清热化湿中药保留灌肠治疗溃疡性结肠炎疗效观察

Clinical Effect of Retention Enema with Heat-clearing and Dampness-resolving Traditional Chinese Medicine in Treatment of Ulcerative Colitis

目的观察中药保留灌肠对溃疡性结肠炎(ulcerative colitis,UC)的疗效。方法将60例轻中度UC患者随机分为观察组和对照组,每组30例。对照组采用美沙拉秦栓塞肛,观察组采用中药保留灌肠,治疗时间为8周。评价两组临床疗效,比较两组治疗前、治疗4周末、治疗8周末的疾病活动指数(disease activity index,DAI)、Baron内镜评分和Geboes指数,采用中文版炎症性肠病生存质量问卷(inflammatory bowel disease quality questionnaire,IBDQ)评价两组患者治疗前后的生存质量,观察两组恶心、腹胀、腹痛、便次增多等不良反应的发生。结果观察组临床总有效率(93.3%)高于对照组(73.3%),但两组临床疗效分布比较,差异无统计学意义(Z=-1.902,P=0.057)。治疗4周末、8周末两组DAI评分均显著降低(P< 0.05 ),且观察组显著低于对照组(P<0.05)。广义估计方程分析结果显示,对照组与观察组比较,Baron内镜评分和Geboes指数的优势比(odds ratio,OR)分别为2.12、2.30;治疗8周末与治疗4周末、治疗前比较,Baron内镜评分的OR值分别为63.66、6.50,Geboes指数的OR值分别为33.57、9.45。两组治疗后生存质量评分与治疗前相比,肠道症状、情感能力、社会能力、全身症状4个维度上得分均显著提高,且观察组4个维度评分升高值均显著大于对照组(P<0.05)。治疗期间,对照组共15例患者出现恶心、腹痛、腹胀、大便次数增多,观察组共5例患者出现恶心、腹痛、大便次数增多,观察组不良反应发生率显著低于对照组(P<0.05)。结论中药保留灌肠能有效治疗UC,降低疾病活动指数,改善内镜评分,提高生存质量。

Objective To investigate the clinical effect of traditional Chinese medicine retention enema in the treatment of ulcerative colitis (UC). Methods Sixty patients with mild or moderate UC were randomly divided into observation group and control group, with 30 cases in each group. The control group was given mesalazine suppositories, while the observation group was given traditional Chinese medicine retention enema. Both groups were treated for 8 weeks. The clinical outcomes of the two groups were assessed. Disease activity index (DAI), Baron endoscopic score, and Geboes index were determined before treatment and at the end of the 4th and 8th weeks of treatment. The quality of life before and after treatment was assessed using the Chinese version of Inflammatory Bowel Disease Questionnaire (IBDQ). Adverse reactions such as nausea, abdominal distension, abdominal pain, and increased stool frequency were evaluated. Results The observation group had a higher overall response rate than the control group (93.3% vs 73.3%), but there was no significant difference in the distribution of clinical outcomes between the two groups (Z=-1.902, P=0.057). At the end of the 4th and 8th weeks of treatment, both groups showed a significant reduction in DAI score (P<0.05), and this score was significantly lower in the observation group than in the control group (P<0.05). The results of generalized estimation equation analysis showed that the odds ratios (ORs) of Baron s endoscopic score and Geboes index were 2.12 and 2.30, respectively, in the control group relative to the observation group;at the end of the 8th week of treatment, relative to the end of the 4th week and before treatment, the ORs of Baron s endoscopic score were 63.66 and 6.50, respectively, and the ORs of Geboes index were 33.57 and 9.45, respectively. After treatment, both groups showed significant increases in the scores of intestinal symptoms, emotional ability, social ability, and systemic symptoms in IBDQ, and the observation group had significantly greater increases in these scores than the control group (P<0.05). During the treatment period, 15 cases in the control group had nausea, abdominal pain, abdominal distension, or increased stool frequency, while 5 cases in the observation group had nausea, abdominal pain, or increased stool frequency;the incidence of adverse reactions was significantly lower in the observation group than in the control group (P<0.05). Conclusion Traditional Chinese medicine retention enema is effective in the treatment of UC as it can reduce DAI, increase Baron s endoscopic score, and improve quality of life.