基于临床疗效及Th1/Th2、Th17/Treg炎性平衡变化探讨痛泻要方治疗溃疡性结肠炎的机制

An Inquiry into Treatment Mechanism of Ulcerative Colitis by Tongxie Yaofang Based on Clinical Efficacy and Inflammatory Balance Change in Th1/Th2 and Th17/Treg

目的：观察痛泻要方加减治疗肝郁脾虚型溃疡性结肠炎的临床疗效以及其对T细胞Th1/Th2、Th17/Treg介导的炎性细胞因子平衡的影响。方法：筛选符合肝郁脾虚证型的溃疡性结肠炎入院及门诊患者62例,随机分为对照组和治疗组。对照组采用柳氮磺胺吡啶片进行常规治疗,治疗组在常规方案的基础上采用痛泻要方加减进行治疗。2周为1个疗程,连续干预2个疗程。治疗前后对患者临床症状和疗效进行评价,采集患者外周血通过ELISA方法检测血清IL-4、IL-10、IL-17和IFN-γ的含量。之后计算每个样本治疗前后IFN-γ/IL-4和IL-17/IL-10的比值。结果：在治疗有效率方面,对照组为41.94%,治疗组的有效率为67.74%,组间比较差异具有统计学意义（P〈0.01）。与治疗前相比,两组治疗后临床症状积分均呈现降低趋势,差异都具有统计学意义,与对照组治疗后相比,治疗组治疗后临床症状积分降低趋势更明显,差异具有统计学意义（P〈0.01）。与治疗前相比,两组治疗后IL-4和IL-10的含量升高明显,IL-17和IFN-γ的含量降低,差异均具有统计学意义（P〈0.01）。比值分析发现,治疗后两组IFN-γ/IL-4和IL-17/IL-10的比值均呈现降低趋势,与对照组治疗后相比,治疗组降低趋势明显,差异具有统计学意义（P〈0.05）。结论：痛泻要方联合常规西医治疗能够明显缓解肝郁脾虚型溃疡性结肠炎的临床症状,机制与其能够促使Th1/Th2、Th17/Treg介导的炎性平衡朝炎性抑制方向转化相关。

Objective：To observe the clinical efficacy of modified prescription for diarrhea with pain on treating ulcerative colitis with syndrome of liver depression and spleen deficiency and its influence on the balance of the inflammatory cytokines mediated by T cells Th1/Th2 and Th17/Treg. Methods：Sixty-two in-and out-patients with ulcerative colitis with syndrome of liver depression and spleen deficiency were selected and randomly divided into the control group and treatment group. The control group received conventional treatment by sulfasalazine tablets,while a modified prescription for diarrhea with pain was applied in the treatment group based on a conventional regime. Every 2 weeks was taken as a course of treatment,and the intervention lasted two courses of treatment. The clinical symptoms and curative effects in the patients were compared before and after treatment,and then the contents of IL-4,IL-10,IL-17 and IFN-γ in peripheral blood were measured. Afterwards,the ratio of IFN-γ to IL-4 and IL-17 to IL-10 in each sample before and after treatment was calculated. Results：In terms of therapeutic response rate,it reached 41. 94% in the control group,and 67. 74% in the treatment group. There was statistical significance in difference between both groups（ P〈0. 01）. After treatment,clinical symptom score showed a decreasing trend in both groups,and there was statistical significance in difference between these two groups. Compared with the control group,the treatment group showed a more significant decline in clinical symptom score after treatment,and there was statistical significance in difference between them（ P〈0. 01）. After treatment,the contents of IL-4 and IL-10 increased significantly in both groups,while that of IL-17 and IFN-γ decreased in them,showing a statistically significant difference（P〈0. 01）. According to the ratio analysis,the ratio of IFN-γto IL-4 and IL-17 to IL-10 showed a declining trend in both groups after treatment. Compared with the control group,the treatment group showed a more obvious decline,so there was a statistically significant difference between these two groups（ P〈0. 05）. Conclusion：Conventional Western medicine therapy based on a prescription for diarrhea with pain can relieve the clinical symptoms of the ulcerative colitis with syndrome of liver depression and spleen deficiency and the mechanism is related to its ability in inhibiting the inflammatory balance mediated by Th1/Th2 and Th17/Treg.