连草泻痢胶囊对活动期溃疡性结肠炎患者血清炎性因子及肠道黏膜屏障的影响
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摘要
[目的]观察连草泻痢胶囊对活动期溃疡性结肠炎大肠湿热证患者炎性因子及肠道黏膜屏障的影响;方法:选取符合诊断及纳入标准的溃疡性结肠炎患者60例,随机分为对照组(n=30)和治疗组(n=30)。其中对照组给予美沙拉嗪肠溶片口服治疗,治疗组在对照组的基础上给予连草泻痢胶囊口服治疗,2组患者疗程均为8周,分别观察2组患者治疗前后中医症状积分、Sutherland疾病活动指数和Baron评分的改善情况,同时检测炎性因子(TGF-α、IL-10和IL-17)、基质金属蛋白酶(MMP2和MMP9)及氧化三甲胺(TMAO)水平的变化,并评价其临床疗效;结果:治疗组总有效率为90%,对照组总有效为73.3%,治疗组优于对照组(P<0.05);治疗组治疗后中医症状积分、Sutherland疾病活动指数和Baron评分与本组治疗前比较显著降低(P<0.01),明显优于对照组(P<0.01);此外,治疗组治疗后TNF-α、IL-17、MMP-2、MMP-9和TMAO水平较治疗前显著降低,IL-10水平显著升高(P<0.01);2组治疗后组间比较,治疗组明显优于对照组(P<0.01);[结论]连草泻痢胶囊联合美沙拉嗪肠溶片能够改善炎性因子的失衡和肠道黏膜屏障功能的异常,缓解大肠湿热证活动期溃疡性结肠炎患者临床症状,疗效显著。
[Objective]To observe the clinical effect of Liancao Xieli capsule on inflammatory factors and intestinal mucosal barrier in patients with active ulcerative colitis of damp-heat syndrome of large intestine.[Methods]60 patients with ulcerative colitis were randomly divided into control group(n=30)and treatment group(n=30).The control group was treated with Mesalazine enteric-coated tablets orally,and the treatment group was treated with Liancaoxieli Capsule orally on the basis of the control group.Both groups were treated for 8 weeks.TCM symptom score,Sutherland disease activity index and Baron score were observed.The changes of inflammatory factors(TGF-α,IL-10 and IL-17),matrix metalloproteinase(MMP-2 and MMP-9)and trimethylamine oxide(TMAO)in peripheral blood were also detected before and after treatment,and the clinical efficacy was evaluated after treatment.[Results]The total effective rate was90%in the treatment group and 73.3%in the control group,which was better than that in the control group(P<0.05).After treatment,the scores of TCM symptoms,Sutherland disease activity index and Baron score in the treatment group were significantly lower than those before treatment(P<0.01),which was significantly better than those in the control group(P<0.01).In addition,the levels of serum TNF-α、IL-17、MMP-2、MMP-9,and TMAO in the treatment group were significantly lower than those before treatment(P<0.01).After treatment,the level of IL-10 in the treatment group was significantly higher than that in the control group(P<0.01).[Conclusion]Liancao Xieli capsule combined with mesalazine enteric-coated tablets can regulate the imbalance of inflammatory factors,the abnormality of intestinal mucosal barrier function,and improve the clinical symptoms of ulcerative colitis patients with active stage of large intestine damp-heat syndrome.
[Objective]To observe the clinical effect of Liancao Xieli capsule on inflammatory factors and intestinal mucosal barrier in patients with active ulcerative colitis of damp-heat syndrome of large intestine.[Methods]60 patients with ulcerative colitis were randomly divided into control group(n=30)and treatment group(n=30).The control group was treated with Mesalazine enteric-coated tablets orally,and the treatment group was treated with Liancaoxieli Capsule orally on the basis of the control group.Both groups were treated for 8 weeks.TCM symptom score,Sutherland disease activity index and Baron score were observed.The changes of inflammatory factors(TGF-α,IL-10 and IL-17),matrix metalloproteinase(MMP-2 and MMP-9)and trimethylamine oxide(TMAO)in peripheral blood were also detected before and after treatment,and the clinical efficacy was evaluated after treatment.[Results]The total effective rate was90%in the treatment group and 73.3%in the control group,which was better than that in the control group(P<0.05).After treatment,the scores of TCM symptoms,Sutherland disease activity index and Baron score in the treatment group were significantly lower than those before treatment(P<0.01),which was significantly better than those in the control group(P<0.01).In addition,the levels of serum TNF-α、IL-17、MMP-2、MMP-9,and TMAO in the treatment group were significantly lower than those before treatment(P<0.01).After treatment,the level of IL-10 in the treatment group was significantly higher than that in the control group(P<0.01).[Conclusion]Liancao Xieli capsule combined with mesalazine enteric-coated tablets can regulate the imbalance of inflammatory factors,the abnormality of intestinal mucosal barrier function,and improve the clinical symptoms of ulcerative colitis patients with active stage of large intestine damp-heat syndrome.
引文
[1]陈文华,黄国栋,方承康,等.溃疡性结肠炎现代医学研究进展[J].中国医药科学,2011,1(7):51-53.
