中西医结合治疗溃疡性结肠炎的优势及临床应用
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摘要
溃疡性结肠炎(UC)是一种病因不明的慢性非特异性结肠炎症性病变。近年来其发病率及患病率逐渐增高,成为临床治疗的热点和难点。随着重度和疑难病例的增多以及治疗目标的转变,单用西医或中医治疗不能满足临床需要。中西医结合治疗在促进深度缓解,提高患者生活质量、节约医疗资源等方面更具优势。如何更好地发挥中西医结合特色,选择最佳的结合范式和时机,有待进一步探索。文章从UC治疗面临的挑战、中医药治疗UC的方法与机制、中西医结合治疗UC的优势和临床应用方面进行探讨。
Ulcerative colitis is a chronic nonspecific inflammatory disease of unknown etiology and,with a rising incidence and prevalence in recent years,has become a focus as well as a difficulty in clinical treatment. With the increase of severe and difficult cases and change of therapeutic objectives,neither Western nor traditional Chinese medicine alone can meet the clinical needs,while integrated traditional Chinese and Western medicine has manifested its advantages of promoting deep remission,improving patients' quality of life and saving medical resources. How to give full play to the characteristic advantages of integrated traditional Chinese and Western medicine and choose the best combination paradigm and timing remains to be further explored.
Ulcerative colitis is a chronic nonspecific inflammatory disease of unknown etiology and,with a rising incidence and prevalence in recent years,has become a focus as well as a difficulty in clinical treatment. With the increase of severe and difficult cases and change of therapeutic objectives,neither Western nor traditional Chinese medicine alone can meet the clinical needs,while integrated traditional Chinese and Western medicine has manifested its advantages of promoting deep remission,improving patients' quality of life and saving medical resources. How to give full play to the characteristic advantages of integrated traditional Chinese and Western medicine and choose the best combination paradigm and timing remains to be further explored.
引文
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[3]Ng SC,Shi HY,Hamidi N,et al.Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century:a systematic review of population-based studies[J].Lancet,2018,390(10114):2769-2778.
[4]Yang SK,Yun S,Kim JH,et al.Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district,Seoul,Korea,1986-2005:a KA-SID study[J].Inflamm Bowel Dis,2008,14(4):542-549.
[5]Jung YS,Han M,Kim WH,et al.Incidence and Clinical Outcomes of Inflammatory Bowel Disease in South Korea,2011-2014:A Nationwide Population-Based Study[J].Dig Dis Sci,2017,62(8):2102-2112.
[6]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(2018年,北京)[J].中华消化杂志,2018,38(5):292-311.
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[9]Gisbert JP,Linares PM,McNicholl AG,et al.Meta-analysis:the efficacy of azathioprine and mercaptopurine in ulcerative colitis[J].Aliment Pharmacol Ther,2009,30(2):126-137.
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[13]Sandborn WJ,Targan SR,Byers VS,et al.Andrographis paniculata extract[HMPL-004]for active ulcerative colitis[J].Am J Gastroenterol2013,108(1):90-98.
[14]Naganuma M,Sugimoto S,Mitsuyama K,et al.Efficacy of Indigo Naturalis in a Multicenter Randomized Controlled Trial of Patients With Ulcerative Colitis[J].Gastroenterology,2018,154(4):935-947.
[15]沈洪,张声生,王垂杰,等.中药分期序贯治疗轻中度溃疡性结肠炎111例疗效观察[J].中医杂志,2011,52(13):1108-1111.
[16]谷静,沈洪,刘军楼,等.清肠化湿方对小鼠骨髓来源树突状细胞生物学特性的影响[J].中国实验方剂学杂志,2013,19(13):200-204.
[17]赵青春,沈洪,程海波,等.清肠化湿方对HT-29细胞IL-6/JAK2/STAT3的影响[J].中国药理学通报,2015,31(6):883-885.
[18]沈洪,刘智群,朱荃,等.清肠化湿方对溃疡性结肠炎NF-κB/Tolls通路的影响及其机制[J].中国中西医结合杂志,2013,33(9):1216-1220.
