美沙拉嗪联合补中益气汤治疗慢性溃疡性直肠炎的临床效果观察
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摘要
目的探讨美沙拉嗪联合补中益气汤治疗慢性溃疡性直肠炎的临床疗效,并初步分析其作用机制。方法选择2017年6月至2018年6月本院收治的84例慢性溃疡性直肠炎患者随机均分为观察组和对照组,每组各42例。对照组予美沙拉嗪肠溶片口服联合美沙拉嗪栓剂纳肛治疗,观察组在对照组基础上加用补中益气汤。比较两组临床疗效、治疗前后肠道菌群紊乱情况及血清IL-33、IL-10水平。结果观察组治疗后排便次数、便血、内镜发现和医师总体评价得分均优于对照组,差异均有统计学意义(均P <0.05)。治疗前,两组患者肠道肠球菌、乳酸杆菌、双歧杆菌数量以及血清IL-33、IL-10水平对比,差异均无统计学意义(均P> 0.05)。治疗后,观察组肠道乳酸杆菌、双歧杆菌数值高于对照组;血清IL-33水平低于对照组,IL-10水平高于对照组,差异均有统计学意义(均P <0.05)。结论美沙拉嗪联合补中益气汤治疗慢性溃疡性直肠炎疗效优于单用美沙拉嗪,可能与补中益气汤有助于纠正肠道菌群紊乱、减轻机体炎症反应有关。
Objectives To investigate the effect of mesalazine combined with Buzhongyiqi decoction in treating chronic ulcerative proctitis and to determine its mechanism. Methods 84 patients with chronic ulcerative proctitis treated in our hospital between June 2017 and June 2018 were recruited and randomly assigned to treatment group and control group, with 42 patients in each group. Patients in the control group received oral mesalazine enteric-coated tablets combined with mesalazine suppositories.Patients in the treatment group received in addition Buzhongyiqi decoction. Clinical effectiveness, intestinal flora disturbance and serum levels of interleukin 33(IL-33) and 10(IL-10) before and after treatment were compared between the two groups. Results Frequency of defecation, hematochezia, endoscopy findings and overall evaluation scores of physicians after treatment were all significant better in treatment group than in control group(P < 0.05). Before treatment, there was no significant difference in the number of enterococcus, lactobacillus and bifidobacterial in intestines and serum levels of IL-33 and IL-10(P > 0.05). After treatment, the number of lactobacillus and bifidobacterial was significantly higher, IL-33 significantly lower and IL-10 significantly higher, in treatment group than in control group(P < 0.05). Conclusion mesalazine combined with Buzhongyiqi decoction was more effective than using mesalazine alone in treatment chronic ulcerative proctitis. This was possibly related to the effect of Buzhongyiqi decoction correcting intestinal flora disturbance and alleviating inflammation.
Objectives To investigate the effect of mesalazine combined with Buzhongyiqi decoction in treating chronic ulcerative proctitis and to determine its mechanism. Methods 84 patients with chronic ulcerative proctitis treated in our hospital between June 2017 and June 2018 were recruited and randomly assigned to treatment group and control group, with 42 patients in each group. Patients in the control group received oral mesalazine enteric-coated tablets combined with mesalazine suppositories.Patients in the treatment group received in addition Buzhongyiqi decoction. Clinical effectiveness, intestinal flora disturbance and serum levels of interleukin 33(IL-33) and 10(IL-10) before and after treatment were compared between the two groups. Results Frequency of defecation, hematochezia, endoscopy findings and overall evaluation scores of physicians after treatment were all significant better in treatment group than in control group(P < 0.05). Before treatment, there was no significant difference in the number of enterococcus, lactobacillus and bifidobacterial in intestines and serum levels of IL-33 and IL-10(P > 0.05). After treatment, the number of lactobacillus and bifidobacterial was significantly higher, IL-33 significantly lower and IL-10 significantly higher, in treatment group than in control group(P < 0.05). Conclusion mesalazine combined with Buzhongyiqi decoction was more effective than using mesalazine alone in treatment chronic ulcerative proctitis. This was possibly related to the effect of Buzhongyiqi decoction correcting intestinal flora disturbance and alleviating inflammation.
引文
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[12]王筱华.云南白药辅助标准方案对老年溃疡性结肠炎患者疗效的影响[J].结直肠肛门外科,2017,23(4):514-517.
