参苓白术散联合美沙拉嗪对溃疡性结肠炎儿童和青少年炎症因子与免疫功能的影响
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摘要
目的探讨参苓白术散联合美沙拉嗪对溃疡性结肠炎少儿炎症因子与免疫功能的影响。方法溃疡性结肠炎少儿62例,按数字表法随机分为对照组与治疗组,各31例。对照组口服美沙拉嗪,每次20 mg·kg~(-1),每天4次。治疗组在对照组基础上口服参苓白术散,每次3.0或6.0 g,每天3次。两组疗程均为2个月。比较两组治疗前后炎症因子水平,T细胞亚群水平(CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+),免疫球蛋白水平,中医证候评分及治疗有效率。结果治疗后,治疗组白细胞介素(IL)-6、IL-17及肿瘤坏死因子-α(TNF-α)水平低于对照组,IL-10水平高于对照组(P<0.05);治疗组CD_3~+、CD_8~+水平明显低于对照组,CD_4~+水平、CD_4~+/CD_8~+比值明显高于对照组(P<0.05);治疗组IgA、IgM水平下降程度明显大于对照组(P<0.05);治疗组腹痛、腹泻、脓血便、里急后重积分及总积分均显著低于对照组;治疗组和对照组治疗有效率分别为93.55%,74.19%(P<0.05)。结论参苓白术散联合美沙拉嗪治疗少儿溃疡性结肠炎有利于调节炎症因子水平,降低炎症反应,平衡T细胞数量,降低免疫球蛋白水平,提升肠道黏膜的免疫功能,促进溃疡愈合,从而改善中医证候,提高临床疗效。
Objective To investigate the effects of Shenlingbaizhu powder combined with mesalazine on inflammatory factors and immune function in children and adolescents with ulcerative colitis. Methods Sixty-two children with ulcerative colitis were randomly divided into control group and treatment group( 31 children each) according to random number table method. The control group received oral Mesal amine,20 mg·kg~(-1) each time,4 times a day. The treatment group was given Shenlingbaizhu powder on the basis of the control group,3.0 or 6.0 g each time,3 times a day. Both groups were treated for 2 months. The levels of inflammatory factors,T cell subsets( CD_3~+,CD_4~+,CD_8~+and CD_4~+/CD_8~+),immunoglobulin levels,Traditional Chinese Medicine( TCM) syndrome scores and treatment effectiveness were compared between the two groups. Results After treatment,the levels of interleukin( IL)-6,IL-17 and tumor necrosis factor-α( TNF-α) in the treatment group were lower than those in the control group,and the level of IL-10 was higher than the control group( P<0.05). The levels of CD_3~+and CD_8~+in the treatment group were significantly lower than those in the control group,and the ratio of CD_4~+and CD_4~+/CD_8~+was significantly higher than the control group( P<0.05). The level of Ig A and Ig M in the treatment group was significantly lower than the control group( P < 0. 05). After treatment,abdominal pain,diarrhea,pus and bloody stool,tenesmus points and total scores in the treatment group were significantly lower than the control group( P < 0.05). The efficacy of the treatment group and the control group were 93.55% and 74.19%,respectively( P<0.05). Conclusion Shenlingbaizhu powder combined with mesalamine in the treatment of in children and adolescents with ulcerative colitis is beneficial to improve clinical efficacy,which regulate the level of inflammatory factors, reduce the inflammatory response, balance the number of T cells, reduce the level of immunoglobulin,improve the immune function of intestinal mucosa,promote ulcer healing,and improve TCM syndromes.
