微生态制剂对溃疡性结肠炎患者治疗前后临床疗效观察

目的 观察微生态制剂如枯草杆菌和屎肠球菌(美常安),双歧杆菌活菌抵制剂(丽珠肠乐)联合柳氮磺胺吡啶(SASP)片治疗轻、中度活动期溃疡性结肠炎(UC)的临床疗效和安全性.方法 采用随机、对照设计,将30例轻、中度活动期UC患者分为:美常安联合SASP组(A组)10例、丽珠肠乐联合SASP组(B组)10例、SASP组(C组)10例,疗程均为4周.对3组患者治疗前后的大便菌群、临床症状总积分降低百分比、Sutherland疾病活动性指数、肠镜分级、组织学分级变化进行比较.结果 大便菌群变化、临床症状总积分降低百分比,A、B组治疗前后为显效,C组治疗前后为有效.治疗前后3组(组内)Sutherland指数、肠镜分级积分、病理组织学分级积分变化均具有统计学意义.3组(组间)比较:Sutherland指数变化差值均数分别为5.400±1.848、5.500±2.273、2.500±0.527,A、B组间差异无统计学意义,与C组比较差异均有统计学意义;肠镜分级积分变化差值均数分别为1.800±0.422、2.100±0.316、0.800±0.432,A、B组间差异无统计学意义,与C组比较差异均有统计学意义;病理组织学分级积分变化差值均数分别为1.900±0.544、1.800±0.484、0.600±0.516.结论 SASP加用微生态制剂治疗轻、中度活动期UC的临床疗效优于单用SASP,而SASP联合美常安,SASP联合丽珠肠乐两组间无明显差异,皆具有较好的安全性,具有临床推广价值.     

丹参合用柳氮磺胺吡啶对溃疡性结肠炎患者血液流变学的影响及疗效观察

目的探讨丹参注射液对溃疡性结肠炎(UC)血液流变学的影响及其疗效。方法将UC患者分为柳氮磺胺吡啶(SASP)治疗组和SASP 丹参组进行治疗,观察其疗效。结果SASP 丹参治疗UC患者血液流变学改善明显,总有效率高。结论在传统治疗的基础上采用针对血液流变的治疗可使患者获益。     

溃结灵颗粒治疗活动期溃疡性结肠炎的临床与实验研究

目的：通过临床和动物实验探讨溃结灵治疗溃疡性结肠炎(UC)的机制。方法：活动期UC(湿热内蕴证)患者92例随机分为溃结灵组、柳氮磺胺吡啶组(SASP)和中西药结合组，以肠粘膜病变、中医证候疗效、主要症状积分作为观察指标；免疫法造成UC大鼠模型，随机分成空白对照组，SASP组，溃结灵高、中、低剂量组(每组10只)及正常组，作结肠病理观察和血清肿瘤坏死因子-α(TNF-α)和白细胞介素—6(1L—6)的检测。结果：溃结灵组对患者的粘膜疗效与SASP组比较差异无显著性意义，但证候疗效明显优于SASP组(P＜0．01)，总有效率为93．33％；对改善腹泻、腹痛、腹胀、里急后重的作用优于SASP组，且无任何不良反应。溃结灵能减轻UC大鼠炎症，改善粘膜病变，并能减少TNF—α。结论：溃结灵具有确切的治疗UC的作用，这可能与它能减轻炎症、调节炎症因子有关。     