[2]张瑞芳,陈朝晖,刘漪沦,等.溃疡性结肠炎的发病机制及其治疗进展[J].生命的化学,2018,38(2):241-249.
[3]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007,12(8):488-495.
[4]Ng SC,Bernstein CN,Vatn MH,et al.Geographical variability and environmental risk factors in inflammatory bowel disease[J].Gut,2013,62(4):630-649.
[5]Molodecky NA,Soon IS,Rabi DM,et al.Increasing incidence and prevalence of the inflammatory bowel diseases with time,based on systematic review[J].Gastroenterology,2012,142(1):46-54.e42.
[6]Ye L,Cao Q,Cheng J.Review of inflammatory bowel disease in China[J].Sci World J,2013,2013:296470.
[7]王欣,王伟明,宋亚娟,等.香连胶囊对大鼠急性肠炎的作用[J].中国实验方剂学杂志,2013,19(3):212-215.
[8]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,2012,17(12):763-781.
[9]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疗共识意见[J].中国中西医结合消化杂志,2018,26(2):105-110.
[10]陈治水,危北海,张万岱,等.溃疡性结肠炎中西医结合诊疗指南(草案)(中国中西医结合学会消化系统疾病专业委员会,2010西昌)[J].中国中西医结合消化杂志,2011,19(1):61-65.
[11]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:159-161.
[12]欧阳钦,胡品津,钱家鸣,等.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007,12(8):488-495.
[13]欧阳钦,苗新普.炎症性肠病评估指标的临床应用[J].中华消化杂志,2009,29(3):209-212.
[14]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.
[15]张林,吴洁琼,张伟,等.青柏溃结汤对溃疡性结肠炎大鼠疗效的研究[J].中国中医急症,2017,26(8):1352-1354,1380.
[16]王美红,陈同辛.静脉内免疫球蛋白对单核巨噬细胞免疫调节机制的研究[J].国际儿科学杂志,2006,33(1):33-35.
[17]李伟华.肠缺血再灌注损伤大鼠肠黏膜组织中TNF-α和VIP的表达及意义[J].青岛大学医学院学报,2007,51(6):510-511,513.
[18]王燕,曹燕飞,朱向东,等.四神丸对溃疡性结肠炎模型大鼠血清白细胞介素-1β、-4、肿瘤坏死因子-α的影响[J].中国老年学杂志,2015,35(1):128-128.
[19]陈子伟,庄俊合,罗宜红,等.血浆IL17在慢性阻塞性肺疾病综合评估中的作用[J].广州医科大学学报,2015,43(2):97-100.
[20]张炳勇,吕愈敏,洪天配,等.炎症性肠病患者肠黏膜白细胞介素18的表达及意义[J].北京大学学报(医学版),2003,35(2):150-153.
[21]林巧嫦,廖博贤,黄飞娜.白细胞介素IL-4、IL-17在溃疡性结肠炎中的表达[J].中国医药科学,2012,2(16):44-45.
[22]姚惠,郑培奋,李希诗,等.益气愈溃汤对溃疡性结肠炎IL-33、IL-10及肠道菌群紊乱的纠正作用[J].中华中医药学刊,2013,31(6):1449-1451.
[23]Alipour M,Zaidi D,Valcheva R,et al.Mucosal Barrier Depletion And Loss Of Bacterial Diversity Are Primary Abnormalities In Paediatric Ulcerative Colitis[J].JCrohnsColitis,2016,10(4):462-471.
[24]戴悦婷,唐志鹏.溃疡性结肠炎肠黏膜损伤的研究进展[J].中国中西医结合消化杂志,2018,26(6):545-549.
[25]颜蓉,梁杏花,尹良钰.关于MMP-2、MMP-9和溃疡性结肠炎患者肠黏膜通透性之间的关联分析[J].岭南急诊医学杂志,2019(1):68-70.
[26]李云,戴岳,夏玉凤.溃疡性结肠炎内源性代谢物和肠道菌群变化研究进展[J].中国药理学与毒理学杂志,2017,31(9):907-913.
[27]张霖,肖晏婴,马保华.香连丸药理作用研究进展[J].陕西中医,2015,36(1):127-128.
[28]向军英,欧阳钦,胡仁伟,等.白芍总苷对小鼠溃疡性结肠炎的作用[J].中华临床营养杂志,2010,18(4):230-234.
[29]郝亚楠,李新平,刘宁,等.薏米提取物对溃疡性结肠炎大鼠抗氧化作用的研究[J].中国预防医学杂志,2012,13(3):177-180.
[30]张振芳,赵宏伟,柴煊,等.白花蛇舌草对葡聚糖硫酸钠诱导的慢性溃疡性结肠炎小鼠的影响[J].中草药,2015,46(23):3520-3525.
[31]Lin JM,Li QY,Chen HW,et al.Hedyotis diffusa Willd.extract suppresses proliferation colorectal cancer cells[J].Oncol Lett,2015,9(4):1962-1970.