Objective To investigate the effects of Shenlingbaizhu powder combined with mesalazine on inflammatory factors and immune function in children and adolescents with ulcerative colitis. Methods Sixty-two children with ulcerative colitis were randomly divided into control group and treatment group( 31 children each) according to random number table method. The control group received oral Mesal amine,20 mg·kg~(-1) each time,4 times a day. The treatment group was given Shenlingbaizhu powder on the basis of the control group,3.0 or 6.0 g each time,3 times a day. Both groups were treated for 2 months. The levels of inflammatory factors,T cell subsets( CD_3~+,CD_4~+,CD_8~+and CD_4~+/CD_8~+),immunoglobulin levels,Traditional Chinese Medicine( TCM) syndrome scores and treatment effectiveness were compared between the two groups. Results After treatment,the levels of interleukin( IL)-6,IL-17 and tumor necrosis factor-α( TNF-α) in the treatment group were lower than those in the control group,and the level of IL-10 was higher than the control group( P<0.05). The levels of CD_3~+and CD_8~+in the treatment group were significantly lower than those in the control group,and the ratio of CD_4~+and CD_4~+/CD_8~+was significantly higher than the control group( P<0.05). The level of Ig A and Ig M in the treatment group was significantly lower than the control group( P < 0. 05). After treatment,abdominal pain,diarrhea,pus and bloody stool,tenesmus points and total scores in the treatment group were significantly lower than the control group( P < 0.05). The efficacy of the treatment group and the control group were 93.55% and 74.19%,respectively( P<0.05). Conclusion Shenlingbaizhu powder combined with mesalamine in the treatment of in children and adolescents with ulcerative colitis is beneficial to improve clinical efficacy,which regulate the level of inflammatory factors, reduce the inflammatory response, balance the number of T cells, reduce the level of immunoglobulin,improve the immune function of intestinal mucosa,promote ulcer healing,and improve TCM syndromes.
引文
[1]ISKANDAR H N,DHERE T,FARRAYE F A.Ulcerative colitis:update on medical management[J].Curr Gastroenterol Rep,2015,17(11):44-53.
[2]TORRES A,CILLONIZ C,FERRER M,et al.Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia:risk and prognosis[J].Eur Respir J,2015,45(5):1353-1363.
[3]徐晓红.舒肝解郁胶囊联合美沙拉嗪治疗溃疡性结肠炎的临床效果[J].中国医药导报,2018,15(16):134-137,141.
[4]陈丽,颜春鲁,朱俊燚,等.黄芩汤对溃疡性结肠炎大鼠的治疗作用及机制研究[J].中药材,2016,39(3):652-655.
[5]何爱明,张涛.四君子汤对溃疡性结肠炎模型小鼠claudin-1/3的影响[J].医药导报,2016,35(11):1190-1194.
[6]中国中西医结合学会消化系统疾病专业委员会.溃疡性结肠炎中西医结合诊疗指南(草案)[J].中国中西医结合消化杂志,2011,19(1):61-65.
[7]李楠,卢艳如.盐酸帕罗西汀辅助治疗老年溃疡性结肠炎伴焦虑抑郁40例[J].医药导报,2015,34(7):903-906.
[8]刘跃平,王志敏,柳茂森,等.黄芩汤加减联合培菲康胶囊对溃疡性结肠炎的干预效果及对免疫功能的影响[J].中华中医药学刊,2015,33(6):1522-1526.
[9]国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:54-55.
[10]CHEN X,HOU J,YUAN Y,et al.Adalimumab for moderately to severely active ulcerative colitis:asystematic review and Meta-analysis[J].Bio Drugs,2016,30(3):207-217.
[11]翁湘涛,胡月,廖柳,等.参苓白术散加减对比西药治疗溃疡性结肠炎的疗效和安全性Meta分析[J].中国实验方剂学杂志,2017,23(10):205-210.
[12]李姿慧,王键,蔡荣林,等.参苓白术散对脾虚湿困型溃疡性结肠炎大鼠结肠组织NF-κB p65蛋白表达及相关炎性因子的影响[J].北京中医药大学学报,2015,38(5):315-317,360-361.
[13]章小平,查安生,丁小丽,等.健脾解毒化瘀方灌肠对溃疡性结肠炎患者T细胞亚群的研究[J].中华中医药学刊,2016,34(2):396-398.
