美沙拉嗪口服联合灌肠治疗轻-中型急性溃疡性结肠炎患者的疗效研究

Effect of combination of oral intake and enema of mesalazine in treating mild to median acute ulcerative colitis

目的探讨美沙拉嗪口服联合灌肠治疗轻-中型急性溃疡性结肠炎患者的临床疗效。方法纳入2016年1月至2018年1月本院诊断为轻-中型急性溃疡性结肠炎的患者为研究对象,按患者就诊顺序将其分为M1组(予以美沙拉嗪口服)、M2组(予以美沙拉嗪口服联合灌肠)及M3组(予以柳氮磺吡啶口服),每组各纳入41例。比较三组临床疗效、血清炎性因子水平、Mayo活动指数评分、Baron内镜分级评分及不良反应发生情况。结果三组患者临床治疗总有效率比较,差异有统计学意义(P <0.05);M2组高于M3组(P <0.05)。治疗前,三组血清炎症因子水平比较,差异均无统计学意义(均P> 0.05);治疗后,三组TNF-α、CRP、IL-1水平比较,差异均有统计学意义(均P <0.05)。治疗后,M1组、M2组血清TNF-α、CRP、IL-1水平均低于M3组(均P <0.05);M2组血清CRP、IL-1水平低于M1组(均P <0.05)。治疗前,三组Mayo评分及Baron内镜分级评分比较,差异均无统计学意义(均P> 0.05)。治疗后,三组患者Mayo评分及Baron评分比较,差异均有统计学意义(均P <0.05),M1组、M2组Mayo评分、Baron评分均低于M3组(均P <0.05);M2组Mayo评分低于M1组(P <0.05)。三组不良反应总发生率比较,差异有统计学意义(P <0.05);M2组不良反应总发生率低于M3组(P <0.05)。结论美沙拉嗪小剂量多次口服联合灌肠治疗轻-中型急性溃疡性结肠炎疗效确切,安全性良好,相比于单用口服治疗更有助于降低血清CRP、IL-1水平及改善肠黏膜状况。

Objectives To investigate the effect of combination of oral intake and enema of mesalazine in treating mild to median acute ulcerative colitis.Methods Patients with mild to median acute ulcerative colitis treated in our hospital from January 2016 to January 2018 were recruited.According to sequence of admission,patients were assigned to group M1(received oral mesalazine),group M2(received oral and enema of mesalazine),and group M3(received oral sulfasalazine),with 41 patients in each group.We compared clinical effectiveness,serum levels of inflammatory cytokines,the Mayo activity score,the Baron endoscopic score,and incidence of adverse events between the two groups.Results There was significant difference in overall clinical effectiveness among the three group(P<0.05),with that of group M2 significantly higher than group M3(P<0.05).Serum levels of inflammatory cytokines did not differ among groups before treatment(P>0.05),but levels of TNF-α,CRP,and IL-1 were significantly different among groups after treatment(P<0.05).After treatment,levels of TNF-α,CRP,and IL-1 were significantly lower in group M1 and M2 than in group M3(P<0.05)and levels of CRP and IL-1 significantly lower in group M2 than in group M1(P<0.05).Before treatment,there was no significant between-group difference in Mayo score and Baron endoscopic score(P>0.05).After treatment,Mayo score and Baron score differed significantly among groups(P<0.05).Both scores were significantly lower in group M1 and M2 than in group M3(P<0.05)and Mayo score significantly lower in group M2 than in group M1(P<0.05).There was significant difference in incidence of adverse event among the three groups(P<0.05),with significantly incidence in group M2 than in group M3(P<0.05).Conclusion Multiple oral intake of low-dose mesalazine combine with enema mesalazine was effective and safe in treating mild to medium acute ulcerative colitis.Compare with using oral mesalazing alone,it could lower serum levels of CRP and IL-1 and improve intestinal mucosal environment.