Lu C L, Chen C Y, Chang F Y, Chang S S, Kang L J, Lu R H, Lee S D
Department of Medicine and Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan.
J Gastroenterol Hepatol. 2000 Aug;15(8):925-30. doi: 10.1046/j.1440-1746.2000.02230.x.
Irritable bowel syndrome (IBS) is a colonic function disorder. Both pinaverlum bromide (a selective calcium channel blocker) and mebeverine (an antispasmodic) are reported to be effective in the long-term (12-16 weeks) treatment of IBS patients. Their efficacy in the short-term treatment of IBS patients and colonic transit time is unclear. Furthermore, substance P and neuropeptide Y have either excitatory or inhibitory effects on colonic motility. Whether the efficacy of both drugs is mediated through these neuropeptides remains unknown.
A clinical trial was conducted with 91 patients with diarrhoea-predominant IBS. After basal measurement of the total colonic transit time, IBS patients were randomized to receive either pinaverlum bromide (50 mg, t.i.d.) or mebeverine (100 mg, t.i.d.) for 2 weeks. The symptomatic scores regarding defaecation, total colonic transit time and serum levels of substance P and neuropeptide Y were measured before and after treatments. The daily defaecation frequency was markedly decreased after treatment (pinaverlum bromide, 2.9+/-1.2 vs 2.0+/-1.0, P< 0.05; mebeverine, 2.7+/-1.1 vs 2.1+/-1.0, P< 0.05). The stool consistency became well formed after both treatments (P< 0.05). Both drugs similarly improved the global well-being in these IBS patients (pinaverlum bromide vs mebeverine 73.4 vs 71.8%, P> 0.05). The total colonic transit time was significantly prolonged only after pinaverlum bromide treatment (21.4+/-15.5 vs 30.8+/-14.8 h, P< 0.01). Neither substance P nor neuropeptide Y serum level was significantly changed after either treatments.
Pinaverlum bromide and mebeverine have similar therapeutic efficacies on diarrhoea-predominant IBS patients. Prolonged colonic transit time may be one of the factors responsible for the efficacy of pinaverlum bromide on the IBS patients. Substance P and neuropeptideY appear less important in the pathogenesis of diarrhoea-predominant IBS.
肠易激综合征（IBS）是一种结肠功能紊乱疾病。据报道，匹维溴铵（一种选择性钙通道阻滞剂）和曲美布汀（一种抗痉挛药）在IBS患者的长期（12 - 16周）治疗中均有效。它们在IBS患者短期治疗中的疗效以及对结肠转运时间的影响尚不清楚。此外，P物质和神经肽Y对结肠运动具有兴奋或抑制作用。这两种药物的疗效是否通过这些神经肽介导仍不清楚。
对91例腹泻型IBS患者进行了一项临床试验。在基础测量全结肠转运时间后，将IBS患者随机分为两组，分别接受匹维溴铵（50毫克，每日三次）或曲美布汀（100毫克，每日三次）治疗2周。在治疗前后测量排便症状评分、全结肠转运时间以及P物质和神经肽Y的血清水平。治疗后每日排便频率显著降低（匹维溴铵组，治疗前2.9±1.2次/天，治疗后2.0±1.0次/天，P<0.05；曲美布汀组，治疗前2.7±1.1次/天，治疗后2.1±1.0次/天，P<0.05）。两种治疗后粪便质地均变为成形（P<0.05）。两种药物对这些IBS患者的整体健康状况改善相似（匹维溴铵组与曲美布汀组分别为73.4%与71.8%，P>0.05）。仅在匹维溴铵治疗后全结肠转运时间显著延长（治疗前21.4±15.5小时，治疗后30.8±14.8小时，P<0.01）。两种治疗后P物质和神经肽Y的血清水平均无显著变化。
匹维溴铵和曲美布汀对腹泻型IBS患者具有相似的治疗效果。结肠转运时间延长可能是匹维溴铵对IBS患者疗效的因素之一。P物质和神经肽Y在腹泻型IBS发病机制中似乎不太重要。
