美沙拉嗪联合康复新液治疗溃疡性结肠炎的临床研究

Clinical trial of mesalazine combined with rehabilitation solution in the treatment of patients with ulcerative colitis

目的观察美沙拉嗪联合康复新液灌肠治疗溃疡性结肠炎对血清炎症因子及肠黏膜中环氧合酶-2(COX-2)和核转录因子-κB(NF-κB)蛋白表达的影响。方法将120例溃疡性结肠炎患者按随机数字表法分为对照组、试验1组及试验2组,各40例。对照组患者口服美沙拉嗪,每次1.0 g,每天3次;试验1组患者在对照组的基础上给予布地奈德2 mg,与生理盐水150 m L混匀,每晚1次,灌肠治疗,试验2组患者在对照组的基础上给予康复新液30 m L,与生理盐水150 m L混匀,每晚1次,灌肠治疗,3组均连续治疗1个月。比较3组患者的临床疗效及肠镜疗效,以酶联免疫吸附实验(ELISA)检测各组炎性因子水平,以免疫组化法检测结肠组织COX-2、NF-κB蛋白表达,统计3组的药物不良反应发生情况。结果对照组、试验1组及试验2组临床总有效率分别为50.00%,75.00%及87.50%;肠镜评估总有效率分别为57.50%,77.50%及90.50%,试验组与对照组相比,差异有统计学意义(P<0.05)。治疗后,对照组、试验1组及试验2组血清TNF-α水平分别为(169.7±28.2),(153.2±23.1),(131.8±18.9)pg·m L^-1,IL-8分别为(199.9±26.4),(159.9±16.7),(129.1±10.5)pg·m L^-1,IL-17分别为(198.3±24.9),(152.4±13.4),(126.3±10.0)pg·m L^-1,IL-10分别为(110.5±11.9),(149.3±15.9),(160.0±24.2)pg·m L^-1,COX-2蛋白阳性细胞比例分别为(73.01±10.21)%,(52.43±8.49)%,(24.09±9.13)%,NF-κB蛋白阳性细胞比例分别为(54.17±8.93)%,(37.46±7.46)%,(18.76±6.53)%,与对照组相比,差异均有统计学意义(均P<0.05)。对照组、试验1组及试验2组药物不良反应发生率分别为17.50%,12.50%,5.00%,与对照组相比,差异有统计学意义(P<0.05)。结论美沙拉嗪联合康复新液灌肠可有效抑制溃疡性结肠炎患者炎性反应,提高其临床疗效,其作用机制与显著下调结肠黏膜组织COX-2、NF-κB表达相关。

Objective To explore the effect of mesalazine combined with rehabilitation solution enema therapy on the serum inflammatory cytokines and intestinal mucosa tissue cyclooxygenase 2(COX-2),nuclear factor-κB(NF-κB)protein expression of ulcerative colitis patients.Methods A total of 120 cases ulcerative colitis patients were divided randomly into control group,treatment 1 group and treatment 2 group,40 cases in each group.Patients in control group were treatedwith mesalazine 1.0 g per time,3 times a day,oral;patients in treatment 1 group were treated with budesonide 2 mg and normal saline solution 150 m L,1 time a day enema treatment on the basis of control group;patients in treatment 2 group were treated with rehabilitation solution 30 m L and normal saline solution 150 m L,1 time a day enema therapy on the basis of control group,each group treated for 1 month.The clinical effect and colonoscopy effect in 3 groups were evaluated,the inflammatory factor levels in each group were detected by elisa enzyme-linked immunosorbent assay(ELISA),the intestinal mucosa tissue COX-2,NF-κB protein expression were detected by immunohistochemical method.The adverse drug reactions in 3 groups were observed.Results The total clinical effective rates in control group,treatment 1 group and treatment 2 group were 50.00%,75.00%and 87.50%;the colonoscopy total effective rates were 57.50%,77.50%and 90.50%,all had significant difference compared with control group(all P<0.05).Affter treatment,the serum tumor necrosis factor-α(TNF-α)levels were(169.7±28.2),(153.2±23.1),(131.8±18.9)pg·m L^-1,serum interleukin-8(IL-8)levels were(199.9±26.4),(159.9±16.7),(129.1±10.5)pg·m L^-1,serum interleukin-17(IL-17)levels were(198.3±24.9),(152.4±13.4),(126.3±10.0)pg·m L^-1,serum interleukin-10(IL-10)levels were(110.5±11.9),(149.3±15.9),(160.0±24.2)pg·m L^-1,the COX-2 protein positive cell proportions were(73.01±10.21)%,(52.43±8.49)%,(24.09±9.13)%,NF-κB protein positive cell proportions were(54.17±8.93)%,(37.46±7.46)%,(18.76±6.53)%,all had significant difference compared with control group(all P<0.05).The incidence of adverse drug reactions in control group,treatment 1 group and treatment 2 group were 17.50%,12.50%,5.00%,had significant difference compared with control group(P<0.05).Conclusion Mesalazine combined with rehabilitation solution enema therapy can inhibit the inflammatory reaction of ulcerative colitis patients,enhance the clinical efficacy,and the mechanism of action is related to significant down-regulation of intestinal mucosa tissue COX-2,NF-κB protein expression.