清肠化湿法治疗溃疡性结肠炎活动期临床疗效观察
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摘要
目的观察清肠化湿法治疗溃疡性结肠炎(UC)活动期的临床疗效,并从中医理论和现代医学观点两个方面系统探讨清肠化湿法治疗UC活动期的作用机制。
方法采用随机阳性药物对照方法研究,将90例经肠镜检查确诊为溃疡性结肠炎活动期及中医辨证为湿热内蕴证的患者,分成三组。口服中药加灌肠组30例,予清肠化湿法口服结合灌肠方保留灌肠治疗。口服中药组30例,予清肠化湿方口服。美沙拉嗪组(对照组)30例,予口服美沙拉嗪片治疗。三组均三个月为一疗程,疗程结束后分别进行安全性观察和疗效性观察。
结果口服中药加灌肠组总有效率93.3%,口服中药组为80.0%,美沙拉嗪组为83.3%。口服中药加灌肠组分别与其他两组进行比较,差异均具有统计学意义(P<0.05),认为口服中药加灌肠治疗本病临床疗效优于其他两组。中药口服组与美沙拉嗪组比较差异不具有统计学意义(P>0.05),认为中药口服治疗本病不优于美沙拉嗪。治疗后三组肠镜像积分、临床症状积分较治疗前均有明显改善,口服中药加灌肠组分别与其他两组进行比较,差异均具有统计学意义(P<0.05),中药口服组与美沙拉嗪组比较差异不具有统计学意义(P>0.05),认为口服中药加灌肠治疗本病的肠镜疗效优于其他两组,中药口服治疗本病的肠镜疗效不优于美沙拉嗪。
结论采用清肠化湿法口服结合保留灌肠治疗溃疡性结肠炎活动期患者的疗效优于单纯口服中药和美沙拉嗪缓释颗粒,尤其在改善患者临床症状及结肠黏膜病变方面。清肠化湿法为治疗溃疡性结肠炎活动期的安全有效方剂。
Objective:The aim of this study is to observe the clinical effect of QingChangHuaShi method treating ulcerative colitis(UC), and to explore the mechanism of this method from the point of traditional Chinese medicine and Western medicine.
Method:90 patients who were diagnosed as in active stage of UC by colonoscopy and diagnosed as the syndrome of internal stasis of dampness and heat by syndrome differentiation of traditional Chinese medicine were divided into three groups. In the first treatment group,30patients were treated with taking QingChangHuaShi prescription; in the second treatment group,30 patients were treated with taking QingChangHuaShi prescription in combination with retention with enema prescription; the other30 patients in the control group were treated with particle release mesalazine (5-ASA). Three months later when the treatment is over, compare the clinical curative effect and monitor the safety index.
Results:The total effective rate of the first treatment group is 80.0%, the total effective rate of the second treatment group is 93.3%, while that of the control group is 83.3%. The effective rate of the second treatment group is superior to the other 2 groups(P<0.05), and there is no statistic difference in comparison of the first group and the control group (P>0.05). The integration of colonoscopy and symptoms has improved after treatment, compare the results of colonoscopy and symptoms of these groups and find that the second group is superior to the other 2 groups (P<0.05). The first treatment group is not superior to the control group(P>0.05).
Conclusion:The curative effect of taking QingChangHuaShi prescription in combination with retention enema treating ulcerative colitis patients in active stage is superior to that of 5-ASA, and is also superior to that of taking QingChangHuaShi prescription alone, especially in improving TCM or clinical syndrome、intestinal mucous membrane. And the QingChangHuaShi method of traditional Chinese medicine is safe.
方法采用随机阳性药物对照方法研究,将90例经肠镜检查确诊为溃疡性结肠炎活动期及中医辨证为湿热内蕴证的患者,分成三组。口服中药加灌肠组30例,予清肠化湿法口服结合灌肠方保留灌肠治疗。口服中药组30例,予清肠化湿方口服。美沙拉嗪组(对照组)30例,予口服美沙拉嗪片治疗。三组均三个月为一疗程,疗程结束后分别进行安全性观察和疗效性观察。
结果口服中药加灌肠组总有效率93.3%,口服中药组为80.0%,美沙拉嗪组为83.3%。口服中药加灌肠组分别与其他两组进行比较,差异均具有统计学意义(P<0.05),认为口服中药加灌肠治疗本病临床疗效优于其他两组。中药口服组与美沙拉嗪组比较差异不具有统计学意义(P>0.05),认为中药口服治疗本病不优于美沙拉嗪。治疗后三组肠镜像积分、临床症状积分较治疗前均有明显改善,口服中药加灌肠组分别与其他两组进行比较,差异均具有统计学意义(P<0.05),中药口服组与美沙拉嗪组比较差异不具有统计学意义(P>0.05),认为口服中药加灌肠治疗本病的肠镜疗效优于其他两组,中药口服治疗本病的肠镜疗效不优于美沙拉嗪。
结论采用清肠化湿法口服结合保留灌肠治疗溃疡性结肠炎活动期患者的疗效优于单纯口服中药和美沙拉嗪缓释颗粒,尤其在改善患者临床症状及结肠黏膜病变方面。清肠化湿法为治疗溃疡性结肠炎活动期的安全有效方剂。
Objective:The aim of this study is to observe the clinical effect of QingChangHuaShi method treating ulcerative colitis(UC), and to explore the mechanism of this method from the point of traditional Chinese medicine and Western medicine.
