加味白头翁汤灌肠治疗大肠湿热型溃疡性结肠炎疗效观察及对炎症因子水平影响

Therapeutic Effect of Modified Baitouweng Decoction Enema for Ulcerative Colitis with Damp Heat in Large Intestine and Its Influence on Levels of Inflammatory Factors

【目的】观察加味白头翁汤肠内滴注治疗大肠湿热型溃疡性结肠炎(UC)活动期的临床疗效及其对血清炎症因子水平的影响。【方法】将60例轻中度大肠湿热型UC患者随机分为中药组和西药组,每组各30例。中药组给予加味白头翁汤药液肠内滴注治疗,西药组给予美沙拉嗪灌肠液灌肠治疗,连续用药8周,观察2组患者治疗前后中医证候积分、肠镜下黏膜征象积分和炎症因子水平变化情况,并评价2组的中医单项证候疗效及安全性。【结果】治疗后,中药组对各项中医证候积分和肠黏膜征象积分的改善作用均明显优于西药组(P<0.05),对血清白细胞介素(IL)-8、肿瘤坏死因子-β(TNF-β)含量的降低作用和血清IL-10、IL-13含量的升高作用也均优于西药组(P<0.05)。单项证候疗效方面:除腹痛外,中药组的腹泻、肛门坠胀、里急后重、黏液脓血便等各项证候疗效均优于西药组,差异均有统计学意义(P<0.05)。安全性方面:用药期间,中药组均未发现明显不良反应,西药组4例出现直肠内烧灼刺痛感,但未影响治疗。【结论】加味白头翁汤肠内滴注可有效抑制UC患者促炎细胞因子释放,减少炎症反应,促进肠黏膜修复。

Objective To investigate the therapeutic effect of enteral drip infusion with modified Baitouweng Decoction for the treatment of ulcerative colitis（UC） with damp heat in large intestine at active phase,and to observe its influence on serum levels of inflammatory factors. Methods Sixty patients suffering from mild to moderate UC with damp heat in the large intestine were randomly divided into treatment group and control group, 30 cases in each group. The treatment group was given enteral drip infusion with modified Baitouweng Decoction and the control group was given Mesalazine Enemas enema. The medication lasted for 8 continuous weeks. Before and after treatment,the scores of traditional Chinese medicine（TCM） syndromes and intestinal mucosal signs under enteroscopy,and serum levels of inflammatory factors were observed. Therapeutic effect on single TCM syndrome and clinical safety were also evaluated after treatment. Results After treatment,the scores of each TCM syndrome and intestinal mucosal signs under enteroscopy in the treatment group were much improved（P〈0.05 compared with those in the control group）;serum interleukin-8（IL-8）and tumor necrosis factor beta（TNF-β）levels in both groups were decreased,serum IL-10 and IL-13 levels were increased（P〈0.05 compared with those before treatment）,and the effect in the treatment group was superior to that in the control group（P〈0.05）. Except for the abdominal pain, the treatment group had better effect on relieving diarrhea, anal expansion, tenesmus, mucous stool and bloody purulent stool than the control group, the difference being statistically significant（P〈0.05）. During the medication, no obvious adverse reaction was found in the treatment group,but 4 cases from the control group had anal burning sensation which had no effect on the mediciation. Conclusion Enteral drip infusion with modified Baitouweng Decoction can inhibit the release of proinflammatory cytokines,reduce the inflammatory response,and promote the healing of intestinal mucosa,which is effective for the treatment of UC with damp heat in large intestine at active phase.