自拟清肠愈疡汤经验方口服、中药灌肠对重度溃疡性结肠炎患者肠道菌群、免疫功能、血清HIF-1α、TGF-β1、β-EP水平的影响
摘要
目的观察自拟清肠愈疡汤经验方口服、中药灌肠对重度溃疡性结肠炎患者肠道菌群、血清低氧诱导因子-1α(HIF-1α)、转化生长因子-β1(TGF-β1)、β-内啡肽(β-EP)水平的影响。方法将河北省唐山市丰南区中医医院56例重度溃疡性结肠炎患者随机分为对照组和观察组,各28例,对照组患者给予西医常规处理,观察组患者则在此基础上加用自拟清肠愈疡汤经验方口服联合中药灌肠治之,两组均连续治疗4周。通过中医症候积分变化评价临床效果,对比两组肠道菌群分布,监测治疗前后免疫功能指标及血清HIF-1α、TGF-β1、β-EP水平。结果观察组重度渍疡性结肠炎患者有效率为89.3%,明显高于对照组有效率67.9%(P<0.05);观察组患者经治疗后血性腹泻、腹痛、发热等中医证候积分与对照组相比降低明显(P<0.05);肠道内容物中肠球菌、肠杆菌数量较治疗前及对照组显著降低,而双歧杆菌、乳酸杆菌、丁酸梭菌的数量则较治疗前及对照组显著升高(P<0.05);两组患者的免疫功能较治疗前有所提高,Ig A、Ig G、Ig M、CD4+、CD4+/CD8+水平显著升高,CD8+水平则明显降低,组间对比,以观察组的变化程度较对照组更为明显(P<0.05);观察组患者的血清HIF-1α、TGF-β1、β-EP水平降低程度优于对照组患者(P<0.05)。结论自拟清肠愈疡汤经验方口服、中药灌肠进行中医内外合治能显著改善重度UC患者的临床症状,改善肠道菌群紊乱状态,促进免疫球蛋白及T淋巴细胞水平的恢复,还能通过抑制血清中HIF-1α、TGF-β1、β-EP的过表达而维持肠黏膜的屏障功能,促进溃疡愈合,值得临床广泛推广应用。
引文
[1]Okabayashi S,Kobayashi T,Sujino T,et al.Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab[J].Intest Res,2017,15(4):535-539.
[2]Fukuba N,Ishihara S,Kawashima K,et al.Irritable bowel syndrome-like symptoms associated with endoscopic activity predict ulcerative colitis relapse in patients with clinical remission[J].Intest Res,2017,15(4):543-545.
[3]Hyams JS,Chan D,Adedokun OJ,et al.Subcutaneous Golimumab in Pediatric Ulcerative Colitis:Pharmacokinetics and Clinical Benefit[J].Inflamm Bowel Dis,2017,23(12):2227-2237.
[4]Beyazit Y,Sayilir A,Tanoglu A,et al.Plasma thrombin-activatable fibrinolysis inhibitor levels correlate with the disease activity of ulcerative colitis[J].Intern Med,2016,55(14):1831-1836.
[5]Lynchr W,Churchhouse AM,Protheroe A,et al.Predicting outcome in acute severe ulcerative colitis:comparison of the Travis and Ho scores using UK IBD audit data[J].Aliment Pharmacol Ther,2016,43(11):1132-1141.
[6]Kim Y,Wu AG,Jaja-Chimedza A,et al.Isothiocyanate-enriched moringa seed extract alleviates ulcerative colitis symptoms in mice[J].PLo S One,2017,12(9):e0184709.
[7]Duricova D,Leroyer A,Savoye G,et al.Extra-intestinal manifestations at diagnosis in paediatric-and elderly-onset ulcerative colitis are associated with a more severe disease outcome:a population-based study[J].J Crohns Colitis,2017,11(11):1326-1334.
[8]周宇倩,陈忠义.80例溃疡性结肠炎的中医证型特点分析[J].辽宁中医杂志,2017,(12):2569-2571.
[9]中华中医药学会脾胃病分会.溃疡性结肠炎中医诊疗共识意见[J].中华中医药杂志,2010,25(6):891-894.
[10]中华医学会消化病学分会炎症性肠病学组C炎症性肠病诊断与治疗的共识意见(2012年广州)[J].中华内镜杂志,2012,51(10):818-831.
[11]皇玲玲,赵晓峰,郭海,等.叶桂治痢五法浅析[J].环球中医药,2017,10(8):894-896.
[12]刘达,叶柏.叶柏运用清热解毒、凉血活血法治疗重度溃疡性结肠炎经验[J].中医药学报,2013,41(6):28-30.
[13]石磊,施丽婕.化瘀通阳法治疗轻中度溃疡性结肠炎经验[J].环球中医药,2016,9(9):1101-1102.
[14]Scaldaferri F,Pecere S,Petito V,et al.Efficacy and mechanisms of action of fecal microbiota transplantation in ulcerative colitis:pitfalls and promises from a first meta-analysis[J].Transplant Proc,2016,48(2):402-407.
