美沙拉嗪对溃疡性结肠炎患者肠道黏膜屏障功能和免疫功能的系统评价

Systematic review of mesalazine on intestinal mucosal barrier and immune function in patients with ulcerative colitis

目的探讨美沙拉嗪应用于溃疡性结肠炎对患者肠道黏膜屏障功能与免疫功能的影响。方法选取2016年3月~2017年2月在我院接受治疗的溃疡性结肠炎患者93例,按照用药不同,分成美沙拉嗪组(n=47)和柳氮磺吡啶组(n=46),于用药前和用药1疗程、2疗程后,比较两组免疫功能、肠道黏膜屏障功能变化及肠黏膜恢复情况。结果用药前,两组Ig A、Ig G、Ig M、Fas/Fas L及CD4+、CD8+和CD4+/CD8+差异均不显著(P>0.05),用药1疗程、2疗程后,两组各项指标均显著变化,且用药1疗程后的各项指标与2疗程后均有显著差异(P<0.05),美沙拉嗪组用药1疗程、2疗程后Ig A、Ig G、Ig M、CD4+、CD4+/CD8+显著高于柳氮磺吡啶组,Fas/Fas L、CD8+显著低于柳氮磺吡啶组(P<0.05);用药前,两组肠道黏膜屏障功能指标差异均不显著(P>0.05),用药1疗程、2疗程后,两组各项肠道黏膜屏障功能表达水平均显著降低,且用药1疗程与用药2疗程各项指标间有显著差异(P<0.05),实验组用药1疗程、2疗程后DAO、LAC、PCT、LPS、D-LA均显著低于柳氮磺吡啶组(P<0.05);用药前,两组肠黏膜临床症状总积分无显著差异(P>0.05),用药1疗程、2疗程后,两组临床症状总积分均显著下降,美沙拉嗪组显著低于柳氮磺吡啶组(P<0.05)。结论对于溃疡性结肠炎患者,可采取美沙拉嗪进行治疗,能够有效促进肠黏膜恢复,其作用机制可能和改善肠道黏膜屏障功能与调节免疫功能有关。

Objective To investigate the effect of mesalazine on intestinal mucosal barrier function and immune function in patients with ulcerative colitis. Methods A total of 93 patients with ulcerative colitis who were treated in our hospital from March 2016 to February 2017 were selected and divided into mesalazine group（n=47） and sulfasalazine group（n=46） according to different drugs. The changes of immune function, intestinal mucosal barrier function and intestinal mucosal recovery were compared before medication and after 1 course and 2 courses of treatment. Results Before treatment, there was no significant difference in Ig A, Ig G, Ig M, Fas/Fas L, CD4^＋, CD8^＋and CD4^＋/CD8 between the two groups（P〉0.05）. There was a significant difference in indexes between groups after 1 course and 2 courses of treatment, and there was a significant difference between the indexes after 1 course of treatment and those after 2 courses of treatment（P〈0.05）. The levels of Ig A, Ig G, Ig M, CD4^＋, CD4^＋/CD8^＋in the mesalazine group after 1 course and 2 courses of treatment were significantly higher than those of the sulfasalazine group. The levels of Fas/Fas L and CD8^＋in the mesalazine group were significantly lower than those in the sulfasalazine group（P〈0.05）. Before treatment, there was no significant difference in the intestinal mucosal barrier function between the two groups（P〉0.05）. The expression levels of intestinal mucosal barrier function in two groups were significantly lower after 1 course and 2 courses of medication.There was significant difference in between indicators after1 course and those after 2 courses of medication（P〈0.05）.The levels of DAO, LAC, PCT, LPS, D-LA in the mesalazine group after 1 course and 2 courses of treatment were significantly higher than those of the sulfasalazine group（P〈0.05）. Before treatment, there was no significant difference in the total score of intestinal mucosal clinical symptoms between the two groups（P〉0.05）. After 1 course and 2 courses of medication, the total scores of clinical symptoms in both groups decreased significantly, and the scores of the mesalazine group was significantly lower than those of the sulfasalazine group（P〈0.05）. Conclusion For patients with ulcerative colitis, mesalazine can be taken for treatment, which can effectively promote intestinal mucosal recovery. The mechanism may be related to the improvement of intestinal mucosal barrier function and immune function regulation.