柳氮磺吡啶口服联合仙白汤灌肠治疗溃疡性结肠炎疗效观察

[目的]观察柳氮磺吡啶(SASP)口服联合仙白汤灌肠治疗溃疡性结肠炎(UC)的临床疗效.[方法]将活动期轻、中度UC患者分为2组:灌肠组50例、对照组30例.灌肠组采用口服SASP联合仙白汤灌肠治疗;对照组单用SASP口服治疗;治疗2周后观察2组患者的大便次数、黏液血便、腹痛症状改善情况,并行结肠镜及组织病理学检查.[结果]灌肠组腹痛、便次、黏液血便症状改善平均时间分别为4.6 d、5.88 d、4.92 d,对照组分别为6.6d、8.4d、7.4d,(P＜0.01);治疗后复查肠镜,对照组总有效率为73.33％,灌肠组为96.00％(P＜0.01);总体评估,灌肠组完全缓解14例,有效32例,无效4例,总有效率为92.00％,对照组依次为6、16、8例、73.33％,2组比较差异有统计学意义(P＜0.01).[结论]SASP联合仙白汤灌肠治疗UC可快速缓解症状、促进溃疡愈合,控制UC的活动期,比单用SASP更能控制炎症急性发作,疗效更显著.     

奥沙拉嗪治疗溃疡性结肠炎疗效观察

目的 观察国产奥沙拉嗪钠胶囊治疗轻、中度活动期溃疡性结肠炎的治疗效果，比较国产奥沙拉嗪钠胶囊与水杨酸偶氮磺胺吡啶(SASP)对轻、中度溃疡性结肠炎(活动期)的疗效和不良反应。方法 采用随机双盲方法验证56例轻中度溃疡性结肠炎(活动期)的疗效和不良反应，疗程为8周。结果 国产奥沙拉嗪钠胶囊的总有效率为85％，观察组患者在临床完全缓解率、内镜完全缓解率和组织学完全缓解率在治疗8周后均比治疗前明显改善，分别达75％、35％、48％，其疗效与对照组相比无明显差异。结论 国产奥沙拉嗪钠胶囊治疗活动期轻、中度溃疡性结肠炎有效，其结果与SASP相当，主要不良反应为腹泻，继续用药或合并使用抗腹泻药后，腹泻即消失。     

柳氮磺胺吡啶和思密达治疗溃疡性结肠炎120例疗效分析

近年来，我们应用柳氮磺胺吡啶(SASP)和思密达口服治疗轻中度活动期溃疡性结肠炎(UC)240例，疗效满意。现报告如下。临床资料：本组240例UC患者，男112例，女128例，年龄15～60岁。均符合下列标准：有持续或反复发作的腹泻、粘液脓血便，伴腹痛、里急后重和不同程度的全身症状，有关节、皮肤、眼、口及肝胆等肠外表现；结肠镜俭查可见病变从直肠     

康复新液联合枯草杆菌二联胶囊辅助治疗活动期轻中度溃疡性结肠炎疗效观察

[目的]探讨康复新液联合枯草杆菌二联胶囊辅助治疗活动期轻中度溃疡性结肠炎(UC)的疗效及安全性。[方法]选取2012年2月~2015年8月我院消化内科收治的活动期轻、中度UC患者60例,随机分为治疗组和对照组,每组各30例。对照组患者单独使用美沙拉嗪治疗,治疗组患者在对照组基础上加用康复新液保留灌肠联合枯草杆菌二联胶囊口服治疗,疗程均为8周,比较2组患者临床疗效及疗程结束后肠镜复查结果。[结果]治疗组总有效率明显高于对照组(100%vs.83.3%,96.6%vs.76.7%),差异有统计学意义(P0.05);2组患者均未出现明显严重不良反应。[结论]康复新液联合枯草杆菌二联胶囊辅助治疗活动期轻中度UC的疗效较为显著,值得临床推广应用。     

柳氮磺吡啶联合白头翁汤灌肠治疗溃疡性结肠炎32例

[目的]观察柳氮磺毗啶(SASP)联合白头翁汤灌肠治疗溃疡性结肠炎(UC)的临床疗效.[方法]62例UC患者随机分为2组,对照组30例,单用SASP治疗,治疗组32例,采用SASP联合白头翁汤灌肠治疗,治疗9周后,2组均行结肠镜检查,观察比较疗效.[结果]治疗组总有效率为93.75%,对照组66.70%,2组比较差异有统讳学意义(P<0.05).[结论]SASP联合白头翁汤灌肠治疗UC比单用SASP更能控制急性发作,维持缓解,巩固和提高疗效的作用.     

