[1]张　伟,杨银利,张　林,等.青柏溃结汤灌肠对溃疡性结肠炎大肠湿热证患者结肠黏膜愈合及血清炎性因子水平的影响[J].新乡医学院学报,2018,35(6):474-477.[doi:10.7683/xxyxyxb.2018.06.006]
　ZHANG Wei,YANG Yin-li,ZHANG Lin,et al.Effect of Qingbaikuijietang enema on colonic mucosa healing and serum inflammatory factors in patients with ulcerative colitis and large intestine damp-heat syndrome[J].Journal of Xinxiang Medical University,2018,35(6):474-477.[doi:10.7683/xxyxyxb.2018.06.006]
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青柏溃结汤灌肠对溃疡性结肠炎大肠湿热证患者结肠黏膜愈合及血清炎性因子水平的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年6
页码:
474-477
栏目:
临床研究
出版日期:
2018-06-05

文章信息/Info

Title:
Effect of Qingbaikuijietang enema on colonic mucosa healing and serum inflammatory factors in patients with ulcerative colitis and large intestine damp-heat syndrome
作者:
张　伟1; 杨银利1; 张　林2; 林俊超2; 郝　蕾2; 吴洁琼1; 相　祎1
（1.陕西中医药大学第二附属医院消化内科，陕西　咸阳　712000；2.陕西中医药大学第二临床医学院，陕西　咸阳　712000）
Author(s):
ZHANG Wei1; YANG Yin-li1; ZHANG Lin2; LIN Jun-chao2; HAO Lei2; WU Jie-qiong1; XIANG Yi1
（1.Department of Digestive System Diseases，the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine，Xianyang 712000，Shaanxi Province，China；2.the Second Clinical Medical College of，Shaanxi University of Traditional Chinese Medicine，Xianyang 712000，Shaanxi Province，China）
关键词:
青柏溃结汤; 溃疡性结肠炎; 黏膜愈合
Keywords:
Qingbaikuijietang; ulcerative colitis; mucosal healing
分类号:
R574.1
DOI:
10.7683/xxyxyxb.2018.06.006
文献标志码:
A
摘要:
目的　探讨青柏溃结汤灌肠对溃疡性结肠炎（UC） 大肠湿热证患者的黏膜愈合及血清炎性因子的影响，探讨其治疗UC的机制。方法　将2014年1月至2015年12月陕西中医药大学第二附属医院消化内科收治的活动期轻中度UC患者120例随机分为对照组和观察组，每组60例。2组患者均给予美沙拉嗪缓释颗粒1 g，每日4次，口服，疗程4周；观察组患者在口服美沙拉嗪缓释颗粒的同时给予青柏溃结汤保留灌肠，每日1次，连续4周。治疗前及治疗4周后，观察2组患者内镜下结肠黏膜愈合情况，并抽取清晨空腹肘静脉血，采用酶联免疫吸附试验测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平，采用散射光比浊法测血清C反应蛋白（CRP）水平。治疗前后对所有患者采用Rachmilewitz评分标准进行内镜下结肠病变评分。治疗2、4周后，参照中华医学会消化病学分会炎症性肠病协作组的标准评价临床疗效。结果　2组患者治疗前结肠黏膜评分比较差异无统计学意义（P>0.05）；治疗4周后，观察组患者结肠黏膜评分与对照组比较显著降低（P<0.05）；观察组患者内镜下缓解53例（88.33%），对照组患者内镜下缓解43例（71.67%），观察组患者内镜下缓解率显著高于对照组（χ2=5.208，P<0.05）。治疗前，2组患者血清IL-6、TNF-α及CRP水平比较差异均无统计学意义（P>0.05）；治疗4周后，2组患者血清IL-6、TNF-α及CRP水平均较治疗前显著降低（P<0.05），且观察组患者血清IL-6、TNF-α及CRP水平均显著低于对照组（P<0.05）。治疗2周后，对照组与观察组患者的总有效率分别为40.00%、88.34%；治疗4周后，对照组与观察组患者的总有效率分别为86.67%、96.67%；观察组患者治疗2、4周后的总有效率均显著高于对照组（χ2=30.480、3.927，P<0.05）。结论　青柏溃结汤灌肠联合美沙拉嗪缓释颗粒口服治疗能降低UC患者的血清相关炎性细胞因子水平，抑制UC患者的炎症反应，促进结肠黏膜愈合，缓解临床症状。
Abstract:
