龙胆泻肝汤加减治疗肛窦炎湿热内蕴证的疗效及对免疫应答、氧化应激的影响

目的:探究龙胆泻肝汤加减治疗肛窦炎(anal cryptitis,AC)湿热内蕴证的疗效及对免疫应答、氧化应激的影响。方法:随机将2017年5月至2018年5月河南省中医院收治的80例湿热内蕴证型AC患者分为对照组和观察组,各40例,对照组采用甲硝唑注射液联合硫酸庆大霉素注射液灌肠治疗,并给予生物刺激反馈仪治疗,在对照组的基础上,治疗组给予龙胆泻肝汤加减水煎服。治疗前后观察两组的症状体征评分,白细胞介素-2(interleukin-2,IL-2),IL-4,IL-6,IL-10,肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),γ-干扰素(interferon-γ,IFN-γ),降钙素原(procalcitonin,PCT),CD3^+,CD^4^+,CD8^+,免疫球蛋白A(immunoglobulin A,Ig A),Ig G,Ig M,Ig E,超氧化物歧化酶(superoxide dismutated alcohol,SOD),丙二醛(malonaldehyde,MDA),并观察两组的疗效、不良反应及复发情况。结果:经秩和检验,治疗组临床疗效明显优于对照组(Z=1.981,P<0.05)。治疗组治疗后肛门坠胀、疼痛等症状评分及肛窦触痛、充血、水肿等体征评分低于对照组(P<0.05)。治疗组治疗后TNF-α,PCT,IL-2,IL-6,MDA水平低于对照组(P<0.05),治疗组治疗后IL-4,IL-10,IFN-γ,SOD水平高于对照组(P<0.05)。治疗组复发率为5.13%,对照组复发率为21.05%,治疗组低于对照组(χ^2=4.319,P<0.05)。结论:龙胆泻肝汤加减治疗湿热内蕴证AC的疗效较好,能有效地缓解症状,调节促炎/抗炎平衡和Th1/Th2平衡,改善细胞免疫功能和体液免疫功能,抑制氧化应激反应,降低复发率,安全性高。

Effect of Modified Longdan Xiegantang in Treatment of Anal Sinusitis Patients with Syndrome of Interior Dampness-heat and on Immune Response, Oxidative Stress

Objective:To explore the effect of modified Longdan Xiegantang in treatment of anal sinusitis patients with syndrome of interior dampness-heat and on immune response,oxidative stress.Method:A total of 80 cases of anal sinusitis patients with syndrome of interior dampness-heat treated in our hospital from May 2017 to May 2018 were randomly divided into two groups,with 40 cases in each group.The control group was treated by enema with Metronidazole injection combined with gentamicin sulfate injection.In addition to the therapy of the control group,the treatment group was also given modified Longdan Xiegantang.The symptoms and signs score,interleukin(IL)-2,IL-4,IL-6,IL-10,tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),procalcitonin(PCT),CD3^+,CD4^+,CD8^+,immunoglobulin A(IgA),IgG,IgM,IgE,SOD,propylene glycol(MDA)levels of two groups were observed before and after treatment,and the curative effect,reactions and relapse were observed.Result:The clinical efficacy of treatment group was significantly better than that of control group,and the rank-sum test showed statistically significant differences(Z=1.981,P<0.05).After treatment,the scores of symptoms,such as anal distension and pain,and signs,such as anal sinus tenderness,hyperemia and edema in the treatment group were lower than those in control group(P<0.05).The levels of TNF-α,PCT,IL-2,IL-6 and MDA in treatment group were lower than those in control group(P<0.05).The levels of IL-4,IL-10,IFN-γand SOD in treatment group were higher than those in control group(P<0.05).The recurrence rate was 5.13%in treatment group,and 21.05%in control group,indicating a significant difference(χ^2=4.319,P<0.05).Conclusion:Modified Longdan Xiegantang is effective in treating syndrome of interior dampness-heat anal sinusitis.It can effectively relieve symptoms,regulate pro-inflammatory/anti-inflammatory balance and Th1/Th2 balance,improve cellular immune function and humoral immune function,inhibit oxidative stress response,and reduce recurrence rate,with a high safety.