桃花汤合补中益气汤加减对克罗恩病Th1和Th17细胞因子的影响

Clinical Efficacy of Taohua Tang and Buzhong Yiqi Tang in Treatment of Deficiency Syndrome of Crohn’s Disease

目的:观察桃花汤合补中益气汤加减治疗克罗恩病(CD)活动期(脾胃虚寒证)的疗效及对Th1和Th17细胞因子的影响。方法:将86例CD患者根据随机按数字表法分成对照组42和观察组44例。对照组轻度,口服柳氮磺吡啶(SASP)肠溶片,3~4 g·d^-1,3次/d;中度或柳氮磺吡啶肠溶片效果不好者,口服醋酸泼尼松片,0.75 mg·kg^-1·d^-1,3次/d。观察组西医治疗同对照组,内服桃花汤合补中益气汤加减,1剂/d。两组疗程均为连续治疗12周。进行治疗前后Best的克罗恩病活动指数(Best CDAI),CD简化内镜评分(SES-CD),脾胃虚寒证和炎症性肠病问卷(IBDQ)评分;检测治疗前后C反应蛋白(CRP),红细胞沉降率(ESR),清蛋白(ALB),血红蛋白(HB),血小板计数(PLT),干扰素-γ(INF-γ),肿瘤坏死因子-α(TNF-α),白细胞介素-2(IL-2)和IL-17水平。结果:治疗后观察组中医证候疗效优于对照组(Z=2.058,P<0.05);观察组临床缓解率、有效率和内镜下缓解率分别为93.18%,100%和86.36%,分别高于对照组的76.19%,83.33%和66.67%(P<0.05);观察组患者Best CDAI,SES-CD和脾胃虚寒证评分均低于对照组(P<0.01),IBDQ评分高于对照组(P<0.01);治疗后观察组患者CD活动情况轻于对照组(Z=2.112,P<0.05);观察组患者炎症程度轻于对照组(Z=2.288,P<0.05);观察组患者CRP,ESR和PLT水平均低于对照组(P<0.01),ALB和HB水平均高于对照组(P<0.01);观察组患者INF-γ,TNF-α,IL-2和IL-17水平均低于对照组(P<0.01)。结论:在常规西医治疗的基础上,内服桃花汤合补中益气汤加减治疗CD活动期脾胃虚寒证患者,可控制疾病的活动度,减轻病情程度和炎症反应,提高缓解率和生活质量,临床疗效优于单纯的西医治疗。

Objective:To observe clinical efficacy of Taohua Tang and Buzhong Yiqi Tang on Crohn’s disease(CD)at active phase(deficiency-cold in spleen and stomach),in order to observed its effect on Th1 and Th17 cytokines.Method:According to random number table,86 patients with CD were divided into control group(42 cases)and observation group(44 cases).The control group(mild)was given SASP,3-4 g·d^-1,Po,tid.The control group(moderate or poor efficacy of SASP)was given prednisone acetate,0.75 mg·kg^-1·d^-1,Po,tid.Observation group was given Taohua Tang and Buzhong Yiqi Tang in addition to therapy of the control group,1 dose·d^-1.The course of treatment was 12 weeks.Before and after treatment,Best CDAI,SES-CD,IBDQ and deficiency syndrome were scored,and levels of CRP,ESR,ALB,HB,PLT,IFN-γ,TNF-α,IL-2 and IL-17 were measured before and after treatment.Result:After treatment,the effect of traditional Chinese medicine(TCM)syndromes in the observation group was better than that in the control group(Z=2.058,P<0.05).The clinical remission rate,the effective rate and the endoscopic remission rate in the observation group were 93.18%,100%and 86.36%,which were higher than 76.19%,83.33%and 66.67%in the control group(P<0.05).Best CDAI,SES-CD and IBDQ scores of the observation group were lower than those of the control group(P<0.01),while IBDQ score was higher than that of the control group(P<0.01).CD activity in the observation group was lower than that in the control group(Z=2.112,P<0.05).The degree of inflammation in the observation group was lighter than that in the control group(Z=2.288,P<0.05).CRP,ESR and PLT levels in the observation group were lower than those in the control group(P<0.01),whereas ALB and HB levels were higher than those in the control group(P<0.01).IFN-γ,TNF-α,IL-2 and IL-17 levels in the observation group were lower than those in the control group(P<0.01).Conclusion:In addition to the therapy of conventional western medicine,Taohua Tang and Buzhong Yiqi Tang in treatment of deficiency syndrome of Crohn’s disease(CD)can control the activity degree of the disease,reduce the degree of illness and inflammation,and improve the remission rate and the quality of life,with a better clinical efficacy than the pure western medicine therapy.