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

Mechanism and therapeutic effects of Smecta combined with Mesalazine in treating diarrhea induced by ulcerative Colitis

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组单纯应用美沙拉嗪治疗（美沙拉嗪缓释颗粒1g，次，4次／d，8N），观察两组腹泻症状缓解情况、临床总疗效，临床症状缓解情况，肠镜缓解情况，组织学缓解情况，腹泻缓解时间及脓血便消失时间采用t检验验，临床总疗效采用Ridit分析。结果腹泻症状缓解情况：与B组[（16．7±4．3）d]比较，A组患者腹泻症状恢复正常时间[（10．1±4．6）d，t=8．22，P〈0．05j及黏液脓血便消失时问[（9．8±5．7）d，（15．3±4．1）d]明显缩短（≠=8．22，P〈0．05）。临床总疗效：A组（完全缓解15例，有效5例，无效1例）显著优于B组（完全缓解10例，有效5例，无效6例，U=8．34，P〈0．05）。临床症状缓解情况：A组（完全缓解15例，部分缓解5例，无效1例）显著优于B组（完全缓解10例，部分缓解8例，无效3例，U=8．47，P〈0．05）。肠镜缓解情况：A组f完全缓解12例，部分缓解8例，无效1例）显著优于B组（完全缓解7例，部分缓解9例，无效5例，U=8．21，P〈O．05）。组织学缓解情况：A组（完全缓解13例，部分缓解7例，无效1例）显著优于B组（完全缓解7例，部分缓解11例，无效1例，U=8．28，P〈0．05）。胃肠道反应情况：A组上腹部不适、烧心、嗯心等反应例数少于B组，未见其他不良反应，而B组则有水样大便次数增多、皮疹各1例不良反应。结论蒙脱石散剂联合美沙拉嗪治疗溃疡性结肠炎，可以通过修复损伤肠黏膜屏障从而快速缓解腹泻症状。将肠黏膜屏障修复作为治疗UC新策略，将为溃疡性结肠炎治疗提供新的思路。

Objective To study the mechanism and therapeutic effects of Smecta in treating diarrhea induced by ulcerative colitis. Methods Forty-two chronic intermittent UC patients were randomly divided into two groups： group A Mesalazine and Smecta treatment group （n =21 ）and Group B Mesalazine group （n =21 ）. Clinical effects and safety were compared between the two groups. The overall clinical efficacy,clinical symptoms, colonic remission,histologic remission were obsewed. Results Compared with group B, group A had an obviously shorter diarrhea recovery time[ （10.1 ±4.6）d, （16.7 ±4.3）d, t=8.22, P〈 0.05） ];a shorter extinction time about the bloody diarrhea and mucus in stools [ （9.8±5.7）, （ 15.3±4.1 ）d, t=8.92, P〈0.05 ].The overall clinical efficacy of group A （complete remission in 15 cases, improvement in 5 patients, ineffective in one case） was better than that in group B （complete remission in 10 cases,improvement in 5 patients, ineffective in 6 cases, U=8.34,P 〈0.05）.The clinical symptoms relieve of group A （complete remission in 15 cases, partly in 5 patients, ineffective in one case） was better than that in group B （complete remission in 10 eases, partly in 8 patients, ineffective in 3 cases,U=8.47 P 〈0.05）. The colouoscopic remission of group A （complete remission in 12 cases, partly in 8 patients, ineffective in one case） was better than that in group B （complete remission in 7 cases, partly in 9 patients, ineffective in 5 cases, U=8.28,P 〈0.05）. The histologie remission of group A （complete remission in 13 cases, partly in 7 patients, ineffective in one case） was better than that in group B （complete remission in 7 cases, partly in 11 patients, ineffective in 3 cases, U=8.28,P 〈0.05）. The side effects of gastrointestinal tract in group A were fewer than that of group B except for frequency of watery diarrhea. （complete remission in 12 cases, partly in 8 patients, ineffective in one case）was better than that in group B （complete remission in 7 cases, partly in 9 patients ,ineffective in 5 cases, P 〈0.05）. histologic remission of group A （complete remission in 13cases, partly in 7 patients, ineffective in one case） was better than that in group B（complete remission in 7 cases, partly in 11 patients, ineffective in 15 cases, P 〈0.05）. The side effects of gastrointestinal tract in group A were fewer than that of group B except for frequency of watery diarrhea. Conclusion To treat diarrhea induced by ulcerative colitis using Mesalazine and Smecta may lead to a quickly recovery time , which would repair damaged enteromueosa barrier. To repair damaged enteromueosa barrier may be a new method in treating ulcerative colitis.