美沙拉嗪不同给药方式治疗溃疡性结肠炎的临床效果研究

Clinical comparison of different administration methods of mesalazine in the treatment of ulcerative colitis

目的比较美沙拉嗪不同给药方式治疗溃疡性结肠炎的临床效果,为临床用药提供参考。方法选取2013年5月至2014年9月我院消化科收治的溃疡性结肠炎患者96例为研究对象,随机分为观察组和对照组各32例,均给予柳氮磺吡啶、美沙拉嗪及糖皮质激素类药物进行治疗,按美沙拉嗪给药方式不同分为M1组(美沙拉嗪口服)、M2组(美沙拉嗪灌肠或肛塞)、M3(美沙拉嗪口服+灌肠或肛塞)三组,每组均32例,均治疗2个月。治疗结束比较两组住院时间、全身支持治疗时间及出院后1周疾病活动指数(DAI),治疗后1个月分析两组血清炎症因子水平,包括肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-1(IL-1),同时比较两组红细胞沉降率(ESR)、血小板计数(PLT)等实验室生化指标,并分析两组并发症发作率与不良反应发生率。结果 M3组住院时间(15.4±2.8)d、全身支持治疗时间(5.3±1.2)d与M1、M2组比较显著较短(P<0.05),M3组DAI指数(1.3±0.8)显著低于M1、M2组(P<0.05);M3组TNF-α(0.1±0.1)μg/m L、CRP(6.2±2.8)mg/L、IL-1(0.5±0.3)ng/ml、ESR(23.3±1.4)mm/h、PLT(2.0±0.1)×10~5/mm^3与M1、M2组比较显著降低(P<0.05);M1、M2、M3组并发症发生率12.5%、18.7%、21.9%比较差异无统计学意义(P>0.05);M1、M2、M3组不良反应发生率12.5%、9.4%、15.6%比较差异无统计学意义(P>0.05)。结论美沙拉嗪治疗溃疡性结肠炎的临床效果易受给药方式影响,其中口服+灌肠或肛塞治疗为最佳给药方案,且不会增加单独口服给药或灌肠与肛塞给药不良反应,值得在临床广泛应用。

Objective To compare the clinical effects of different administration methods of mesalazine in the treatment of ulcerative colitis, and to provide reference for clinical medication. Methods 96 patients with ulcerative colitis who were treated in the Digestive Department of our hospital between May 2013 and September 2015 were selected as the study objects and were divided into the observation group and control group by the random number table method, 32 cases in each. All patients were treated with sulfasalazine, mesalazine and glucocorticoids. According to the administration methods of mesalazine, the patients were divided into M1 group（oral administration of mesalazine）, m^2 group（enema or anal plug of mesalazine） and M3 group（oral administration combined with enema or anal plug of mesalazine） three groups, 32 cases in each group. All patients were treated for 2 months. At the end of treatment, the hospitalization time, systemic support treatment time and disease activity index（DAI） at 1 month after discharge were compared between the two groups. After 1 months of treatment,the levels of serum inflammatory cytokines, including tumor necrosis factor alpha（TNF-α）, C reactive protein（CRP） and interleukin-1（IL-1） in the two groups were analyzed. The laboratory biochemical indexes such as erythrocyte sedimentation rate（ESR） and platelet count（PLT） were compared between the two groups. The incidence rates of complications and adverse reactions in the two groups were analyzed. Results The hospitalization time（15.4± 2.8） d and systemic support treatment time（5.3±1.2） d of M3 group was significantly shorter than M1 and m^2 group（P〈0.05）. DAI of M3 group（1.3±0.8） was significantly lower than that of M1 and m^2 group（P〈0.05）; TNF-α（0.1±0.1） μg / m L, CRP（6.2 ±2.8） mg / L, IL-1（0.5 ±0.3） ng / m L, ESR（23.3 ±1.4） mm / h and PLT（2.0±0.1）×10-5/ mm^3 in M3 group were significantly lower than those in M1 and m^2 group（P〈0.05）;There was no significant difference in the incidence rates of complications（12.5% VS 18.7% VS 21.9%） and adverse reactions（12.5% VS 9.4% VS 15.6%） between M1, m^2 and M3 group（P〈0.05）. Conclusion The clinical effects of mesalazine in the treatment of ulcerative colitis is easy to be affected by administration methods. Oral combined with enema or anal plug administration of mesalazine is the best regimen and it does not increase the adverse drug reactions of single oral or enema and anal plug administration. It is worthy of clinical application.