| Objective:IBS-like symptoms are frequently reported among patients with Ulceratove Colitis(UC)in remission.We aimed to analyse the general information and the characteristics of TCM symptoms in quiescent Ulcerative Colitis overlapping IBS-like symptoms,and exploring the the pathomechanism and etiologic factors according to the TCM theory.Methods:121 cases of UC patients in remission and 63 cases of IBS patients are studied by questionnaire,UC patients are divided into UCr+IBS group and UCr-IBS group according to the IBS standard established by Rome IV.The questionnaire includes general information,anxiety and depression assessment,the four diagnostic information and the quantitative score of TCM symptoms.The investigation of UC patients also includes the course of disease,the extent and the range of lesions during exacerbation,As well as the current treatment and the,fecal calcitonin results,etc.TCM syndrome types were identified according to the four diagnostic information provided by patients,with reference to "consensus of TCM experts in diagnosis and treatment of Ulcerative Colitis" and "consensus of TCM experts in diagnosis and treatment of Irritable Bowel Syndromen",The data are analyzed with SPSS22.0 software.The measurement data takes normality test,the normal distribution data are described in mean and standard deviation,the skewness distribution data are represented by the median.The counting data are presented as absolute numbers and percentages,and T-test or nonparametric test is mainly used for comparison.Results:(1)General data:a total of 59 patients were collected in UCr+IBS group,including 23 males and 36 females,the ratio of male to female was 1.565,the oldest was 72 years old,the youngest was 19 years old,the median was 39 years old,and the peak was 35-54 years old.The proportion of patients born and living in urban areas is much higher than that in rural areas,more than half of them have college education or above,and the proportion of patients with monthly income between 3001 to 5000 yuan and 5001 to 7,000 yuan is relatively large,accounting for 41%and 14%respectively.There was no statistical significance in the above differences between the overlap group and the IBS group.There were more males in the non-overlapping group,and the ratio of male to female was 1.385.There was significant difference in gender distribution between the two groups,but there was no significant difference in age,place of birth,place of residence and educational background.The longest course of disease in UCr+IBS group was 13 years,the shortest was 2 years,the average was 5.5±2.88 years,and the frequency of patients with disease course between 4 and 6 years was the highest.Before remission,the lesion range was left colon(E2)in 19 cases(32%),rectal type(El)and extensive colon type(E3)in 20 cases(34%).In the remission period,the most severe cases were mild or moderate,accounting for 51%and 42%,respectively,while severe patients accounted for only 7%.The minimum value of fecal calcitonin(FC)in remission stage was 2.6,the maximum value was 86.2,and the mean value was 36.8.The Mayo score was 1 in 37 cases,2 in 14 cases and 0 in 8 cases.In terms of the utilization of medical resources,the average number of hospitalization in remission period in the overlap group was 1.22 times per year,and the average number of visits due to intestinal problems was 1.76 times per month.At present,25%of patients still take adequate(4g/d)aminosalicylic acid preparation to maintain remission,71%of patients maintain reduction,and 27%of patients take oral administration combined with anal plug to maintain remission.In the overlap group,the average anxiety score was 3.53±1.356,and the depression score was 2.68±1.491.The anxiety and depression scores of females were significantly higher than those of males.The scores of anxiety and depression,the number of visits and hospitalization in remission,mayo score and the number of patients without drug reduction in the overlap group were significantly higher than those in the non-overlap group(P<0.05).There was no significant difference in the other course of disease,the range of pre-remission lesions,the severity of the disease and the level of calcitonin in stool between the two groups.