健脾清肠方治疗脾虚湿热型激素依赖溃疡性结肠炎患者的临床疗效
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摘要
目的:观察健脾清肠方治疗脾虚湿热型激素依赖溃疡性结肠炎患者的临床疗效评价。方法:选择并收集2012年4月1日至2014年1月31日在上海中医药大学附属龙华医院门诊及住院脾虚湿热型激素依赖UC患者60例,根据就诊顺序编号,采用随机数字表随机分为对照组和观察组各30例。两组患者均给予强的松基础治疗,对照组给予口服补脾益肠丸,6 g/次,3次/d。连续治疗3个月。观察组给予口服健脾清肠方,每日1剂,水煎300 m L,每次150 m L,2次/d,早晚分温服。连续治疗3个月。治疗后观察两组患者患者肠道症状积分、中医证候积分、内镜评分变化情况。结果:与本组治疗前比较,治疗后对照组腹泻、黏液脓血便症状积分均显著减少(P <0. 01);观察组黏液脓血便、腹泻、腹痛、里急后重症状积分均显著减少(P <0. 01),且观察组黏液脓血便、腹泻症状积分下降明显低于对照组(P <0. 05)。治疗前两组患者中医证候积分比较,差异无统计学意义;治疗后,两组患者中医证候积分均显著减少(P <0. 01),且观察组减少较对照组明显(P <0. 05)。与本组治疗前比较,治疗后两组患者内镜评分均显著减少(P <0. 01),且观察组下降较对照组显著(P <0. 01)。与本组治疗前比较,治疗后两组患者疾病活动指数(UCAI),C反应蛋白(CRP),血沉(ESR)指标及白细胞介素-8(IL-8),肿瘤坏死因子-α(TNF-α)水平均降低(P <0. 05),且治疗后治疗组较对照组明显降低(P <0. 05)。结论:健脾清肠方能有效改善脾虚湿热型激素依赖溃疡性结肠炎患者的黏液脓血便、腹泻症状,减少中医证候积分、内镜评分和降低炎症指标,值得临床借鉴推广。
Objective: To observe the clinical efficacy of Jianpi Qingchang decoction in the treatment of spleen deficiency and damp-heat hormone-dependent ulcerative colitis and explore its possible target. Method: A total of 60 patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis were selected and collected from the outpatient department and the inpatient department of Longhua Hospital affiliated to Shanghai University of Chinese Medicine on April 31,2012. Two groups were given the basic therapy of prednisone,and control group received orally bolus for spleen and spleen and intestines,6 g/time,3 times/d. The treatment continued for three months. The experimental group was given orally Jianpi Qingchang decoction,1 dose per day,and 300 m L water decoction,150 m L each time,2 times/d,and took at different temperatures in the morning and evening. The treatment continued for three months. After treatment, changes in intestinal symptom score,traditional Chinese medicine( TCM) syndrome score and endoscopic score of two groups were observed. Result:Compared with before treatment, the symptom scores of diarrhea, mucous purulent in control group were significantly reduced after treatment( P < 0. 01). The scores of mucous purulent and bloody stool,diarrhea,abdominal pain,and tenesmus were significantly reduced in experimental group( P < 0. 01),and the scores of mucous purulent and bloody stool,and symptom of diarrhea were significantly decreased in experimental group after treatment than that of control group( P < 0. 01). Before treatment,the scores of TCM syndromes in two groups were compared,with no statistically significant difference. After treatment,the scores of TCM syndromes of two groups were significantly reduced( P < 0. 01),and the reduction of the experimental group was more significant than that of control group( P < 0. 05). Compared with before treatment,the endoscopy scores of two groups were significantly reduced after treatment( P < 0. 01),and the decrease of the experimental group was more significant than that of control group( P < 0. 01). Mayo scores were significantly reduced in both groups after treatment compared with that before treatment( P < 0. 01),and significantly reduced in the experimental group compared with control group( P < 0. 05). Conclusion: Jianpi Qingchang decoction can effectively improve mucous purulent stool and diarrhea symptoms in patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis,and reduce TCM syndrome score and endoscopic score,and thus is worthy of clinical reference and promotion.
Objective: To observe the clinical efficacy of Jianpi Qingchang decoction in the treatment of spleen deficiency and damp-heat hormone-dependent ulcerative colitis and explore its possible target. Method: A total of 60 patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis were selected and collected from the outpatient department and the inpatient department of Longhua Hospital affiliated to Shanghai University of Chinese Medicine on April 31,2012. Two groups were given the basic therapy of prednisone,and control group received orally bolus for spleen and spleen and intestines,6 g/time,3 times/d. The treatment continued for three months. The experimental group was given orally Jianpi Qingchang decoction,1 dose per day,and 300 m L water decoction,150 m L each time,2 times/d,and took at different temperatures in the morning and evening. The treatment continued for three months. After treatment, changes in intestinal symptom score,traditional Chinese medicine( TCM) syndrome score and endoscopic score of two groups were observed. Result:Compared with before treatment, the symptom scores of diarrhea, mucous purulent in control group were significantly reduced after treatment( P < 0. 01). The scores of mucous purulent and bloody stool,diarrhea,abdominal pain,and tenesmus were significantly reduced in experimental group( P < 0. 01),and the scores of mucous purulent and bloody stool,and symptom of diarrhea were significantly decreased in experimental group after treatment than that of control group( P < 0. 01). Before treatment,the scores of TCM syndromes in two groups were compared,with no statistically significant difference. After treatment,the scores of TCM syndromes of two groups were significantly reduced( P < 0. 01),and the reduction of the experimental group was more significant than that of control group( P < 0. 05). Compared with before treatment,the endoscopy scores of two groups were significantly reduced after treatment( P < 0. 01),and the decrease of the experimental group was more significant than that of control group( P < 0. 01). Mayo scores were significantly reduced in both groups after treatment compared with that before treatment( P < 0. 01),and significantly reduced in the experimental group compared with control group( P < 0. 05). Conclusion: Jianpi Qingchang decoction can effectively improve mucous purulent stool and diarrhea symptoms in patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis,and reduce TCM syndrome score and endoscopic score,and thus is worthy of clinical reference and promotion.