[19]陆玥琳,沈洪,姚宏凤,等.清肠化湿方联合美沙拉嗪颗粒对溃疡性结肠炎患者血浆及肠黏膜组织IL-17的影响[J].中国中西医结合杂志,2014,34(10):1160-1163.
[20]朱磊,沈洪,顾培青,等.健脾补肾、清肠化湿方联合BMSCs对溃疡性结肠炎模型大鼠肠屏障的修复作用[J].世界华人消化杂志,2016,24(7):1017-1023.
[21]刘智群,沈洪,朱萱萱,等.清肠化湿方对TNBS诱导大鼠UC模型紧密连接蛋白的影响[J].辽宁中医,2012,39(8):1617-1619.
[22]Vecchi Brumatti L,Marcuzzi A,Tricarico PM,et al.Curcumin and inflammatory bowel disease:potential and limits of innovative treatment[J]Molecules,2014,19(12):21127-21153.
[23]Li R,Alex P,Ye M,Zhang T,et al.An old herbal medicine with a potentially new therapeutic application in inflammatory bowel disease[J].Int J Clin Exp Med,2011,4(4):309-319.
[24]Bouguen G,Levesque BG,Pola S,et al.Endoscopic assessment and treating to target increase the likelihood of mucosal healing in patients with Crohn's disease[J].Clin Gastroenterol Hepatol,2014,12(6):978-985.
[25]Colombel JF1,Keir ME2,Scherl A,et al.Discrepancies between patient-reported outcomes,and endoscopic and histological appearance in UC[J].GUT,2017,66(12):2063-2068.
[26]俞媛,李晨.芍黄安肠汤治疗溃疡性结肠炎的临床疗效及对免疫功能的影响[J].现代中西医结合杂志,2019,28(1):30-33.
[27]邓文珺,马颖才,马丽莉.美沙拉嗪联合丹参注射液治疗溃疡性结肠炎的疗效及对患者炎性因子与凝血指标的影响[J].世界华人消化杂志,2016,24(3):462-466.
[28]王教学,余森源,严和中,等.美沙拉嗪联合锡类散、黄连素及云南白药保留灌肠治疗轻中度E2型活动期溃疡性结肠炎疗效观察[J].临床军医杂志,2017,45(8):793-795.
[29]邹浩.参苓白术散联合美沙拉嗪治疗脾胃气虚型溃疡性结肠炎疗效[J].中国医药科学,2015,5(21):74-76,173.
[2]Kaplan GG.The global burden of IBD:from 2015 to 202[J].Nat Rev Gastroenterol Hepatol,2015,12:720-727.
[3]Ng SC,Shi HY,Hamidi N,et al.Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century:a systematic review of population-based studies[J].Lancet,2018,390(10114):2769-2778.
[4]Yang SK,Yun S,Kim JH,et al.Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district,Seoul,Korea,1986-2005:a KA-SID study[J].Inflamm Bowel Dis,2008,14(4):542-549.
[5]Jung YS,Han M,Kim WH,et al.Incidence and Clinical Outcomes of Inflammatory Bowel Disease in South Korea,2011-2014:A Nationwide Population-Based Study[J].Dig Dis Sci,2017,62(8):2102-2112.
[6]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(2018年,北京)[J].中华消化杂志,2018,38(5):292-311.
[7]Ford AC,Khan KJ,Achkar JP,et al.Efficacy of oral vs.topical,or combined oral and topical 5-aminosalicylates,in Ulcerative Colitis:systematic review and meta-analysis[J].Am J Gastroenterol,2012,107(2):167-176.
[8]Sandborn WJ,Bosworth B,Zakko S,et al.Budesonide foam induces remission in patients with mild to moderate ulcerative proctitis and ulcerative proctosigmoiditis[J].Gastroenterology,2015,148(4):740-750.
[9]Gisbert JP,Linares PM,McNicholl AG,et al.Meta-analysis:the efficacy of azathioprine and mercaptopurine in ulcerative colitis[J].Aliment Pharmacol Ther,2009,30(2):126-137.
[10]Nielsen OH,Bjerrum JT,Herfarth H,et al.Recent Advances Using Immunomodulators for Inflammatory Bowel Disease[J].J Clin Pharmacol,2013,53(6):575-588.
