微生态制剂辅助治疗溃疡性结肠炎的疗效与安全性研究

Effect and security of adjuvant therapy for ulcerative colitis with probiotic agents

目的观察微生态制剂(思连康)辅助治疗活动期溃疡性结肠炎(UC)的疗效和安全性,并进一步探讨微生态制剂对肠黏膜局部细胞因子的影响。方法活动期UC患者86例,随机分为2组,对照组(40例)口服美沙拉嗪,同时用琥珀酸氢化考的松及庆大霉素、蒙脱石散保留灌肠,重度患者加静脉用激素。治疗组(46例)在上述治疗基础上,口服思连康1.5 g,每天3次。治疗6个月后评价2组疗效,主要症状和结肠镜变化情况,免疫组化法检测患者肠黏膜局部细胞因子IL-10、IL-6和IL-18的变化。结果治疗后2组临床表现均有明显好转,且治疗组优于对照组,2组比较差异有统计学意义(P<0.05)。2组治疗后结肠镜表现均有明显改善,治疗组优于对照组;疾病活动指数(DAI)降低(P<0.05),降低幅度治疗组优于对照组(P<0.05)。所有患者均未见明显的不良反应。免疫组化结果显示治疗后肠黏膜细胞因子IL-10的水平升高,治疗组优于对照组,IL-6和IL-18均有降低,IL-6下降治疗组优于对照组,而IL-18的降低2组间差异无统计学意义。结论微生态制剂口服辅助治疗UC疗效明显,并能降低UC的复发,且无不良反应。其机制可能与上调局部肠黏膜抗炎性细胞因子,下调炎性细胞因子有关。

Objective To observe the therapeutic effect and safety of probiotic agents on active ulcerative colitis （UC） and investigate its effects on the cytokines in mucosa. Method Eighty-six patients with active UC were randomly assigned to the treatment group （46 patients） and the control group （40 patients）. Besides the basic treatment of oral taking mesalazine, they were treated by retention enema with hydrcortisone sodium suceinate plus Gentamiein and Smectite Powder. In addition, the patients in the treatment group were treated by orally took probiotic agents, 1.5 g each time, thrice a day. The efficacy of treatment such as the clinical symptom score, colon mucosa inflammation and the expressions of IL-10, IL-6 and IL-18 in mucosa of patients with immunohistocbemistry 6 months after treatment were evaluated. Result The clinical symptom, colon mucosa inflammation had no difference between groups before treatment. Six months after treatment. The clinical symptoms and colon mucosa inflammation were better significantly than before （ P 〈 0.05 ）, especially in experiment group （P 〈 0.05 ）. The disease active index （DAI） was lowered after treatment in both groups （ P 〈 0.05 ）, decrease of DAI in the treatment group were superior to those in the control group （ P 〈 0.05 ）. The expressions of IL-10 in mueosa was significantly increased, especially in experiment group （P〈0.05）. The expressions of IL-6 in mucosa was significantly descended （P 〈0.05）, but the difference of IL-18 had no statistical significance. No adverse reaction was found in all patients. Conclusion The probiotic agents shows an effect obviously superior to that treated with oral taking mesalazine and retention enema, and with no adverse reaction. Its curative effect on ulcerative colitis is related to affecting IL-10, IL-6 and IL-18 in mucosa of patients .