白头翁汤加减灌肠方治疗左半结肠型急性期溃疡性结肠炎17例临床观察

Clinical Observation on Modified Pulsatilla Decoction(白头翁汤) for Enema Treating Acute Period of Ulcerative Colitis of Left Hemicolon Type: Report of 17 Cases

目的观察白头翁汤加减灌肠方治疗左半结肠型急性期溃疡性结肠炎的临床疗效及可能作用机制。方法选取34例左半结肠型急性期溃疡性结肠炎患者随机分成治疗组和对照组各17例。治疗组予白头翁汤加减灌肠方保留灌肠,每日1剂,每日1次,对照组予柳氮磺胺吡啶灌肠,每次1 g,每日2次,疗程均为45天。治疗前后比较两组中医证候评分及结肠黏膜病变评分,测定肠黏膜白细胞介素8(IL-8)的表达,判定中医证候疗效。结果两组患者治疗后腹泻、脓血便、腹痛、腹胀、里急后重、纳呆、乏力症状评分及总积分均较本组治疗前下降(P<0.05或P<0.01);治疗组治疗后腹泻、脓血便、腹痛症状评分及总积分较对照组下降明显(P<0.05)。治疗组与对照组的中医证候疗效总有效率分别为94.11%和76.47%,差异有统计学意义(P<0.05)。两组治疗后镜下结肠黏膜病变评分及IL-8的表达均较本组治疗前明显改善(P<0.01)。治疗组结肠黏膜病变评分显著低于对照组(P<0.05),IL-8表达强度与对照组比较,差异无统计学意义(P>0.05)。结论白头翁汤加减灌肠方能改善左半结肠型急性期溃疡性结肠炎患者的临床症状、修复黏膜组织,其机制可能与下调肠黏膜IL-8的表达有关。

Objective To observe clinical effects and possible mechanism of Modified Pulsatilla Decoction for enema treating acute period of ulcerative colitis of left hemicolon type. Methods Totally 34 cases of patients with acute period of ulcerative colitis of left hemicolon type were randomly divided into treatment group and control group,with 17 cases in each group. Gave treatment group Modified Pulsatilla Decoction for retention enema,1 dose per day,once every day. Gave control group Sulfasalazine for enema,1 g each time,twice per day. Treatment course was 45 days both. Compared Chinese medicine syndrome scores and colon mucosa lesion of the two groups before and after treatment. Tested the expression of intestinal mucosa interleukin-8（ IL-8）,and evaluated the treatment effect of Chinese medicine syndrome. Results Symptom scores and aggregate scores of diarrhea,bloody purulent stool,abdominal pain,abdominal distention,tenesmus,anorexia and feeble of two groups after treatment decreased compared with those before treatment（ P〈0. 05 or P〈0. 01）. Symptom scores and aggregate scores of diarrhea,bloody purulent stool,abdominal pain of treatment group after treatment remarkably decreased compared with those of control group（ P〈0. 05）. Total effective rate of Chinese medicine syndrome of treatment group and control group was respectively 94. 11% and 76. 47%. The difference was statistically significant（ P〈0. 05）. Microscopy colon mucosa lesion score and expression of IL-8 all remarkably improved compared with those before treatment（ P〈0. 01）. Colon mucosa lesion score of treatment group was remarkably lower than that of control group（ P〈0. 05）. Difference of expressional intensity of IL-8 was not statistically significant compared with that of control group（ P〉0. 05）. Conclusion Modified Pulsatilla Decoction for enema could improve clinical symptom and repair mucosal tissue of patients with acute period of ulcerative colitis of left hemicolon type. Its mechanism may be related to down-regulating expression of IL-8 in intestinal mucosa.