[11]Vickers AD,Ainsworth C,Mody R,et al.Systematic Review with Network Meta-Analysis:Comparative Efficacy of Biologics in the Treatment of Moderately to Severely Active Ulcerative Colitis[J].PLoS One,2016,11(10):e0165435.
[12]C Motoya S,Watanabe M,Kim HJ,et al.Corrigendum:Tofacitinib induction and maintenance therapy in East Asian patients with active ulcerative colitis:subgroup analyses from three phase 3 multinational studies[J].Intest Res,2018,16(3):499-501.
[13]Sandborn WJ,Targan SR,Byers VS,et al.Andrographis paniculata extract[HMPL-004]for active ulcerative colitis[J].Am J Gastroenterol2013,108(1):90-98.
[14]Naganuma M,Sugimoto S,Mitsuyama K,et al.Efficacy of Indigo Naturalis in a Multicenter Randomized Controlled Trial of Patients With Ulcerative Colitis[J].Gastroenterology,2018,154(4):935-947.
[15]沈洪,张声生,王垂杰,等.中药分期序贯治疗轻中度溃疡性结肠炎111例疗效观察[J].中医杂志,2011,52(13):1108-1111.
[16]谷静,沈洪,刘军楼,等.清肠化湿方对小鼠骨髓来源树突状细胞生物学特性的影响[J].中国实验方剂学杂志,2013,19(13):200-204.
[17]赵青春,沈洪,程海波,等.清肠化湿方对HT-29细胞IL-6/JAK2/STAT3的影响[J].中国药理学通报,2015,31(6):883-885.
[18]沈洪,刘智群,朱荃,等.清肠化湿方对溃疡性结肠炎NF-κB/Tolls通路的影响及其机制[J].中国中西医结合杂志,2013,33(9):1216-1220.
[19]陆玥琳,沈洪,姚宏凤,等.清肠化湿方联合美沙拉嗪颗粒对溃疡性结肠炎患者血浆及肠黏膜组织IL-17的影响[J].中国中西医结合杂志,2014,34(10):1160-1163.
[20]朱磊,沈洪,顾培青,等.健脾补肾、清肠化湿方联合BMSCs对溃疡性结肠炎模型大鼠肠屏障的修复作用[J].世界华人消化杂志,2016,24(7):1017-1023.
[21]刘智群,沈洪,朱萱萱,等.清肠化湿方对TNBS诱导大鼠UC模型紧密连接蛋白的影响[J].辽宁中医,2012,39(8):1617-1619.
[22]Vecchi Brumatti L,Marcuzzi A,Tricarico PM,et al.Curcumin and inflammatory bowel disease:potential and limits of innovative treatment[J]Molecules,2014,19(12):21127-21153.
[23]Li R,Alex P,Ye M,Zhang T,et al.An old herbal medicine with a potentially new therapeutic application in inflammatory bowel disease[J].Int J Clin Exp Med,2011,4(4):309-319.
[24]Bouguen G,Levesque BG,Pola S,et al.Endoscopic assessment and treating to target increase the likelihood of mucosal healing in patients with Crohn's disease[J].Clin Gastroenterol Hepatol,2014,12(6):978-985.
[25]Colombel JF1,Keir ME2,Scherl A,et al.Discrepancies between patient-reported outcomes,and endoscopic and histological appearance in UC[J].GUT,2017,66(12):2063-2068.
[26]俞媛,李晨.芍黄安肠汤治疗溃疡性结肠炎的临床疗效及对免疫功能的影响[J].现代中西医结合杂志,2019,28(1):30-33.
[27]邓文珺,马颖才,马丽莉.美沙拉嗪联合丹参注射液治疗溃疡性结肠炎的疗效及对患者炎性因子与凝血指标的影响[J].世界华人消化杂志,2016,24(3):462-466.
[28]王教学,余森源,严和中,等.美沙拉嗪联合锡类散、黄连素及云南白药保留灌肠治疗轻中度E2型活动期溃疡性结肠炎疗效观察[J].临床军医杂志,2017,45(8):793-795.
[29]邹浩.参苓白术散联合美沙拉嗪治疗脾胃气虚型溃疡性结肠炎疗效[J].中国医药科学,2015,5(21):74-76,173.