蒙脱石散剂联合美沙拉嗪治疗溃疡性结肠炎腹泻患者的疗效

目的 研究蒙脱石散剂联合美沙拉嗪治疗轻中度溃疡性结肠炎(UC)患者的腹泻的机制和疗效.方法 42例轻中度活动期UC患者(男22例,女20例,平均年龄32.6岁,病程3～5年)随机分为A、B两组,A组应用蒙脱石散剂联合美沙拉嗪(蒙脱石散剂,3g/次;3次/d,美沙拉嗪缓释颗粒1g/次,4次/d,8周)治疗,B组单纯应...     

肠内营养对溃疡性结肠炎的临床疗效观察

目的探讨肠内营养对活动期溃疡性结肠炎(ulcerative colitis,UC)的临床疗效及肠黏膜的作用。方法将符合UC标准的45例患者随机分为两组,对照组采用传统抗炎治疗,治疗组采用传统抗炎治疗和肠内营养支持治疗,观察两组患者临床疗效及内镜下肠黏膜的变化。结果治疗组临床疗效总有效率明显优于对照组,差异有统计学意义(P0.05)。治疗组中、重度UC患者临床疗效优于对照组中、重度UC患者临床疗效,差异有统计学意义(P0.05);治疗组轻、中度UC患者临床疗效与对照组轻、中度UC患者临床疗效比较,差异无统计学意义(P0.05)。结论肠内营养作为对活动期UC患者的辅助治疗,其疗效显著,值得临床推广。     

Effects of sulfasalazine on biopsy mucosal pathologies and histological grading of patients with active ulcerative colitis

AIM: To investigate the mechanisms of sulfasalazine (SASP) in the treatment of ulcerative colitis (UC). METHODS: Changes of pathological signs and histological grading of 106 patients with active UC were observed before and after the treatment with SASP, 1 g, thrice daily for 6 wk. RESULTS: The effect of SASP on the vasculitis in lamina propria was 48.2% and 17.4% in the mild active UC (P<0.001) and 68% and 26.7% in the moderate active UC (P<0.001) before and after treatment. Fibroid necrosis of vessel wall was found in one case of mild UC and two cases of moderate UC before treatment and was not found after treatment. No thrombosis was found in mild UC before and after treatment, while thrombosis was found in one case of moderate UC before treatment. The effect on mucosal glandular abnormality was 30.4% and 13.0% in mild UC (P<0.05), and 42% and 40% in moderate UC (P>0.05) before and after treatment. The rate of eosinophil infiltration was 98.2% and 80.4% in mild UC (P<0.01), and 100% and 91.1% in moderate UC (P<0.05) before and after treatment. The effect on crypt abscess was 21.4% and 4.4% in mild UC (P<0.05), and 48% and 13.3% in moderate UC (P<0.001) before and after treatment. The effect on mucosal pathohistological grading was 2.00+/-0.84 and 0.91+/-0.46 in mild UC (P<0.001), and 2.49+/-0.84 and 1.31+/-0.75 in moderate UC (P<0.001) before and after treatment. CONCLUSION: SASP can improve small vessel lesions and crypt abscesses and reduce neutrophilic and eosinophilic leukocyte infiltration in inflammatory mucosa of UC.     

理肠四方治疗大鼠溃疡性结肠炎疗效观察

目的:观察理肠四方对溃疡性结肠炎(UC)大鼠不同的组织形态学变化,比较四方疗效大小,并分析其中医病机.方法:应用2,4-二硝基氯苯免疫加醋酸局部灌肠法建立UC大鼠模型,将98只健康SD大鼠(雌雄各半),按雌雄随机分为7组[乌梅丸组、白头翁汤组、参苓白术散组、痛泻要方组、柳氮磺胺吡啶(SASP)组、模型组和正常组],每组14只,分别观察治疗后大鼠一般情况变化、结肠组织损伤评分、结肠粘膜病理及超微病理变化.结果:经理肠四方治疗后,其组织学呈不同的病理变化.结论:乌梅丸疗效最好,白头翁汤、参苓白术散、痛泻要方与SASP疗效相当.     