Method:90 patients who were diagnosed as in active stage of UC by colonoscopy and diagnosed as the syndrome of internal stasis of dampness and heat by syndrome differentiation of traditional Chinese medicine were divided into three groups. In the first treatment group,30patients were treated with taking QingChangHuaShi prescription; in the second treatment group,30 patients were treated with taking QingChangHuaShi prescription in combination with retention with enema prescription; the other30 patients in the control group were treated with particle release mesalazine (5-ASA). Three months later when the treatment is over, compare the clinical curative effect and monitor the safety index.
Results:The total effective rate of the first treatment group is 80.0%, the total effective rate of the second treatment group is 93.3%, while that of the control group is 83.3%. The effective rate of the second treatment group is superior to the other 2 groups(P<0.05), and there is no statistic difference in comparison of the first group and the control group (P>0.05). The integration of colonoscopy and symptoms has improved after treatment, compare the results of colonoscopy and symptoms of these groups and find that the second group is superior to the other 2 groups (P<0.05). The first treatment group is not superior to the control group(P>0.05).
Conclusion:The curative effect of taking QingChangHuaShi prescription in combination with retention enema treating ulcerative colitis patients in active stage is superior to that of 5-ASA, and is also superior to that of taking QingChangHuaShi prescription alone, especially in improving TCM or clinical syndrome、intestinal mucous membrane. And the QingChangHuaShi method of traditional Chinese medicine is safe.
引文
[1]Wltilks S. The morbid appearance of the intestine of miss banks. Medical Times and Gazette,1859,2:264
[2]Mayer L. IBD:immunologic research at the mount Sinai hospital. MtSinai J Med, 2000,67(3):208-213
[3]邓长生,夏冰.炎症性肠病[M].人民卫生出版社,1998,133-134
[4]Thomas GA, Rhodes J, Green JT. Inflammatory bowel disease and smoking a review. AM J Castroentero,1998:93:144-149
[5]郑家驹.炎症性肠病[M].上海科学技术出版社,1998,第1版：24-43,51-68
[6]张晓梅,肖培新.以寒热为纲辨治溃疡性结肠炎.陕西中医,1998,6：7
[7]Travis SPL, Jewell DP. Salicylates for ulcerative colitis-their mod of action [J]. Pharmacol Ther,1994,63(2):135-161