[2]张瑞芳,陈朝晖,刘漪沦,等.溃疡性结肠炎的发病机制及其治疗进展[J].生命的化学,2018,38(2):241-249.
[3]中华医学会消化病学分会炎症性肠病协作组.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007,12(8):488-495.
[4]Ng SC,Bernstein CN,Vatn MH,et al.Geographical variability and environmental risk factors in inflammatory bowel disease[J].Gut,2013,62(4):630-649.
[5]Molodecky NA,Soon IS,Rabi DM,et al.Increasing incidence and prevalence of the inflammatory bowel diseases with time,based on systematic review[J].Gastroenterology,2012,142(1):46-54.e42.
[6]Ye L,Cao Q,Cheng J.Review of inflammatory bowel disease in China[J].Sci World J,2013,2013:296470.
[7]王欣,王伟明,宋亚娟,等.香连胶囊对大鼠急性肠炎的作用[J].中国实验方剂学杂志,2013,19(3):212-215.
[8]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,2012,17(12):763-781.
[9]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疗共识意见[J].中国中西医结合消化杂志,2018,26(2):105-110.
[10]陈治水,危北海,张万岱,等.溃疡性结肠炎中西医结合诊疗指南(草案)(中国中西医结合学会消化系统疾病专业委员会,2010西昌)[J].中国中西医结合消化杂志,2011,19(1):61-65.
[11]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:159-161.
[12]欧阳钦,胡品津,钱家鸣,等.对我国炎症性肠病诊断治疗规范的共识意见[J].胃肠病学,2007,12(8):488-495.
[13]欧阳钦,苗新普.炎症性肠病评估指标的临床应用[J].中华消化杂志,2009,29(3):209-212.
[14]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.
[15]张林,吴洁琼,张伟,等.青柏溃结汤对溃疡性结肠炎大鼠疗效的研究[J].中国中医急症,2017,26(8):1352-1354,1380.
[16]王美红,陈同辛.静脉内免疫球蛋白对单核巨噬细胞免疫调节机制的研究[J].国际儿科学杂志,2006,33(1):33-35.
[17]李伟华.肠缺血再灌注损伤大鼠肠黏膜组织中TNF-α和VIP的表达及意义[J].青岛大学医学院学报,2007,51(6):510-511,513.
[18]王燕,曹燕飞,朱向东,等.四神丸对溃疡性结肠炎模型大鼠血清白细胞介素-1β、-4、肿瘤坏死因子-α的影响[J].中国老年学杂志,2015,35(1):128-128.
[19]陈子伟,庄俊合,罗宜红,等.血浆IL17在慢性阻塞性肺疾病综合评估中的作用[J].广州医科大学学报,2015,43(2):97-100.
[20]张炳勇,吕愈敏,洪天配,等.炎症性肠病患者肠黏膜白细胞介素18的表达及意义[J].北京大学学报(医学版),2003,35(2):150-153.
[21]林巧嫦,廖博贤,黄飞娜.白细胞介素IL-4、IL-17在溃疡性结肠炎中的表达[J].中国医药科学,2012,2(16):44-45.
[22]姚惠,郑培奋,李希诗,等.益气愈溃汤对溃疡性结肠炎IL-33、IL-10及肠道菌群紊乱的纠正作用[J].中华中医药学刊,2013,31(6):1449-1451.
[23]Alipour M,Zaidi D,Valcheva R,et al.Mucosal Barrier Depletion And Loss Of Bacterial Diversity Are Primary Abnormalities In Paediatric Ulcerative Colitis[J].JCrohnsColitis,2016,10(4):462-471.
[24]戴悦婷,唐志鹏.溃疡性结肠炎肠黏膜损伤的研究进展[J].中国中西医结合消化杂志,2018,26(6):545-549.
[25]颜蓉,梁杏花,尹良钰.关于MMP-2、MMP-9和溃疡性结肠炎患者肠黏膜通透性之间的关联分析[J].岭南急诊医学杂志,2019(1):68-70.
[26]李云,戴岳,夏玉凤.溃疡性结肠炎内源性代谢物和肠道菌群变化研究进展[J].中国药理学与毒理学杂志,2017,31(9):907-913.
[27]张霖,肖晏婴,马保华.香连丸药理作用研究进展[J].陕西中医,2015,36(1):127-128.
[28]向军英,欧阳钦,胡仁伟,等.白芍总苷对小鼠溃疡性结肠炎的作用[J].中华临床营养杂志,2010,18(4):230-234.
[29]郝亚楠,李新平,刘宁,等.薏米提取物对溃疡性结肠炎大鼠抗氧化作用的研究[J].中国预防医学杂志,2012,13(3):177-180.
[30]张振芳,赵宏伟,柴煊,等.白花蛇舌草对葡聚糖硫酸钠诱导的慢性溃疡性结肠炎小鼠的影响[J].中草药,2015,46(23):3520-3525.
[31]Lin JM,Li QY,Chen HW,et al.Hedyotis diffusa Willd.extract suppresses proliferation colorectal cancer cells[J].Oncol Lett,2015,9(4):1962-1970.