愈肠煎保留灌肠联合美沙拉嗪治疗溃疡性结肠炎60例

目的:观察愈肠煎保留灌肠配合美沙拉嗪治疗(大肠湿热证)溃疡性结肠炎(UC)的临床疗效及对血清白介素(IL)-17,IL-21的影响。方法:将120例UC患者随机按数字表法分为对照组和综合组各60例。对照组给予美沙拉嗪肠溶片,1 g/次,4次/d,吞服勿咀嚼。综合组在对照组治疗的基础上加用愈肠煎,1次/d,保留灌肠。两组疗程均为4周。进行治疗前后Baron内镜评分法评分;采用肠黏膜病变活动指数(Sutherland DAI)对疾病严重度与活动度进行评价;记录治疗前后主要症状、体征;进行治疗前后炎症性肠病问卷(IBDQ)评分;检测治疗前后血清IL-17,IL-21水平。结果:综合组临床疗效总有效率为90%,对照组为76.67%,综合组优于对照组(P0.05);综合组Baron评分和Sutherland DAI疾病活动性指数评价均低于对照组(P0.01);综合组腹泻、脓血便、腹痛和腹胀评分均低于对照组(P0.01);综合组IBDQ量表肠道症状、全身症状、情感能力及社会能力评分及总分均高于对照组(P0.01);治疗后两组血清IL-17,IL-21水平均较治疗前下降(P0.01),综合组血清IL-17,IL-21水平均低于对照组(P0.05)。结论:愈肠煎保留灌肠联合美沙拉嗪治疗(大肠湿热证)溃疡性结肠炎能减轻症状,控制疾病活动,临床疗效优于单纯美沙拉嗪,其作用机制可能与调节炎症因子有关。

Effect of Retention Enema of Yuchang Decoction Combined Mesalazine in Treating 60 Patients with Ulcerative Colitis

Objective: To observe the curative effect of retention enema of Yuchang decoction combined mesalazine in treating ulcerative colitis (UC) of large intestinal dampness-heat syndrome, and to investigate its influence on interleukin (IL) -17 and IL-21. Method: One hundred and twenty patients with UC were randomly divided into the control group and the combined group of 60 patients each. The patients in the control group received 1 g mesalazine enteric-coated tablets quartic daily. Based on the treatment of the control group, patients in the combined group added retention enema of Yuchang decoction combined with mesalazine once daily. The patients in two groups received a 4-week period of treatment. Before and after treatment, colonoscopy was performed and the examinations were assessed by Baron scoring method and Sutherland DAI. Before and after treatment, the main signs and symptoms were scored. The quality of life in inflammatory bowel disease (IBD) was evaluated by IBD questionnaire (IBDQ). The levels of serum IL-17, IL-21 were detected. Result: The total effective rate in the combined group was 90%, which was superior to that of 76.67% in the control group (P<0.05). Baron scores and Sutherland DAI scores of the combined group were lower than those in the control group (P<0.01). The scores of diarrhea, bloody purulent stool, stomachache, and abdominal distension in the combined group were lower than those in the control group (P<0.01). IBDQ scores including intestinal tract symptom, constitutional symptom, emotional capability, and social competence of the combined group were higher than those of the control group (P<0.01). After treatment, the levels of serum IL-17 and IL-21 of two groups decreased (P<0.01), while the results were lower in the combined group (P<0.05). Conclusion: Using retention enema of Yuchang decoction combined with mesalazine could alleviate symptom and control disease activity in treating UC of large intestinal dampness-heat syndrome. Its effect is better than using mesalazine alone. The mechanism may be related to regulating inflammatory factors.