[15]Seah D,De Cruz P.Review article:the practical management of acute severe ulcerative colitis[J].Aliment Pharmacol Ther,2016,43(4):482-513.
[16]朱燕莉,张海,饶德利.低氧诱导因子-1α和胰岛素样生长因子-I检测在溃疡性结肠炎的临床应用价值[J].中国中西医结合消化杂志,2017,25(2):132-134.
[17]谢正兴,邸雅南,彭德银,等.HIF-1α、CRP在溃疡性结肠炎患者血清中表达的意义[J].现代医学,2017,45(10):1468-1471.
[18]刘爱玲,吕红,杨红,等.英夫利西单抗在急性重度溃疡性结肠炎拯救治疗中的疗效分析[J].胃肠病学,2017,22(10):604-609.
[19]陈亮,景姗,孙蓓,等.健脾化瘀解毒中药复方对溃疡性结肠炎患者血清细胞因子EGF、TGF-β1及TNF-α的影响[J].天津中医药大学学报,2017,36(5):352-355.
[20]刘琳,刘丽,张蕊,等.溃疡性结肠炎患者β-内啡肽表达与免疫功能变化的相关性[J].临床荟萃,2017,32(11):969-973.
[2]Fukuba N,Ishihara S,Kawashima K,et al.Irritable bowel syndrome-like symptoms associated with endoscopic activity predict ulcerative colitis relapse in patients with clinical remission[J].Intest Res,2017,15(4):543-545.
[3]Hyams JS,Chan D,Adedokun OJ,et al.Subcutaneous Golimumab in Pediatric Ulcerative Colitis:Pharmacokinetics and Clinical Benefit[J].Inflamm Bowel Dis,2017,23(12):2227-2237.
[4]Beyazit Y,Sayilir A,Tanoglu A,et al.Plasma thrombin-activatable fibrinolysis inhibitor levels correlate with the disease activity of ulcerative colitis[J].Intern Med,2016,55(14):1831-1836.
[5]Lynchr W,Churchhouse AM,Protheroe A,et al.Predicting outcome in acute severe ulcerative colitis:comparison of the Travis and Ho scores using UK IBD audit data[J].Aliment Pharmacol Ther,2016,43(11):1132-1141.
[6]Kim Y,Wu AG,Jaja-Chimedza A,et al.Isothiocyanate-enriched moringa seed extract alleviates ulcerative colitis symptoms in mice[J].PLo S One,2017,12(9):e0184709.
[7]Duricova D,Leroyer A,Savoye G,et al.Extra-intestinal manifestations at diagnosis in paediatric-and elderly-onset ulcerative colitis are associated with a more severe disease outcome:a population-based study[J].J Crohns Colitis,2017,11(11):1326-1334.
[8]周宇倩,陈忠义.80例溃疡性结肠炎的中医证型特点分析[J].辽宁中医杂志,2017,(12):2569-2571.
[9]中华中医药学会脾胃病分会.溃疡性结肠炎中医诊疗共识意见[J].中华中医药杂志,2010,25(6):891-894.
[10]中华医学会消化病学分会炎症性肠病学组C炎症性肠病诊断与治疗的共识意见(2012年广州)[J].中华内镜杂志,2012,51(10):818-831.
[11]皇玲玲,赵晓峰,郭海,等.叶桂治痢五法浅析[J].环球中医药,2017,10(8):894-896.
[12]刘达,叶柏.叶柏运用清热解毒、凉血活血法治疗重度溃疡性结肠炎经验[J].中医药学报,2013,41(6):28-30.
[13]石磊,施丽婕.化瘀通阳法治疗轻中度溃疡性结肠炎经验[J].环球中医药,2016,9(9):1101-1102.
[14]Scaldaferri F,Pecere S,Petito V,et al.Efficacy and mechanisms of action of fecal microbiota transplantation in ulcerative colitis:pitfalls and promises from a first meta-analysis[J].Transplant Proc,2016,48(2):402-407.
[15]Seah D,De Cruz P.Review article:the practical management of acute severe ulcerative colitis[J].Aliment Pharmacol Ther,2016,43(4):482-513.
[16]朱燕莉,张海,饶德利.低氧诱导因子-1α和胰岛素样生长因子-I检测在溃疡性结肠炎的临床应用价值[J].中国中西医结合消化杂志,2017,25(2):132-134.
[17]谢正兴,邸雅南,彭德银,等.HIF-1α、CRP在溃疡性结肠炎患者血清中表达的意义[J].现代医学,2017,45(10):1468-1471.
[18]刘爱玲,吕红,杨红,等.英夫利西单抗在急性重度溃疡性结肠炎拯救治疗中的疗效分析[J].胃肠病学,2017,22(10):604-609.
[19]陈亮,景姗,孙蓓,等.健脾化瘀解毒中药复方对溃疡性结肠炎患者血清细胞因子EGF、TGF-β1及TNF-α的影响[J].天津中医药大学学报,2017,36(5):352-355.
[20]刘琳,刘丽,张蕊,等.溃疡性结肠炎患者β-内啡肽表达与免疫功能变化的相关性[J].临床荟萃,2017,32(11):969-973.