[14]朱兰香,陈彦君,严苏,等.炎症性肠病血清学抗体的临床意义[J].胃肠病学,2017,22(4):233-237.
[15]李晓冰,崔利宏,陈玉龙,等.参苓白术散对溃疡性结肠炎小鼠肠道调节性T细胞免疫调节作用[J].中成药,2014,36(6):1295-1297.
[16]FLEMING K,ASHCROFT A,ALEXAKIS C,et al.Proposed case of mesalazine induced cardiomyopathy in severe ulcerative colitis[J].World J Gastroenterol,2015,21(11):3376-3379.
[17]陈浩,张波,徐速,等.甘草泻心汤联合美沙拉嗪对溃疡性结肠炎的疗效及对血清炎症指标的影响[J].中药材,2017,40(2):475-478.
[2]TORRES A,CILLONIZ C,FERRER M,et al.Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia:risk and prognosis[J].Eur Respir J,2015,45(5):1353-1363.
[3]徐晓红.舒肝解郁胶囊联合美沙拉嗪治疗溃疡性结肠炎的临床效果[J].中国医药导报,2018,15(16):134-137,141.
[4]陈丽,颜春鲁,朱俊燚,等.黄芩汤对溃疡性结肠炎大鼠的治疗作用及机制研究[J].中药材,2016,39(3):652-655.
[5]何爱明,张涛.四君子汤对溃疡性结肠炎模型小鼠claudin-1/3的影响[J].医药导报,2016,35(11):1190-1194.
[6]中国中西医结合学会消化系统疾病专业委员会.溃疡性结肠炎中西医结合诊疗指南(草案)[J].中国中西医结合消化杂志,2011,19(1):61-65.
[7]李楠,卢艳如.盐酸帕罗西汀辅助治疗老年溃疡性结肠炎伴焦虑抑郁40例[J].医药导报,2015,34(7):903-906.
[8]刘跃平,王志敏,柳茂森,等.黄芩汤加减联合培菲康胶囊对溃疡性结肠炎的干预效果及对免疫功能的影响[J].中华中医药学刊,2015,33(6):1522-1526.
[9]国家中医药管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:54-55.
[10]CHEN X,HOU J,YUAN Y,et al.Adalimumab for moderately to severely active ulcerative colitis:asystematic review and Meta-analysis[J].Bio Drugs,2016,30(3):207-217.
[11]翁湘涛,胡月,廖柳,等.参苓白术散加减对比西药治疗溃疡性结肠炎的疗效和安全性Meta分析[J].中国实验方剂学杂志,2017,23(10):205-210.
[12]李姿慧,王键,蔡荣林,等.参苓白术散对脾虚湿困型溃疡性结肠炎大鼠结肠组织NF-κB p65蛋白表达及相关炎性因子的影响[J].北京中医药大学学报,2015,38(5):315-317,360-361.
[13]章小平,查安生,丁小丽,等.健脾解毒化瘀方灌肠对溃疡性结肠炎患者T细胞亚群的研究[J].中华中医药学刊,2016,34(2):396-398.
[14]朱兰香,陈彦君,严苏,等.炎症性肠病血清学抗体的临床意义[J].胃肠病学,2017,22(4):233-237.
[15]李晓冰,崔利宏,陈玉龙,等.参苓白术散对溃疡性结肠炎小鼠肠道调节性T细胞免疫调节作用[J].中成药,2014,36(6):1295-1297.
[16]FLEMING K,ASHCROFT A,ALEXAKIS C,et al.Proposed case of mesalazine induced cardiomyopathy in severe ulcerative colitis[J].World J Gastroenterol,2015,21(11):3376-3379.
[17]陈浩,张波,徐速,等.甘草泻心汤联合美沙拉嗪对溃疡性结肠炎的疗效及对血清炎症指标的影响[J].中药材,2017,40(2):475-478.