(2)Symptoms and tongue and pulse information:the most common symptoms in the overlap group were abdominal pain(100%),diarrhea(81%),abdominal distension(86%)and intestinal tinnitus(83%).A small number of patients showed constipation or alternation of diarrhea and constipation.The most frequent concurrent diseases were mental fatigue(71%),cold fear(64%),belching(61%),insomnia(47%),loss of appetite(34%),dry mouth or bitter mouth(22%),waist soreness and knee weakness(22%),chest distension or pain(20%)and dizziness(15%).Reddish tongue,tooth mark tongue,fat tongue,thin white fur,thin yellow fur,fine string vein and slippery vein are the most common.The average quantitative score of TCM symptoms was 16±4.631,which was slightly higher in females than in males.The common inducing or aggravating factors of symptoms are poor diet(59%),climate change(51%),overwork(49%)and emotional factors(37%).The frequency of the main symptoms and the quantitative score of TCM symptoms in the overlap group were higher than those in the non-overlap group,the difference was statistically significant,but there was no statistical difference compared with the IBS group,and there was no significant difference in the overall tongue pulse among the three groups.(3)Distribution of TCM syndrome types:the frequency order of TCM syndrome types in the overlap group is as follows:liver depression and spleen deficiency syndrome(32%),spleen and kidney yang deficiency syndrome(19%),spleen deficiency and dampness syndrome(17%),cold-heat mixed syndrome(14%),large intestine damp-heat syndrome(10%),yin deficiency and intestinal dryness syndrome(8%).In the non-overlapping group,the most common TCM syndrome was spleen deficiency and dampness accumulation syndrome(35%),followed by spleen and kidney yang deficiency syndrome(21%),large intestine damp-heat syndrome(18%),liver depression and spleen deficiency syndrome(13%),cold-heat mixed syndrome(10%),lung and spleen qi deficiency syndrome(3%).There were significant differences in spleen deficiency and dampness accumulation syndrome and liver depression and spleen deficiency syndrome between the two groups.The TCM syndrome types of IBS group were liver depression and spleen deficiency syndrome(29%),spleen deficiency and dampness syndrome(22%),spleen and kidney yang deficiency syndrome(17%),large intestine damp-heat syndrome(14%),cold-heat mixed syndrome(10%),yin deficiency and intestinal dryness syndrome(6%),lung and spleen qi deficiency syndrome(2%).There was no statistical difference compared with the overlap group.(4)Comparison of syndrome types in overlap group:the number of female patients with liver depression and spleen deficiency in overlap group was 3 times higher than that in male,and there was no significant difference in gender composition of other syndrome types.The results showed that the distribution of different syndrome types in different age groups was statistically significant,in which the patients of liver depression and spleen deficiency,large intestine damp-heat and cold-heat mixed syndrome were concentrated in 35-54 years old,and spleen deficiency and dampness accumulation type was more common in people under 35 years old.most of the people over 55 years old belong to the type of yang deficiency of spleen and kidney.The quantitative scores of TCM symptoms,anxiety and depression of different syndrome types were compared,and it was found that the scores of liver depression and spleen deficiency syndrome were significantly higher than those of other syndrome types.(5)There are 17 kinds of high-frequency traditional Chinese medicine,among which the core drugs are Atractylodes macrocephala,white peony,tangerine peel,fried Coix seed,licorice,wood incense,Scutellaria baicalensis,yam,Liushenqu,Poria,Fangfeng and roasted ginger,which belong to the types of traditional Chinese medicine,which are mainly tonifying medicine,regulating qi medicine,diuresis and dampness medicine,which are basically consistent with the medication principles and rules of the main syndrome types.Conclusion:The symptoms of overlapping irritable bowel syndrome in remission stage of ulcerative colitis are mostly female,and the peak incidence is between 35 and 54 years old,which has nothing to do with region,education,income,course of disease,severity of disease before remission and scope of disease.Patients with overlap occupied more medical resources,and anxiety,depression and somatic symptoms were more serious than those without IBS symptoms.In traditional Chinese medicine,the key pathogenesis of overlap is spleen deficiency and liver depression,the disease is mainly a mixture of deficiency and excess,and some patients have the syndrome characteristics of damp-heat and yin deficiency. |
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