引文
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[12]于玲,王知斌,王秋红,等.黄芪中黄酮类化合物药理作用研究进展[J].中医药信息,2018,35(2):104-108.
[13]冯彦.马齿苋的药理作用及营养保健作用[J].中医临床研究,2017,9(3):117-118.
[14]郑烈,张亚利,王志敏,等.肠道菌群和活性氧自由基与炎症性肠病的关系[J].中国中西医结合消化杂志,2017,23(1):69-72.
[15]赵莉,石志敏,李雪青.补脾胃泻阴火升阳汤联合美沙拉嗪治疗溃疡性结肠炎患者临床疗效观察[J].中国实验方剂学杂志,2017,23(14):188-192.
[16]戴彦成,郑烈,张亚利,等.健脾清肠方对溃疡性结肠炎患者生活质量作用的随机对照试验(英文)[J].中华中医药杂志,2016,31(5):1926-1932.
[17] ZHENG L,ZHANG Y L,DAI Y C,et al. Jianpi Qingchang decoction alleviates ulcerative colitis by inhibiting nuclear factor-κB activation[J]. World J Gastroenterol,2017,23(7):1180-1188.
[18] DAI Y C,ZHENG L,ZHANG Y L,et al. Effects of Jianpi Qingchang decoction on the quality of life of patients with ulcerative colitis:a randomized controlled trial[J]. Medicine,2017,96(16):e6651.
[2] Sud S,Puri A S,Sachdeva S,et al. Tacrolimus as rescue therapy for Steroid dependent/steroid refractory ulcerative colitis:experience from tertiary referral centre[J]. Gastroenterology,2017,152(5):735.
[3] Dalal R S,Buchner A M,Lichtenstein G R. Factors associated with steroid-free clinical remission in ulcerative colitis[J]. Gastroenterology,2017,152(5):369.
[4] Khazraei H, Bananzadeh A, Hosseini S V. Early outcome of patient with ulcerative colitis who received high dose of steroid and underwent two staged total proctocolectomy[J]. Adv Biomed Res, 2018, 7(1):11.
[5] Auth M K,Bunn S K,Protheroe A L,et al. Improved medical treatment and surgical surveillance of children and adolescents with ulcerative colitis in the united kingdom[J]. Inflamm Bowel Dis,2018,24(7):223-225.
[6]胡品津.炎症性肠病诊断与治疗的共识意见(2012年·广州)解读[J].胃肠病学,2012,17(12):709-711.
[7] Kugathasan S,Fiocchi C. Progress in basic inflammatory bowel disease research[J]. Sem Ped Surg,2007,16(3):146-153.
[8]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治方案(2003年重庆)[J].中国中西医结合杂志,2004,24(11):1052-1055.
[9]杨春波,劳绍贤,危北海,等.胃肠疾病中医症状评分表(中国中西医结合学会消化系统疾病专业委员会,2010,苏州)[J].中国中西医结合消化杂志,2011,19(1):66-68.
[10] Baron J H,Conell A M,Lennard-Jones J E. Variation between observers in describingmucosal appearances in proctocolitis[J]. Br Med J,1964,11(1):89-92.
[11]罗爽,罗霞,刘琦,等.大黄酸对DSS诱导溃疡性结肠炎小鼠的治疗作用及机制探讨[J].中国实验方剂学杂志,2017,23(11):109-113..
[12]于玲,王知斌,王秋红,等.黄芪中黄酮类化合物药理作用研究进展[J].中医药信息,2018,35(2):104-108.
[13]冯彦.马齿苋的药理作用及营养保健作用[J].中医临床研究,2017,9(3):117-118.
[14]郑烈,张亚利,王志敏,等.肠道菌群和活性氧自由基与炎症性肠病的关系[J].中国中西医结合消化杂志,2017,23(1):69-72.
[15]赵莉,石志敏,李雪青.补脾胃泻阴火升阳汤联合美沙拉嗪治疗溃疡性结肠炎患者临床疗效观察[J].中国实验方剂学杂志,2017,23(14):188-192.
[16]戴彦成,郑烈,张亚利,等.健脾清肠方对溃疡性结肠炎患者生活质量作用的随机对照试验(英文)[J].中华中医药杂志,2016,31(5):1926-1932.
[17] ZHENG L,ZHANG Y L,DAI Y C,et al. Jianpi Qingchang decoction alleviates ulcerative colitis by inhibiting nuclear factor-κB activation[J]. World J Gastroenterol,2017,23(7):1180-1188.
[18] DAI Y C,ZHENG L,ZHANG Y L,et al. Effects of Jianpi Qingchang decoction on the quality of life of patients with ulcerative colitis:a randomized controlled trial[J]. Medicine,2017,96(16):e6651.