中药内服联合清溃方保留灌肠治疗溃疡性结肠炎

Oral Traditional Chinese Medicine Combined with Retained Enema of Qing Kui Decoction Treatment on Patients with Ulcerative Colitis

目的:探讨中药内服联合清溃方保留灌肠诱导和维持治疗溃疡性结肠炎(UC)的近期和远期疗效。方法:将160例UC患者随机按数字表法分为西药组和中药组各80例。西药组采用口服柳氮磺胺吡啶片+强的松治疗,疗程8周,对治疗达到缓解期患者再以柳氮磺胺吡啶片维持治疗2个月;中药组采用中药内服联合清溃方保留灌肠,疗程8周,对经治疗达到缓解期患者再根据不同证型以中成药维持治疗8周。对进入缓解期患者进行12个月随访。进行治疗前后结肠镜检查,以结肠镜Baron内镜评分法进行评价;采用肠黏膜病变活动指数(Sutherland)评估疾病严重度与活动度;采用炎症性肠病问卷(IBDQ)评价生活质量;对主要症状、体征进行治疗前后评分,记录患者复发次数。结果:中药组临床疗效总有效率为91.2%,西药组为75%,中药组优于西药组(P<0.05);中药组Baron评分和Sutherland疾病活动指数评分低于西药组(P<0.01);中药组腹泻、脓血便和腹痛评分低于西药组(P<0.01);中药组IBDQ量表肠道症状、全身症状、情感能力和社会能力评分及总分均高于西药组(P<0.01);中药组12个月内复发频率为(0.76±0.41)次少于西药组的(1.28±0.64)(P<0.01)。结论:中药内服联合清溃方保留灌肠诱导和维持治疗溃疡性结肠炎能控制UC活动,促进溃疡愈合,控制临床症状,并能降低复发率。

Objective： To discuss the short-term and long-term effects of oral traditional Chinese medicine combined with retention enema of Qingkui decoction in treating patients with ulcerative colitis （UC）. Method： One hundred and sixty patients with UC were randomly divided into control group and observation group of 80 patients each. Patients in control group received oral sulfasalazine tablets plus prednisone for 8 weeks, then received maintenance treatment with sulfasalazine tablets for 2 months for patients in remission. Patients in observation group received oral traditional Chinese medicine combined with retention enema of Qingkui decoction for 8 weeks, then received maintenance treatment with corresponding Chinese patent medicines according to differentiated syndrome for 8 weeks for patients in remission. And patients in remission received a 12 month follow- up. Before and after treatment, colonoscopy was performed and the results were evaluated by Baron scoring method. The disease activity was scored by Sutherland DAI. Quality of life in inflammatory bowel disease （IBD） was assessed by IBD questionnaire （IBDQ）. The main signs and symptoms, were scored, and the recurrence rate of patients was recorded. Result： The total effective rate in observation group was 91.2% superior to 75% in control group （P 〈 0.05）. Baron score and Sutherland DAI score in observation group were lower than those in control group （P 〈 0.01 ）. The score of diarrhea, bloody purulent stool and stomachache in observation group were lower than those in control group （P 〈 0. 01 ）. IBDQ scores including intestinal tract symptom, constitutional symptom, emotional capability and social competence in observation group were higher than those in control group （P 〈0.01 ）. Recurrence rate in observation group within 12 months was （0.76 ＋0.41 ） less than （ 1.28 ＋0.64） in control group （P 〈0.01）. Conclusion： Induction and maintenance treatment of oral Chinese patent medicine combined with retention enema of Qingkui decoction is an effective therapy to prevent the activity of UC, improve the healing of anabrosis, control clinical symptoms and reduce recurrence rate.