自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康治疗强直性脊柱炎

目的 评价自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康治疗强直性脊柱炎(ankylosing spondylitis,AS)的临床疗效.方法 纳入86例AS患者并按随机数字表法分观察组和对照组,每组各43例.对照组口服柳氮磺胺吡啶和美洛昔康;观察组在对照组基础上加服自拟益肾通督汤.分别采用Bath强直性脊柱炎功能指数(Bath Ankylosing Spondylitis Functional Index,BASFI)和Bath强直性脊柱炎疾病活动性指数(Bath Ankylosing Spondylitis Disease Activity Index,BASDAI)评价躯体功能和疾病活动性.并检测ESR和血清CRP.结果 观察组治疗后BASFI[(3.25±1.18)分比(4.18±0.96)分;t=4.544,P＜0.01]、BASDAI[(2.33±1.46)分比(3.26±1.43)分;t=5.245,P＜0.01]均较对照组显著下降.观察组治疗后血清CRP水平[(8.62±14.71)mg/L比(12.57±16.32) mg/L;t=3.143,P＜0.05]和ESR[(14.93±17.15)mm/h比(18.61±20.98) mm/h;t=3.615,P＜0.05]显著低于对照组.观察组治疗后枕墙距[(2.07±0.59) cm比(2.68±0.69) cm;t=5.332,P＜0.01]、指地距[(12.88±1.92) em比(13.26±1.71) cm;t=3.593,P＜0.05]、颌柄距[(1.58±0.63) cm比(2.43±0.64) cm;t=4.671,P＜0.01]较对照组显著缩短,胸廓活动度[(4.99±0.73) cm比(4.26±0.68) cm;t=4.226,P＜0.01]、Schober试验[(6.57±0.91) cm比(6.13±0.87) cm;t=3.733,P＜0.01]较对照组显著增大.结论 自拟益肾通督汤结合柳氮磺胺吡啶与美洛昔康可改善AS患者的躯体功能和疾病活动性,其疗效优于柳氮磺胺吡啶和美洛昔康治疗.     

The possible mechanisms of Picrasma quassiodes (D. Don) Benn. in the treatment of colitis induced by 2,4,6-trinitrobenzene sulfonic acid in mice

Ethnopharmacological relevance

Picrasma quassiodes (D. Don) Benn.(PQB) is used in folk medicines for the treatment of colds, upper respiratory infection, acute tonsillitis, acute gastroenteritis, bacillary dysentery and a variety of acute infectious diseases in Asia. Although recent reports indicate that PQB has antibacterial, and anti-inflammatory effects, its effects on colitis and its inhibitory mechanisms have not been previously reported.

Aim of the study

To assess the effects and the mode of action of the extract of Picrasma quassiodes (D. Don) Benn.(PQB) on a model of colitis in mice induced by trinitrobenzene sulfonic acid (TNBS).

Materials and methods

We induced mice colitis using TNBS/ethanol, then different doses of Picrasma quassiodes (D. Don) Benn.(PQB) extract (100, 200 and 400 mg/kg/day) and sulfasalazine (500 mg/kg/day) were administered by gavage for 7 days after the induction of colitis. The mice body weight, colonic wet weight, colonic lengths, myeloperoxidase (MPO) activity, macroscopic and histological colon injury were observed. Pro-inflammatory cytokines such as: tumor necrosis factor-alpha (TNF-α) and interleukin-8 (IL-8) were assayed by enzyme-linked immunoassay. The protein expression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in the colons were determined by immunohistochemical analysis.

Results

PQB administration effectively prevented mice diarrhea, decreasing of the body weights, shortening of colon length and increasing of colon wet weight. Macroscopic and histological examinations also indicated that it was protected against colonic edema, ulceration and MPO activity elevation. Furthermore, PQB inhibited the abnormal secretions of pro-inflammatory cytokines, such as TNF-α and IL-8. Additionally, administration of PQB effectively inhibited COX-2 and iNOS protein expression.

