动阈值、最大耐受容量〕、血清5-HT水平。结果　治疗后观察组患者IBS-SSS、VSI得分低于对照组（P<0.05）；对照组、观察组患者治疗后IBS-SSS、VSI得分均低于本组治疗前（P<0.05）。治疗后观察组患者ARP、初始感觉阈值、初始排便冲动阈值、最大耐受容量大于对照组（P<0.05）；对照组、观察组患者治疗后ARP、初始感觉阈值、初始排便冲动阈值、最大耐受容量均大于本组治疗前（P<0.05）。治疗后观察组患者血清5-HT水平低于对照组（P<0.05）；对照组、观察组患者血清5-HT水平均低于本组治疗前（P<0.05）。结论　从内脏敏感性的角度，安肠汤能够从整体上改善IBS-D患者的症状严重程度及内脏高敏感性，其可能是通过降低IBS-D患者血清5-HT水平，提高ARP、初始感觉阈值、初始排便冲动阈值及最大耐受容量，调节患者的内脏高敏感性，从而缓解其腹痛、腹泻、腹胀等症状。

关键词: 肠易激综合征, 腹泻型肠易激综合征, 内脏敏感性, 安肠汤, 5-羟色胺, 治疗结果