Objective　To investigate the effect and the mechanism of Qingbaikuijietang enema on colonic mucosa healing and serum inflammatory factors in patients with ulcerative colitis（UC） and large intestine damp-heat syndrome.Methods　A total of 120 patients with mild and moderate UC were selected from January 2014 to December 2015 in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine.The patients were randomly divided into control group and observation group，with 60 cases in each group.The patients in the two groups were treated with mesalazine sustained release granules 1 g by oral，4 times a day for 4 weeks.Based on this，the patients in the observation group were given retention enema with Qingbaikuijietang，once a day for 4 weeks.The score of colonic mucosa healing under endoscopy were evaluated before and at 4 weeks after treatment.The levels of serum tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） were determined by enzyme linked immunosorbent assay，and the level of C-reactive protein（CRP） was determined by scattering turbidimetry before and after 4 weeks of treatment.The endoscopic colonic lesions of all patients were scored by Rachmilewitz scoring standard before and after treatment.The clinical effect was evaluated by the standard set by the Cooperative Group of Inflammatory Bowel Disease in Digestive Diseases Branch of Chinese Medical Association after 2 and 4 weeks of treatment.Results　There was no significant difference in the score of colon mucosa healing between the two groups before treatment（P>0.05）.The score of colonic lesions in the observation group was significantly lower than that in the control group after 4 weeks of treatment（P<0.05）.A total of 53 cases（88.33%） in the observation group and 43 cases（71.67%） in the control group were endoscopically remission，the remission rate in the observation group was significantly higher than that in the control group（χ2=5.208，P<0.05）.There was no significant difference in serum IL-6，TNF-α and CRP levels between the two groups before treatment（P>0.05）.The levels of serum IL-6，TNF-α and CRP after 4 weeks of treatment were significantly lower than those before treatment in the two groups（P<0.05）.The levels of serum IL-6，TNF-α and CRP in the observation group were significantly lower than those in the control group after 4 weeks of treatment（P<0.05）.The total effective rate in the control group and the observation group was 40.00% and 88.34% respectively after 2 weeks of treatment，and it was 86.67% and 96.67% respectively after 4 weeks of treatment，the total effective rate in the observation group was significantly higher than that in the control group after 2 and 4 weeks of treatment（χ2=30.480，3.927；P<0.05）.Conclusion　Qingbaikuijietang enema combined with mesalazine sustained release granules can reduce the levels of serum inflammatory inflammatory factors，inhibit the inflammatory reaction，promote the healing of colonic mucosa and alleviate the clinical symptoms in patients with UC.

参考文献/References:

［1］　王晓妍，孙蓉，张平，等.四君痛泻方对溃疡性结肠炎患者血清NGF、TNF-α、IL-10的影响［J］.河南中医，2018，38（4）：578-581.
［2］　郭倩，唐志鹏，王立娟.溃疡性结肠炎组织病理学诊断的研究进展［J］.世界华人消化杂志，2014，22（2）：190-196.
［3］　杨川华，陈晓宇，冉志华，等.C反应蛋白反映炎症性肠病的活动性［J］.胃肠病学，2006，11（6）：350-352.
［4］　口锁堂，昊焕淦，施达仁.白介素与溃疡性结肠炎［J］.世界华人消化杂志，2006，14（4）：405-411.
［5］　褚杨芳.血清C反应蛋白和D-二聚体联合检测在溃疡性结肠炎病情活动性判断中的价值［J］.中国实用医药，2016，11（22）：87-88.
［6］　王少鑫，浦江，刘超群，等.炎症因子TNF-α、IL-6和IL-4在溃疡性结肠炎中的表达及临床意义［J］.胃肠病学和肝病学杂志，2015，24（1）：104-106.
［7］　李晓宁，王艳，翟军鹏.中药灌肠治疗溃疡性结肠炎的临床研究现状［J］.北京中医药，2008，27（9）：743-746.
［8］　吴洁琼，相祎，张锋利，等.中西药合用灌肠治疗溃疡性结肠炎225例［J］.现代中医药，2010，30（2）：6-7.
［9］　杨薪博，张伟，吴洁琼.青柏溃结汤灌肠对溃疡性结肠炎活动期血清炎症因子的影响研究［J］.陕西中医药大学学报，2017，40（4）：42-44.
［10］　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.
［11］　中华中医药学会脾胃病分会.溃疡性结肠炎中医诊疗共识意见［J］.中华中医药杂志，2010，25（6）：891-895.
［12］　葛均波，徐永健.内科学［M］.8版.北京：民卫出版社，2013：386-387.
［13］　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］.中华消化杂志，2007，27（8）：545-550.
［14］　江学良，崔慧斐.溃疡性结肠炎［M］.北京：中国医药科技出版社，2005：136.
［15］　曹婷婷，薛原，曲波.炎症性肠病发病机制的研究进展［J］.胃肠病学和肝病学杂志，2012，21（2）：110-113.
［16］　陈慕豪，王立恒.中药内服加灌肠治疗大肠湿热型溃疡性结肠炎临床研究［J］.新中医，2016，48（3）：47-49.
［17］　丁伟群，林庚金，徐三荣，等.溃疡性结肠炎发病中白介素水平的变化［J］.复旦学报（医学版），2001，28（4）：330-333.
［18］　SOLEM C A，LOFTUS E V，JR TREMAINS W J，et al.Correlation of C-reactive protein with clinical，endoscopic，histologic and radiographic activity in inflammatory bowel disease［J］.Inflam Bowel Dis，2005，11（8）：707-712.
［19］　HENRIKSEN M，JAHNSEN J，LYGREN I.C-reactive protein：a predictive factor and marker of inflammation in inflammatory bowel disease.Results from a prospective population-based study［J］.Gut，2008，57（11）：1518-1523.
［20］　赵嘉莉，张慧敏.枯草杆菌二联活菌肠溶胶囊治疗溃疡性结肠炎疗效观察［J］.新乡医学院学报，2016，33（11）：983-986.
［21］　MOHAMMED N，SUBRAMANIAN V.Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis：can endoscopic evaluation predict outcomes［J］.World J Gastroenterol，2016，22（42）：9324-9332.
［22］　ARDIZZONE S，CASSINOTTI A，DUCA P，et al.Mucosal healing predicts late outcomes after the frst course of corticosteroids for newly diagnosed ulcerative colitis［J］.Clin Gastroenterol Hepatol，2011，9（6）：483-489.
［23］　BOAL CARVALHO P，COTTER J.Mucosal healing in ulcerative colitis：a comprehensive review［J］.Drugs，2017，77（2）：159-173.
［24］　SHAH S C，COLOMBEL J F，SANDS B E，et al.Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis：a systematic review and meta-analysis［J］.Clin Gastroenterol Hepatol，2016，14（9）：1245-1255.
［25］　盖雅，唐志鹏，袁雷.溃疡性结肠炎黏膜愈合评价的研究进展［J］.中国中西医结合消化杂志，2012，20（10）：471-474.
［26］　赵秋枫，王实，夏亮.甘草泻心汤治疗复发性溃疡性结肠炎临床观察及其对肠道菌群和血清白介素6、10的影响［J］.中华中医药学刊，2013，31（4）：944-946.

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更新日期/Last Update: 2018-06-05