Different therapy for different types of ulcerative colitis in China

AIM: To study the different therapy for different types of ulcerative colitis (UC) in China. METHODS: Among 102 UC patients, 42 chronic relapse type UC patients were randomly divided into olsalazine sodium treatment group (n=21) and SASP group (n=21). Clinical effects and safety were observed in the 2 groups. Forty-two first episode type UC patients were randomly divided into Heartleaf houttuynia herb treatment group (n=21) and SASP group (n=21). Clinical effects were observed in the 2 groups while ultrastructure of colonic mucosa, ICAM-1 and the pressure of distant colon were studied in Heartleaf houttuynia herb group. Eighteen patients (8 males, 10 females) with refractory UC and unresponsive to high-dose prednisolone and sulfasalazine therapy more than one month were treated with Kangshuanling (7200 U/d). Prednisolone was gradually stopped and sulfasalazine was maintained. Stool frequency, rectal bleeding, colonoscopy, general well-being, histology were observed and CD62p, CD63, CD54, Pgp-170 (flow cytometry), TXA2 (RIA), blood platelet aggregation rate and thrombosis length in vitro were assessed. RESULTS: In the 42 chronic relapse type UC patients, the overall clinical effects of olsalazine sodium group (complete remission in 16, improvement in 4, inefficiency in 1) were better than those of SASP group (complete remission in 10, improvement in 4, inefficiency in 7, P<0.05). Symptomatic remission of olsalazine sodium group (complete remission in 15, partial remission in 5, inefficiency in 1) was better than that of SASP group (complete remission in 10, partial remission in 5, inefficiency in 6, P<0.05). The colonoscopic remission of olsalazine sodium group(complete remission in 11, partial remission in 9, inefficiency in 1) was better than that of SASP group (complete remission in 7, partial remission in 8, inefficiency in 6, P<0.05). The histologic remission of olsalazine sodium group (complete remission in 13, partial remission in 7, inefficiency in in 1) was better than that of SASP group (complete remission in 6, partial remission in 10, inefficiency in 5, P<0.05). The side effects of gastrointestinal tract in olsalazine sodium group were less than those of SASP group except for frequency of watery diarrhea. No other side effects were observed in olsalazine sodium group while ALT increase, WBC decrease and skin eruption were observed in SASP group. Two patients relapsed in olsalazine sodium group while 8 cases relapsed in SASP group during the flow-up period (from six months to one year). In the 42 first episode type UC patients, the clinical effect of Heartleaf houttuynia herb group (complete remission in 20, 95.2%; improvement in 1, 4.8%) was better than that of SASP group (complete remission in 15, 72.4%, improvement in 5, 23.8%; inefficiency in 1, 3.8%, P<0.01). The time of stool frequency recovering to normal (5.6+/-3.3 d), and blood stool disappearance (6.7+/-3.8 d) and abdominal pain disappearance (6.1+/-3.5 d) in Heartleaf houttuynia herb group was all shorter than that in SASP group (9.5+/-4.9 d, 11.7+/-6.1 d, 10.6+/-5.3 d, P<0.01). Heartleaf houttuynia herb could inhibit the epithelial cell apoptosis of colonic mucous membrane and the expression of ICAM-1 (45.8+/-5.7% vs 30.7+/-4.1%, P<0.05). Compared with normal persons, the mean promotive speed of contraction wave stepped up (4.6+/-1.6 cm/min vs 3.2+/-1.8 cm/min, P<0.05) and the mean amplitude of the wave decreased (14.2+/-9.3 kPa vs 18.4+/-8.0 kPa, P<0.05) in active UC patients. After treatment with Heartleaf houttuynia herb, these 2 indexes improved significantly (17.3+/-8.3 kPa, 3.7+/-1.7 cm/min, P<0.05). In normal persons, the postprandial pressure of sigmoid (2.9 +/-0.9 kPa) was higher than that of descending colon (2.0+/-0.7 kPa) and splenic flexure (1.7+/-0.6 kPa), while the colonic pressure (1.5+/-0.5 kPa, 1.4+/-0.6 kPa, 1.3+/-0.6 kPa) decreased significantly (P<0.05) in active UC patients. After treatment with Heartleaf houttuynia herb, the colonic pressure (2.6+/-0.8 kPa, 1.8+/-0.6 kPa, 1.6+/-0.5 kPa) recovered to normal. The pain threshold Heartleaf houttuynia herb, the colonic pressure (2.6+/-0.8 kPa, 1.8+/-0.6 kPa, 1.6+/-0.5 kPa) recovered to normal. The pain threshold of distant colon (67.3+/-18.9 mL) in active UC patients decreased significantly compared with that of normal persons (216.2+/-40.8 mL, P<0.05) and recovered to normal after treatment with Heartleaf houttuynia herb(187.4+/-27.2 mL, P<0.05). In the 18 refractory UC patients with platelet activation, after more than 4 wk of combined Kangshuanling and sulfasalazine therapy, 16 patients achieved clinical remission, with a highly significant statistical difference (P<0.01) between pre-and post-treatment mean scores for all disease parameters: stool frequency (8.2/d vs 1.6/d), rectal bleeding (score 2.7 vs 0.3), colonoscopy (score 2.6 vs 1.1), histology (score 12.0 vs 5.0), general well being (score 4.0 vs 0.6) and CD62p (8.0+/-3.1% vs 4.1+/-1.8%), CD63 (6.3+/-2.1% vs 3.2+/-1.6%), TXA2 (548+/-85 ng/L vs 390+/-67 ng/L), platelet aggregation rate (43.2+/-10.7% vs 34.8+/-8.1%), thrombosis length in vitro (2.3+/-0.6 cm vs 1.8+/-0.3 cm), CD54 in blood (26.9+/-6.9% vs 14.4+/-5.1%), CD54 in tissues (51.1+/-6.2% vs 23.1+/-4.1%), Pgp-170 in blood (18.9+/-3.9% vs 10.4+/-2.7%), Pgp-170 in tissues (16.5+/-3.2% vs 10.2+/-2.3%, P<0.01 or 0.05). CONCLUSION: Based on the characteristics of UC cases in China, different therapy should be given to different types of UC with expected satisfactory results.     

