美常安联合美沙拉嗪在UC患者中的应用效果及其对患者SOD、MDA、白细胞介素和TNF-α的影响

Bacillus subtilis and Enterococcus faecium enteric-coated capsules combined with mesalazine for treatment of patients with ulcerative colitis: Efficacy and impact on serum levels of SOD, MDA, interleukins, and TNF-α

目的观察枯草杆菌二联活菌肠溶胶囊联合美沙拉嗪治疗溃疡性结肠炎的疗效及对血清相关因子的影响.方法选取湖州市安吉县人民医院消化内科在2014-08/2016-11收治的溃疡性结肠炎患者86例,按照随机数字表法分为观察组和对照组,各43例,对照组患者给予美沙拉嗪肠溶片口服治疗;观察组在对照组基础上联用枯草杆菌二联活菌肠溶胶囊口服治疗;连续治疗2 mo.观察两组患者临床疗效、症状缓解时间、Rachmitewitz评分、Sutherland评分;检测血清白介素-6(interleukin 6,IL-6)、IL-8、IL-10、肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)炎症因子水平和丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、环氧合酶-2(cyclooxygenase-2,COX-2)、核因子-κB(nuclear factor-κB,NF-κB)水平,随访6 mo,记录两组患者复发情况.结果观察组临床总有效率高于对照组(93.02%v s76.74%),差异具有统计学意义(Z=4.440,P=0.035);观察组腹泻缓解时间、腹痛缓解时间、黏液脓血便缓解时间短于对照组,差异显著(P<0.05);治疗后两组患者Rachmitewitz、Sutherland评分与治疗前比较明显下降,观察组评分低于对照组(P<0.05);治疗后,观察组IL-6、IL-8、TNF-α水平低于对照组,IL-10水平高于对照组,差异显著(P<0.05);治疗后观察组MDA、COX-2、NF-κB水平低于对照组,SOD水平高于对照组,差异显著(P<0.05);随访6 mo,观察组复发率为11.63%,对照组复发率为16.28%,比较无统计学差异.结论枯草杆菌二联活菌肠溶胶囊与美沙拉嗪联合治疗溃疡性结肠炎效果优于单一采用美沙拉嗪治疗,能够促进患者临床症状缓解,降低血清炎症因子水平,改善机体氧化应激状态,但对远期复发无明显影响.

AIM To observe the curative effect of Bacillus subtilis and Enterococcus faecium enteric-coated capsules and mesalazine in patients with ulcerative colitis and their impact on serum levels of interleukin （IL）-6, IL-8, IL-10, tumor necrosis factor α（TNF-α）, malondialdehyde （MDA）, superoxide dismutase （SOD）, cyclooxygenase-2 （COX-2）, and nuclear factor-κB （NF-κB）. METHODS Eighty-six patients with ulcerative colitis admitted to our hospital from August 2014 to November 2016 were selected and randomly divided into an observation group and a control group, with 43 cases in each group. Both groups were given mesalazine enteric-coated tablets, and the observation group was additionally given Bacillus subtilis and Enterococcus faecium entericcoated capsules. After continuous treatment for 2 months, the clinical curative effect, time to symptom relief, Rachmitewitz score, and Sutherland score were recorded. Serum levels of IL-6, IL-8, IL-10, TNF-α, MDA, SOD）, COX-2, and NF-κB were measured. The patients were followed for 6 mo to record the recurrence. RESULTS The total effective rate in the observation group was 93.02%, which was significantly higher than that in the control group （76.74%; Z = 4.440, P = 0.035）. The time to relief of symptoms such as diarrhea, abdominal pain, and mucus and blood in stool was significantly shorter in the observation group than in the control group （P 〈 0.05）. After treatment, Rachmitewitz and Sutherland scores of both groups decreased significantly compared with those before treatment, and the scores of the observation group were significantly lower than those of the control group （P 〈 0.05）. After treatment, the levels of IL-6, IL-8, and TNF-α in the observation group were significantly lower and that of IL-10 was significantly higher in the observation group than in the control group （P 〈 0.05）. Moreover, the levels of MDA, COX-2, and NF-κB were significantly lower and that of SOD was significantly higher in the observation group than in the control group （P 〈 0.05）. During a follow-up period of 6 months, the recurrence rate was lower in the observation group than in the control group （11.63% vs 16.28%）. CONCLUSION Bacillus subtilis and Enterococcus faecium enteric-coated capsules combined with mesalazine is better than mesalazine alone in reducing clinical symptoms and improving serum levels of inflammatory cytokines and oxidative stress in patients with ulcerative colitis, with no significant effect on long-term recurrence.