[8]李世荣,翟力平,郑力等.5-氨基水杨酸与柳氮磺胺吡啶治疗溃疡性结肠炎的对比研究[J].中国新药杂志,1999,8(4)：248-250
[9]欧平安,郑松柏,徐富星等.美沙拉嗪治疗溃疡性结肠炎的多中心研究[J].中国新药与临床杂志,1998,i7(5)：283-285
[10]胡伏莲,林庚金.美沙拉嗪治疗炎症性肠病的疗效及安全性一全国多中心临床研究[J].中国新药杂志,2001,10(3)：201-203
[11]谭华,李克迪.艾迪莎与SASP治疗溃疡性结肠炎的疗效比较[J].天津医药,2001,9(8)：967-969
[12]杨玉龙,黄乃侠,吴琳等.奥沙拉嗪治疗溃疡性结肠炎疗效观察[J].临床荟萃,2000,15(17)：790-791
[13]王晓华,李杨,朱平等.奥柳氮对实验性大鼠非特异性结肠炎的作用[J].中国临床药学杂志,1998,7(3)：136-138
[14]Hude GM. Jewell DP, kettle well MG, etal. Cyclosporin for severe ulcerative Colitis does not increase the rate of Perrioperative complication. Dis Colin Rectum, 2002,44:1436-1440
[15]王群英,陈村龙,孙勇等.溃疡性结肠炎患者菌群分析结果的研究[J].中国微生态学杂志,2002,14(1)：31-32
[16]辛光宾,李立新.地尔硫卓与环丙沙星联用治疗溃疡性结肠炎16例分析[J].辽宁医学杂志,2000,14(4)：213
[17]全国慢性非感染性肠道疾病学术研讨会.溃疡性结肠炎的诊断及疗效标准[J].中华消化杂志,1993,13(6)：354
[18]谭丹.溃疡性结肠炎辨证分型浅析[J].中医药学刊2001,12(6)：555
[19]周丽英,于长禄.辨证治疗慢性非特异性溃疡性结肠炎45例[J].国医论坛,2003,18(1)：28
[20]罗珊珊,许东云.难治性溃疡性结肠炎的中医辨证论治规律探讨,[J].云南中医中药杂志,2005：26(1)：58
[21]邹世玲,中药治疗馈疡性结肠炎166例报道,[J].江西中医药,1994;(25)：6
[22]高向欣.参连汤治疗非特异性溃疡性结肠炎50例.[J].河北中医,2002,24(9)：674
[23]高洪寿.祛邪扶正法治疗溃疡性结肠炎[J].实用中西医结合杂志,1998,11(1)：73
[24]苏路侠.中药口服及灌肠治疗慢性溃疡性结肠炎124例疗效观察[J].新中医,1998,30(1)：22-24
[25]阎鼎忠.归芍泻心汤配合灌肠治疗慢性非特异性溃疡性结肠48例临床观察[J].新中医,2000,32(4)：16-17
[26]方向明,许能贵,肖永俭.艾灸治疗溃疡性结肠炎58例疗效观察.[J].针刺研究,1999,24(1)：66-67
[27]杨顺益.针灸治疗溃疡性结肠炎的临床观察[J].上海针灸杂志,2001;(1)：17-18
[28]康新年,赵建波,刘建民.灌肠及肠炎贴膏治疗非特异性溃疡性结肠炎256例.[J].中国肛肠病杂志,1999：19(7)：39
[29]赵广智,王淑媛.熨脐法治疗慢性非特异性溃疡性结肠炎30例[J].吉林中医药,1992：(4)：20
[30]陈治水,危北海,张万岱等.溃疡性结肠炎中西医结合诊治方案(草案).中国中西医结合消化杂志,2004,24(11)：1052-1055
[31]中华人民共和国卫生部颁布.中药新药临床研究指导原则.第二辑.2002,142-145
[32]欧阳建东,高靖.锡类散栓剂治疗大鼠溃疡性结肠炎的临床研究。铁道医学[J].1999,27(3)：150-151
[33]蒋激扬,耿东升.黄连的抗炎作用与其机制[J].中国药理学通报,1998,14(5)：434
[34]莫少红.白头翁的化学成分及药理作用研究进展[J].中药材,2001：24(5)：385
[35]邓建云.蒲黄等五种中药对中性粒细胞趋化的抑制作用[J].中草药,1998,(增刊)：115
[36]王明江..木香、玄胡及其复方对离体兔肠平滑肌的作用[J].同济医科大学学报,1992,21(3)：209。
[37]雷载权,张廷模.[M].中华临床中药学(上、下卷),北京：人民卫生出版社,1998,第1版：377-378,531-533,798
[38]杨怀莉等.甘草、白芍及合用对在体兔肠管运动的影响[J].中草药,1993,15(5)：485
[39]孙秀梅等,炮制对芍甘汤中蹂质含量及对小鼠抗炎作用的影响[J].中药材,1991, 14(3)：2
[40]高学敏.[M].中药学.第一版中国中医药出版社,2002,339
[41]韩捷.白头翁汤治疗溃疡性结肠炎作用机制的实验研究[J].河南中医药学刊,2001,16(3)：23-26
[42]张茂,吴小玫,李永柏.试论扶正祛邪与免疫的关系[J].重庆医科大学学报,2002,27(3)：357-358
[2]Mayer L. IBD:immunologic research at the mount Sinai hospital. MtSinai J Med, 2000,67(3):208-213
[3]邓长生,夏冰.炎症性肠病[M].人民卫生出版社,1998,133-134
[4]Thomas GA, Rhodes J, Green JT. Inflammatory bowel disease and smoking a review. AM J Castroentero,1998:93:144-149