溃疡性结肠炎患者核因子-κB活化与细胞因子基因表达

目的　探讨溃疡性结肠炎 (UC)患者肠黏膜活检组织细胞因子mRNA的表达及其与NF κB活化的关系 ,以及抗炎药物 (柳氮磺吡啶和糖皮质激素 )对其的影响。方法　 31例来自四川大学华西医院的UC患者 (符合 1993年太原会议制定的UC诊断标准 )被纳入本研究。其中 17例使用过药物 (柳氮磺吡啶或柳氮磺吡啶 +糖皮质激素 )治疗 ,14例未用过任何与UC治疗相关的药物 ,11例同期结肠癌患者 (取其癌旁正常组织 )作为对照。采用 :(1)凝胶电泳迁移率改变分析检测核因子 (NF) κBDNA结合活性 ;(2 )逆转录聚合酶链反应检测白细胞介素 (IL) 1βmRNA和IL 8mRNA的表达。 结果　 (1)UC患者肠黏膜活检组织IL 1βmRNA和IL 8mRNA表达与对照组相比明显升高 (P <0 0 5 ) ,且与NF κBDNA结合活性呈显著正相关 (IL 1β :r=0 836 3,P <0 0 5 ;IL 8:r=0 6 0 2 4 ,P <0 0 5 )。 (2 )糖皮质激素和柳氮磺吡啶明显抑制NF κB的活性 ,降低IL 1βmRNA和IL 8mRNA的表达。结论　 (1)NF κB是UC细胞因子释放的关键调控因素 ,在UC的发生和发展中起着十分重要的作用。 (2 )糖皮质激素和柳氮磺吡啶可能通过抑制NF κB的活性 ,减少细胞因子的表达而起到抗炎作用。     