Conclusions

These results suggest that PQB has an anti-inflammatory effect on TNBS-induced colitis due to the down-regulations of the productions and expressions of inflammatory mediators, and that it may be a potential inflammatory bowel disease (IBD) drug candidate.     

中西医结合治疗强直性脊柱炎45例临床观察

目的：观察中西医结合治疗强直性脊柱炎（AS）的临床疗效。方法：将90例强直性脊柱炎患者随机分为对照组与治疗组,每组45例。对照组仅用西药柳氮磺吡啶片治疗,治疗组采用中药与柳氮磺吡啶片联合治疗。结果：经治疗后,治疗组总有效率为97.78%,对照组为51.11%,两组比较,差异有统计学意义（P〈0.01）。结论：中药与柳氮磺吡啶片联合治疗强直性脊柱炎疗效显著,不良反应少,值得临床推广使用。     

18例白头翁汤治疗溃疡性结肠炎临床分析

目的:观察白头翁汤辅助治疗溃疡性结肠炎的疗效,为临床工作提供参考。方法:选择我院与合作中医院2010年1月～2011年6月收治的溃疡性结肠炎患者36例,随机分为对照组和治疗组各18例。对照组患者均给予口服水杨酸柳氮磺胺吡啶治疗,治疗组患者给予口服白头翁汤颗粒治疗。连续治疗4周,观察并比较两组患者治疗效果和不良反应的差异。结果:经过4周治疗后,两组总有效率比较,治疗组明显较高,差异有统计学意义(P0.05);两组不良反应发生率比较,治疗明显较低,差异有统计学意义(P0.05)。结论:采用白头翁汤颗粒治疗溃疡性结肠炎,可以取得较满意的治疗效果,且不良反应较小,值得推广。     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的减量探索

目的探索一种经济、有效、安全的强直性脊柱炎(AS)患者应用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)的减量方法。方法对入选的48例活动期AS患者随机分为A、B两组,进行1年的疗效观察。两组患者均接受益赛普治疗,初始剂量为25mg每周2次皮下注射,当疾病得到缓解(BASDAI<2;ESR男<15mm/h,女<20mm/h;CRP<0.8mg/dl;PLT<300×109/L),即将益赛普每隔2个月逐渐减量。如果减量使患者症状加重或ESR、CRP、PLT计数等炎性指标反弹至异常水平,则将益赛普重新调回前一个剂量,并于下次复查时评估以确定益赛普的剂量。A组患者同时接受柳氮磺吡啶(SSZ)口服治疗,初始剂量为0.25tid,第2周增至0.5bid,第3周增至0.75bid,第4周增至1.0bid维持至第24周。结果两组患者前2个月均使用推荐剂量的益赛普即25mg每周2次皮下注射,均取得令人满意的疗效,起效快,缓解率高,组间差别无统计学意义。病情获得缓解的病例从第3个月起减量至25mg每周1次,至第4个月末评估疗效,达到ASAS20的百分数A组明显高于B组,且差异具有统计学意义(P<0.05)。随着用药间隔逐渐延长,两组间的差距越来越大。当益赛普减量至25mg每2周1次后,组间差别更是达到P<0.01。结论 SSZ联合益赛普治疗AS可取得较高的疾病缓解率或低疾病活动状态,可明显延长益赛普的用药间隔。     

盐酸小檗碱片联合柳氮磺吡啶治疗溃疡性结肠炎的临床研究

目的 探讨盐酸小檗碱片联合柳氮磺吡啶肠溶片治疗溃疡性结肠炎的临床疗效.方法 选取2019年2月—2020年2月在漯河市中医院诊治的溃疡性结肠炎患者94例,根据就诊顺序分为对照组(47例)和治疗组(47例).对照组口服柳氮磺吡啶肠溶片,初始剂量为1 g/次,若无不适增至2 g/次,3次/d,待症状缓解后减至1 g/次,2...