美沙拉嗪、双歧杆菌三联活菌联合复方谷氨酰胺治疗活动期轻中度溃疡性结肠炎的研究

Research of mesalazine,bifidobacteria trigeminy viable organism capsule combined with compound glutamine enteric capsules in treatment of mild to moderate ulcerative colitis at active period

目的探讨口服美沙拉嗪、双歧杆菌三联活菌胶囊联合复方谷氨酰胺肠溶胶囊对活动期轻中度溃疡性结肠炎的疗效和复发情况以及对患者凝血功能、血清炎性因子和不良反应的影响。方法选取消化内科住院治疗的活动期轻中度溃疡性结肠炎患者64例,依据随机数字表法分为观察组和对照组,每组32例。对照组给予口服美沙拉嗪肠溶片(活动期:4次/d,1 g/次,维持治疗:3次/d,0. 5 g/次)和双歧杆菌三联活菌胶囊(3次/d,0. 42 g/次)治疗。观察组给予口服美沙拉嗪肠溶片(3次/d,0. 5 g/次)、培菲康(3次/d,0. 42 g/次)和复方谷氨酰胺肠溶胶囊(3粒/次,3次/d)治疗。2组治疗时间均为4周。比较2组患者的临床疗效以及治疗前后的疾病活动指数、凝血因子和炎性因子水平。比较2组患者治疗期间的不良反应发生几率和治疗后6个月内的复发情况。结果观察组总有效率显著高于对照组(96. 8%vs 82. 4%,Z=4. 010,P <0. 05)。2组患者治疗前Mayo指数以及凝血指标、炎性因子水平比较,差异无统计学意义(P> 0. 05)。治疗4周后,2组患者Mayo指数评分均较治疗前显著下降(P <0. 05),且观察组Mayo指数下降程度大于对照组,差异有统计学意义(P <0. 05); 2组患者PLT和FIB均显著降低(P <0. 05),PT和MPV均显著升高(P <0. 05),但2组患者治疗后凝血指标比较,差异均无统计学意义(P> 0. 05); 2组患者治疗4周后血清IL-6、TNF-α和hs-CRP水平均显著降低(P <0. 05),IL-2水平显著升高(P <0. 05);与对照组相比,观察组治疗后血清IL-6、TNF-α和hs-CRP水平更低,而IL-2水平更高(P <0. 05)。观察组复发几率低于对照组,但差异无统计学意义(18. 75%vs 31. 25%,χ2=1. 333,P> 0. 05)。观察组不良反应发生几率低于对照组(6. 25%vs 21. 88%,χ2=4. 598,P <0. 05)。结论美沙拉嗪、双歧杆菌三联活菌胶囊联合复方谷氨酰胺肠溶胶囊对活动期轻中度UC患者临床疗效满意,临床症状改善明显,降低炎性反应,且不良反应少。

Objective To investigate the curative effects and recurrence condition of oral mesalazine,bifidobacteria trigeminy viable organism capsule combined with compound glutamine enteric capsules in treatment of mild to moderate ulcerative colitis at active period,and to explore their effects on the coagulation function,serum inflammatory factors and adverse effects of patients.Methods A total of 64 patients with mild to moderate ulcerative colitis at active period who were treated in our hospital from Jan 2013 to April 2017 were divided into observation group(n=32)and control group(n=32)according to random number table method.The patients in control group were treated by oral administration of mesalazine slow release tablets(active period:4 times/day,1g/time,maintenance treatment:3 times/day,0.5g/time)and bifidobacterium trigeminy viable organism capsule(3 times/day,0.42g/time).The patients in observation group were treated by oral administration of mesalazine slow release tablets(3 times/day,0.5g/time),bifico(3 times/day,0.42g/times)and compound glutamine entersoluble capsules(3 capsules/time,3 times/day),with a treatment course of 4 weeks for both groups.The clinical curative effects,the disease activity indexes,the levels of coagulation factor and inflammatory factor before and after treatment were observed and compared between the two groups Moreover the incidence rate of adverse reactions during treatment and the recurrence condition after 6-month treatment were also observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group(96.8%vs 82.4%,Z=4.010,P<0.05).Before treatment there were no significant differences in Mayo index,coagulation indicators and the levels of inflammatory factor between the two groups(P>0.05).After 4-week treatment,the Mayo index scores were significantly decreased in both groups,as compared with those before treatment(P<0.05),moreover,the decreasing degrees of Mayo index in observation group was significantly greater than that in control group(P<0.05).The PLT and FIB in the two groups were significantly decreased in both groups,as compared with those before treatment(P<0.05),however,the PT and MPV were significantly increased in both groups(P<0.05).There was no significant difference in coagulation indicator after treatment between the two groups(P>0.05).The levels of IL-6,TNF-αand hs-CRP were significantly decreased in both groups after 4-week treatment(P<0.05),however the levels of IL-2 were significantly increased(P<0.05).After treatment the levels of IL-6,TNF-αand hs-CRP in observation group were significantly lower than those in control group(P<0.05),moreover,the levels of IL-2 in observation group were significantly higher than those in control group(P<0.05).The recurrence rate in observation group was lower than that in control group,but there was no significant difference between the two groups(18.75%vs 31.25%,χ^2=1.333,P>0.05).The incidence rate of adverse reactions in observation group was significantly lower than that in control group(6.25%vs 21.88%,χ^2=4.598,P<0.05).Conclusion The mesalazine,bifidobacterium trigeminy viable organism capsule combined with compound glutamine capsulae enterosolubilis in treatment of mild to moderate ulcerative colitis at active period can obtain satisfactory therapeutic effects,which can obviously improves the clinical symptoms of patients,decrease the inflammatory response,with fewer adverse reactions.