健脾解毒化瘀方对大鼠实验性溃疡性结肠炎细胞因子的影响

[目的]探讨以益气健脾、清热解毒、活血化瘀为原则组成方剂对溃疡性结肠炎(UC)大鼠细胞因子的影响,探讨其治疗UC的机制.[方法]除15只大鼠作为正常组外,其他大鼠采用TNBS复制UC模型后随机分成模型组、对照组、柳氮磺胺吡啶(SASP)组、中药组,肉眼及镜下观察各组大鼠的组织学损伤,并检测血清中细胞因子的含量.[结果]中药组、SASP组在减轻肉眼及镜下的组织学损伤方面和改善细胞因子方面较模型组、对照组均具有明显效果(P＜0.05);中药组较SASP组疗效更明显(P＜0.05).[结论]以益气健脾、清热解毒、活血化瘀为原则组成方剂对UC治疗有效,其机制可能是提高抗炎因子的含量,降低炎症因子的含量,维持细胞因子之间的平衡,进而调节免疫炎症反应.     

Characteristics and therapeutic efficacy of sulfasalazine in patients with mildly and moderately active ulcerative colitis

AIM: To investigate the characteristics and short-term efficacy of sulfasalazine (SASP) in patients with mildly and moderately active ulcerative colitis (UC). METHODS: Two hundred and twenty-eight patients with mildly and moderately active UC were recruited, 106 patients in 1993-1995, and 122 patients in 2000-2002, they were assigned as the 1990s group (n - 106) and the 2000s group (n = 122), prospectively. The general characteristics, clinical manifestations, colonoscopic and histological data were compared between the two groups. The short-term efficacy and safety of SASP 3 g per d were evaluated. RESULTS: Between 2000s and 1990s groups, the gender ratio of men to women was 1:1.18 and 1:1.04, 57.4% and 50.9% of the patients were between 30 and 49 years old. The gender ratio and age of UC patients were not significantly different. The total course of 50.0% and 37.1% of UC patients was less than 1 year (P<0.05), 10.6% and 31.2% of the cases had a duration of more than 5 years (P<0.05) in 2000s and 1990s groups, respectively. The most common clinical type was first episode in 2000s group and chronic relapse in 1990s group. The patients showed a higher frequency of abdominal pain and tenderness in 1990s group than in 2000s group. Erosions were found in 84.4% and 67.9% of patients in 2000s and 1990s groups (P<0.05). Rough and granular mucosa (67.9% vs43.4%, P<0.05) and polyps (47.2% vs32.8%, P<0.05) were identified in 1990s group more than in 2000s group. There were no significant differences in clinical, colonoscopic and histological classifications. After SASP (1 g thrice per d) treatment for 6 wk, the clinical, colonoscopic and histological remission rates were 71.8%, 21.8% and 16.4%, respectively. In 79 patients with clinical remission, 58.2% and 67.1% remained grade 1 in colonoscopic and histological findings, respectively. The overall effects in first episode type (complete remission in 10, 18.9%, partial remission in 28, 52.8%, and improvement in 9, 17.0%) were better than in chronic relapse type (complete remission in 3, 7.5%; partial remission in 16, 40.0%; and improvement in 15, 37.5%) and chronic persistent type (complete remission in 1, 5.9%; partial remission in 6, 35.3%; and improvement in 6, 35.3%) respectively (P<0.05). In 110 patients treated with SASP, 18 patients (16.4%) had adverse reactions. Except for two cases of urticaria and one case of WBC decrease, none of the patients had to stop the treatment because of severe adverse reactions. CONCLUSION: Patients with mildly and moderately active UC in 2000s group had a shorter disease course, milder clinical manifestations, more first episode type and higher frequency of acute mucosal lesions in colonoscopy than in 1990s group. The patients in 1990s group had higher proportion of chronic relapse type and chronic mucosal change in colonoscopy than in 2000s group. The short-term efficacy of SASP could be mainly remission of clinical manifestations. But more than half of the patients still had light inflammation in colonoscopy and histology. The overall effects of SASP in first episode type were better than those in other types. SASP was a safe and effective drug to treat mildly and moderately active UC.