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[14]王艳,李俊霞,王化虹,等.溃疡性结肠炎肠道菌群失调与免疫球蛋白水平的相关性[J].实用医学杂志,2016,32(10):1631-1634.
[15]崔路佳,王裕宣.溃疡性结肠炎患者肠道菌群改变与炎性指标的相关性研究[J].海南医学,2014,25(20):3014-3016.
[16]石磊,施丽婕.溃疡性结肠炎中西医发病机制研究[J].长春中医药大学学报,2014,30(6):1173-1176.
[17]郝莹莹,都广礼.补中益气汤临床应用方证相关的病机探讨[J].中成药,2015,37(8):1872-1874.
[18]施旭光,邹忠杰,吴美音,等.补中益气汤治疗慢性浅表性胃炎脾气虚证的代谢组学研究[J].广州中医药大学学报,2014,31(4):504-509.
[19]郑培奋,李希诗,朱琴,等.连理汤加味对活动期溃疡性结肠炎IL-33表达的影响及临床疗效[J].中华中医药学刊,2014,32(10):2472-2474.
[20]谢晶日,李婷婷.肠愈宁对溃疡性结肠炎大鼠模型IL-10的影响[J].中医药学报,2014,42(1):53-55.
[2]朱振华,曾志荣,彭侠彪,等.广东省中山市炎症性肠病的发病率及临床特点[J].中华消化杂志,2013,33(6):390-393.
[3]KATO S,ISHIBASHI A,KANI K,et al.Optimized management of ulcerative proctitis:when and how to use mesalazine Suppository[J].Digestion,2018,97(1):59-63.
[4]邱婷.美沙拉嗪不同给药方式治疗溃疡性结肠炎的临床效果研究[J].结直肠肛门外科,2016,22(2):203-206.
[5]田玲玲,刘丽娜.284例溃疡性结肠炎患者临床疗效分析[J].大连医科大学学报,2015,37(5):484-487.
[6]王燕,段永强,朱向东,等.基于“脾肾相关”探讨中医干预溃疡性结肠炎疗效机制[J].中国中医药信息杂志,2015,22(2):99-101.
[7]中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见(2012年·广州)[J].胃肠病学,2012,51(12):818-831.
[8]张声生,沈洪,郑凯,等.溃疡性结肠炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(8):3585-3589.
[9]D’HAENS G,SANDBORN W J,FEAGAN B G,et al.A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis[J].Gastroenterology,2007,132(2):763-786.
[10]ZHANG Y Z,LI Y Y.Inflammatory bowel disease:pathogenesis[J].World J Gastroenterol,2014,20(1):91-99.
[11]牟海军,陈幸幸,周光群,等.美沙拉嗪肠溶片治疗激素抵抗型重症溃疡性结肠炎的临床研究[J].中国临床药理学杂志,2016,32(21):1950-1952.
[12]王筱华.云南白药辅助标准方案对老年溃疡性结肠炎患者疗效的影响[J].结直肠肛门外科,2017,23(4):514-517.
[13]SHEEHAN D,MORAN C,SHANAHAN F.The microbiota in inflammatory bowel disease[J].J Gastroenterol,2015,50(5):495-507.
[14]王艳,李俊霞,王化虹,等.溃疡性结肠炎肠道菌群失调与免疫球蛋白水平的相关性[J].实用医学杂志,2016,32(10):1631-1634.
[15]崔路佳,王裕宣.溃疡性结肠炎患者肠道菌群改变与炎性指标的相关性研究[J].海南医学,2014,25(20):3014-3016.
[16]石磊,施丽婕.溃疡性结肠炎中西医发病机制研究[J].长春中医药大学学报,2014,30(6):1173-1176.
[17]郝莹莹,都广礼.补中益气汤临床应用方证相关的病机探讨[J].中成药,2015,37(8):1872-1874.
[18]施旭光,邹忠杰,吴美音,等.补中益气汤治疗慢性浅表性胃炎脾气虚证的代谢组学研究[J].广州中医药大学学报,2014,31(4):504-509.
[19]郑培奋,李希诗,朱琴,等.连理汤加味对活动期溃疡性结肠炎IL-33表达的影响及临床疗效[J].中华中医药学刊,2014,32(10):2472-2474.
[20]谢晶日,李婷婷.肠愈宁对溃疡性结肠炎大鼠模型IL-10的影响[J].中医药学报,2014,42(1):53-55.