[5]郑家驹.炎症性肠病[M].上海科学技术出版社,1998,第1版：24-43,51-68
[6]张晓梅,肖培新.以寒热为纲辨治溃疡性结肠炎.陕西中医,1998,6：7
[7]Travis SPL, Jewell DP. Salicylates for ulcerative colitis-their mod of action [J]. Pharmacol Ther,1994,63(2):135-161
[8]李世荣,翟力平,郑力等.5-氨基水杨酸与柳氮磺胺吡啶治疗溃疡性结肠炎的对比研究[J].中国新药杂志,1999,8(4)：248-250
[9]欧平安,郑松柏,徐富星等.美沙拉嗪治疗溃疡性结肠炎的多中心研究[J].中国新药与临床杂志,1998,i7(5)：283-285
[10]胡伏莲,林庚金.美沙拉嗪治疗炎症性肠病的疗效及安全性一全国多中心临床研究[J].中国新药杂志,2001,10(3)：201-203
[11]谭华,李克迪.艾迪莎与SASP治疗溃疡性结肠炎的疗效比较[J].天津医药,2001,9(8)：967-969
[12]杨玉龙,黄乃侠,吴琳等.奥沙拉嗪治疗溃疡性结肠炎疗效观察[J].临床荟萃,2000,15(17)：790-791
[13]王晓华,李杨,朱平等.奥柳氮对实验性大鼠非特异性结肠炎的作用[J].中国临床药学杂志,1998,7(3)：136-138
[14]Hude GM. Jewell DP, kettle well MG, etal. Cyclosporin for severe ulcerative Colitis does not increase the rate of Perrioperative complication. Dis Colin Rectum, 2002,44:1436-1440
[15]王群英,陈村龙,孙勇等.溃疡性结肠炎患者菌群分析结果的研究[J].中国微生态学杂志,2002,14(1)：31-32
[16]辛光宾,李立新.地尔硫卓与环丙沙星联用治疗溃疡性结肠炎16例分析[J].辽宁医学杂志,2000,14(4)：213
[17]全国慢性非感染性肠道疾病学术研讨会.溃疡性结肠炎的诊断及疗效标准[J].中华消化杂志,1993,13(6)：354
[18]谭丹.溃疡性结肠炎辨证分型浅析[J].中医药学刊2001,12(6)：555
[19]周丽英,于长禄.辨证治疗慢性非特异性溃疡性结肠炎45例[J].国医论坛,2003,18(1)：28
[20]罗珊珊,许东云.难治性溃疡性结肠炎的中医辨证论治规律探讨,[J].云南中医中药杂志,2005：26(1)：58
[21]邹世玲,中药治疗馈疡性结肠炎166例报道,[J].江西中医药,1994;(25)：6
[22]高向欣.参连汤治疗非特异性溃疡性结肠炎50例.[J].河北中医,2002,24(9)：674
[23]高洪寿.祛邪扶正法治疗溃疡性结肠炎[J].实用中西医结合杂志,1998,11(1)：73
[24]苏路侠.中药口服及灌肠治疗慢性溃疡性结肠炎124例疗效观察[J].新中医,1998,30(1)：22-24
[25]阎鼎忠.归芍泻心汤配合灌肠治疗慢性非特异性溃疡性结肠48例临床观察[J].新中医,2000,32(4)：16-17
[26]方向明,许能贵,肖永俭.艾灸治疗溃疡性结肠炎58例疗效观察.[J].针刺研究,1999,24(1)：66-67
[27]杨顺益.针灸治疗溃疡性结肠炎的临床观察[J].上海针灸杂志,2001;(1)：17-18
[28]康新年,赵建波,刘建民.灌肠及肠炎贴膏治疗非特异性溃疡性结肠炎256例.[J].中国肛肠病杂志,1999：19(7)：39
[29]赵广智,王淑媛.熨脐法治疗慢性非特异性溃疡性结肠炎30例[J].吉林中医药,1992：(4)：20
[30]陈治水,危北海,张万岱等.溃疡性结肠炎中西医结合诊治方案(草案).中国中西医结合消化杂志,2004,24(11)：1052-1055
[31]中华人民共和国卫生部颁布.中药新药临床研究指导原则.第二辑.2002,142-145
[32]欧阳建东,高靖.锡类散栓剂治疗大鼠溃疡性结肠炎的临床研究。铁道医学[J].1999,27(3)：150-151
[33]蒋激扬,耿东升.黄连的抗炎作用与其机制[J].中国药理学通报,1998,14(5)：434
[34]莫少红.白头翁的化学成分及药理作用研究进展[J].中药材,2001：24(5)：385
[35]邓建云.蒲黄等五种中药对中性粒细胞趋化的抑制作用[J].中草药,1998,(增刊)：115
[36]王明江..木香、玄胡及其复方对离体兔肠平滑肌的作用[J].同济医科大学学报,1992,21(3)：209。
[37]雷载权,张廷模.[M].中华临床中药学(上、下卷),北京：人民卫生出版社,1998,第1版：377-378,531-533,798
[38]杨怀莉等.甘草、白芍及合用对在体兔肠管运动的影响[J].中草药,1993,15(5)：485
[39]孙秀梅等,炮制对芍甘汤中蹂质含量及对小鼠抗炎作用的影响[J].中药材,1991, 14(3)：2
[40]高学敏.[M].中药学.第一版中国中医药出版社,2002,339
[41]韩捷.白头翁汤治疗溃疡性结肠炎作用机制的实验研究[J].河南中医药学刊,2001,16(3)：23-26
[42]张茂,吴小玫,李永柏.试论扶正祛邪与免疫的关系[J].重庆医科大学学报,2002,27(3)：357-358