辨证分型中药内服结合外治治疗溃疡性结肠炎的临床疗效及对免疫功能的影响

Clinical Observation on Syndrome Differentiation Internal Administration of Chinese Herbal Medicine Combined with External Therapy in the Treatment of Ulcerative Colitis and its Influence on Immune Function

目的:探讨辨证分型中药内服结合外治法治疗溃疡性结肠炎的临床疗效及对免疫功能的影响。方法:选取2012年1月至2014年12月南京中医药大学附属医院南通市中医院脾胃专科门诊就诊的溃疡性结肠炎患者92例作为研究对象,根据中医证候分类标准分为大肠湿热型组(38例),脾虚湿蕴型组(32例),脾肾阳虚型组(22例),选择同期溃疡性结肠炎的患者40例为对照组,观察组予以辨证分型中药口服结合中药灌肠、耳穴埋籽等治疗,对照组予以美沙拉嗪口服,疗程约3个月。观察比较4组患者中医证候积分、SutherlandDAI积分、炎性反应指标、免疫学指标、疗效及安全性指标。结果:4组治疗前中医证候积分、SutherlandDAI积分差异无统计学意义(P>0.05);与治疗前比较,大肠湿热型组、脾虚湿蕴型组、脾肾阳虚型组治疗后1个月、3个月中医证候积分、SutherlandDAI积分明显降低(P<0.05);与对照组比较,大肠湿热型组、脾虚湿蕴型组、脾肾阳虚型组治疗后3个月中医证候积分、SutherlandDAI明显降低(P<0.05);4组治疗前IgA、IgG、IgE、CRP、TNF-α、IL-8水平差异无统计学意义(P>0.05);与治疗前比较,大肠湿热型组、脾虚湿蕴型组、脾肾阳虚型组治疗后1个月、3个月IgA、IgG、IgE、CRP、TNF-α、IL-8水平明显降低(P<0.05);与对照组比较,大肠湿热型组、脾虚湿蕴型组、脾肾阳虚型组治疗后3个月IgA、IgG、IgE、CRP、TNF-α、IL-8水平明显降低(P<0.05);中药内服结合外治法患者总有效率为91.30%,显著高于对照组总有效率。大肠湿热型组、脾虚湿蕴型组、脾肾阳虚型组总有效率分别为89.47%、90.63%、95.45%,大肠湿热型组最低,脾肾阳虚型组最高,但3组差异无统计学意义(P>0.05);结论:辨证分型中药内服结合保留灌肠、耳穴埋籽外治疗法治疗溃疡性结肠炎临床疗效确切,可能与改善机体的免疫功能,控制炎性反应等有关,且安全简便,在临床上具有一定的可行性。

Objective： To investigate the clinical efficacy and the influence on immune function of ulcerative colitis treated by syndrome differentiation internal administration of Chinese herbal medicine combined with external therapy. Methods： A total of 92 cases with ulcerative colitis treated in our hospital from January 2012 to December 2014 were selected and divide into large intestine damp-heat group（ group A）,spleen deficiency dampness accumulation group（ group B）,spleen kidney yang deficiency group（ group C） according to TCM syndrome classification standard,and another 40 cases of patients with ulcerative colitis were selected as control group. The treatment group was treated with syndrome differentiation oral administration of Chinese herbal medicine combined with Chinese medicine enema,and auricular point therapy,and the control group was received oral mesalazine. Bothe groups were treated for 3 months. TCM syndrome scores,SutherlandDAI score,inflammatory indexes,immunological indexes,clinical efficacy and safety index of four groups were observed. Results： There was no statistically significant difference in TCM syndromes and SutherlandDAI score of four groups（ P 〈 0. 05）. Compared with before treatment,the TCM syndrome score and SutherlandDAI score was significantly reduced in patients with group A,group B and C in one month and three months after treatment（ P 〈 0. 05）.Compared with the control group,the TCM syndrome scores and SutherlandDAI score were significantly reduced in group A,group B and group C in three months after treatment（ P 〈 0. 05）. There was no statistically significant difference in the levels of IgA,IgG,IgE,CRP,TNF-α and IL-8 of four groups before treatment（ P 〈 0. 05）. Compared with before treatment,the levels of IgA,IgG,IgE,CRP,TNF-α and IL-8 were significantly reduced of group A,group B,and group C in one month,three months after treatment（ P 〈 0. 05）. Compared with the control group,the levels of IgA,IgG,IgE,CRP,TNF-α and IL-8 were significantly reduced of group A,group B and group C in three months after treatment（ P 〈 0. 05）. The total effective rate of group A,group B and group C was 91. 30%,which was significantly higher than the control group. There was no statistically significant difference in the total effective rate of group A（ 89. 47%）,group B（ 90. 63%） and group C（ 95. 45%）. Conclusion： Syndrome differentiation oral administration of Chinese herbal medicine combined with Chinese medicine enema,and auricular point therapy has certain effects in the treatment of ulcerative,and may be related with improving the immune function of organism and controlling inflammation. It is safe and convenient,and has certain feasibility in clinical practice.