肠炎清合剂治疗慢性复发型溃疡性结肠炎大肠湿热证的临床观察

目的:观察肠炎清合剂对慢性复发型溃疡性结肠炎(UC)大肠湿热证患者诱导缓解效果及维持治疗对复发的影响,并从神经-内分泌-免疫炎症网络方面探讨了其作用机制。方法:将112例符合要求的患者随机分成对照组55例和观察组57例。对照组内服美沙拉嗪肠溶片,1.0 g/次,4次/d;Mayo评分系统≥7分者,加服醋酸泼尼松片,0.75 mg·kg^-1·d^-1;加用双歧杆菌活菌散剂,1包/次,2次/d,餐后温水冲服。观察组在对照组治疗的基础上服用肠炎清合剂,1包/次,分早晚2次服用。两组疗程均为连续治疗6周,再每周门诊复诊1次。进入缓解期后,两组患者均给予美沙拉嗪肠溶片,0.5 g/次,3次/d,维持治疗;观察组仍内服肠炎清合剂内服,至大肠湿热证评分减少≥90%以上。记录进入6周内缓解期的人数和缓解时间;进行治疗前后结肠镜检查,并进行Geboes指数和Baron法评价;进行治疗前后大肠湿热证评分和Mayo评分;检测治疗前后外周血白细胞介素-6(IL-6),IL-8,IL^-10,IL^-17,血管活性肠肽(VIP),胃动素(MTL)和神经肽Y(NPY);随访24周,记录复发情况。结果:经6周治疗后,观察组临床有效率为100%,黏膜愈合率为96.4%,均分别高于对照组的89.09%和81.82%(P<0.05),两组患者内镜应答率均为100%;经6周治疗后,观察组临床缓解率为91.23%,高于对照组的76.36%(χ2=4.581,P<0.05),观察组平均缓解时间短于对照组(P<0.01);治疗后观察组结肠黏膜评分,Geboes指数、大肠湿热证评分和Mayo评分均低于对照组(P<0.01);观察组患者外周血IL-6,IL-8和IL^-17水平均低于对照组(P<0.01),IL^-10水平高于对照组(P<0.01);观察组患者外周血VIP,MTL水平均低对照组(P<0.01),NPY水平高于对照组(P<0.01);观察组复发率为17.54%,低于对照组的38.18%(χ2=5.955,P<0.05);观察组平均复发时间长于对照组(P<0.01)。结论:在常规西医治疗的基础上,肠炎清合剂用于慢性复发型UC大肠湿热证的治疗,可诱导病情缓解,缩短病程,并能降低复发率,推迟复发时间,并对神经-内分泌-免疫炎症网络具有调节作用,从而可改善病情。

Clinical Efficacy of Changyanqing Mixture on Chronic Recurrent Ulcerative Colitis with Damp-heat Ayndrome of Large Intestine

Objective:To observe the clinical efficacy of Changyanqing mixture on chronic recurrent ulcerative colitis(UC)with damp-heat syndrome of large intestine and the effect on the recurrence of disease,in order to discuss the mechanism of action in terms of the neuro-endocrine-immune inflammation network.Method:One hundred and twelve patients were randomly divided into control group(55 cases)and observation group(57 cases)by random number table.Patients in control group got mesalazine slow release tablets,0.1 g/time,4 times/days,and those the score of Mayo≥7 were added with prednisone acetate tablets,0.75 mg·kg^-1·d^-1,and bifidobacterium viable powder with warm water after dinner,1 pack/day,2 times/days.In addition to the therapy of control group,patients in observation group were also given Changyanqing mixture in the morning and evening,1 pack/day.A course of treatment was 6 weeks,and patients got further consultation once a week.During the remission stage,patients in both groups got mesalazine slow release tablets,0.5 g/time,3 times/days,and patients in observation group were added with Changyanqing mixture until the score of damp-heat syndrome of large intestine reduced by more than 90%.The number of patients entering the remission stage of 6 weeks and the time of remission stage were recorded.Before and after treatment,colonoscopy was detected,and Geboes index,Baron,damp-heat syndrome of large intestine and Mayo were scored.And levels of peripheral blood interleukin-6(IL-6),IL-8,IL^-10,IL^-17,vasoactive intestinal peptide(VIP),motilin(MTL)and neuropeptide(NPY)were detected,and relapse at the 24-week follow-up was recorded.Result:After the 6-week treatment,the clinical efficacy in observation group was 100%,which was higher than 89.09%in control group(P<0.05).And the healing rate of mucosa was 96.4%,which was higher than 81.82%in control group(P<0.05).And the response rate in two groups was 100%.At the 6 thmonth after the treatment,the clinical remission rate in observation group was 91.23%,which was higher than 76.36%in control group(χ2=4.581,P<0.05).And the average remission time was shorter than that in control group(P<0.01).After treatment,scores of colonic mucosa,Geboes index,colonic mucosa and Mayo were all lower than those in control group(P<0.01).And levels of IL-6,IL-8,IL^-17,VIP and MTL were lower than those in control group(P<0.01),while levels of IL^-10 and NPY were higher than those in control group(P<0.01).The relapse rate in observation group was 17.54%,which was lower than38.18%in control group(χ2=5.955,P<0.05).And the mean recurrence time was longer than that in control group(P<0.01).Conclusion:In addition to the routine western medicine therapy,Changyanqing mixture can alleviate the condition of patients by shortening the course of the disease,reducing the recurrence rate,delaying the recurrence time,and regulating the nerve-endocrine-immune inflammation network.