调肠消炎片对轻中度溃疡性结肠炎患者血清细胞因子的影响

Effect of Tiaochang Xiaoyan Tablets on Serum Cytokines in Patients with Mild-to-moderate Ulcerative Colitis

【目的】观察调肠消炎片对轻中度溃疡性结肠炎(UC)患者血清细胞因子白细胞介素(IL)-4、IL-10、IL-6和肿瘤坏死因子-α(TNF-α)的影响。【方法】将45例轻中度活动期UC患者随机分为美沙拉嗪组、调肠消炎片组、中西医结合组(美沙拉嗪+调肠消炎片),每组各15例,并予相应药物治疗,疗程为8周。观察3组患者治疗前后改良Mayo评分、中医证候评分的变化情况,评价3组患者的临床疗效、肠镜疗效、中医证候疗效及安全性,并采用酶联免疫吸附试验(ELISA)检测患者血清IL-4、IL-10、IL-6、TNF-α的水平。【结果】(1)45例患者中,39例完成试验,6例退出试验,其中美沙拉嗪组退出1例,调肠消炎片组退出3例,中西医结合组退出2例。(2)治疗后,3组患者的改良Mayo评分及中医证候评分(包括主症评分和次症评分)均较治疗前明显下降,差异均有统计学意义(P<0.05),但3组间比较,差异均无统计学意义(P>0.05)。(3)治疗8周后,美沙拉嗪组的临床疗效、肠镜疗效及中医证候疗效的总有效率分别为78.57%、57.14%和86.67%,调肠消炎片组分别为66.67%、50.00%和100.00%,中西医结合组分别为100.00%、69.23%和100.00%,组间比较,差异均无统计学意义(P>0.05)。(4)治疗后,3组患者的抑炎因子IL-4、IL-10水平明显升高(P<0.05),促炎因子IL-6、TNF-α水平明显降低(P<0.05),中西医结合组对IL-4水平的升高作用及对IL-6水平的降低作用明显优于调肠消炎片组和美沙拉嗪组(P<0.05)。(5)治疗过程中,除中西医结合组1例患者出现胃脘部疼痛外,其他患者均未发现明显的不良反应。【结论】调肠消炎片可能通过升高抑炎因子IL-4、IL-10水平,降低促炎因子IL-6、TNF-α水平,抑制炎症反应,从而发挥疗效。

Objective To observe the effect of Tiaochang Xiaoyan Tablets(TXT)on serum cytokines of interleukin(IL)-4,IL-10,IL-6,and tumor necrosis factor alpha(TNF-α)in patients with mild-to-moderate ulcerative colitis.Methods Forty-five patients with mild to moderate ulcerative colitis were randomly divided into mesalazine group,TXT group and integrated Chinese and western medicine group(mesalazine+TXT),15 cases in each group.Each group was given the corresponding medicine,and the course of the treatment lasted 8 weeks.The clinical efficacy,efficacy for colonoscopy,and efficacy for TCM syndrome as well as the safety in the 3 groups were evaluated by modified Mayo scores and TCM symptom scores before and after treatment.The levels of serum inflammatory factors of interleukin(IL)-4,IL-10,IL-6 and tumor necrosis factor(TNF)-αwere also detected by enzyme-linked immunosorbent assay(ELISA)before and after treatment.Results(1)Of the 45 study subjects,39 cases completed the trial,and 6 cases quitted the trial,one from mesalazine group,3 cases from TXT group,and 2 cases from integrated Chinese and western medicine group.(2)After treatment,modified Mayo scores and TCM syndrome scores(including the scores of primary symptoms and secondary symptoms)of the 3 groups were decreased significantly in comparison with those before treatment(P<0.05),but the differences among the 3 groups were insignificant(P>0.05).(3)After treatment for 8 weeks,the clinical efficacy,efficacy for colonoscopy,and efficacy for TCM syndrome were 78.57%,57.14%and 86.67%in mesalazine group,66.67%,50.00%and 100.00%in TXT group,and 100.00%,69.23%and 100.00%in integrated Chinese and western medicine group,respectively.The inter-group comparison showed that the difference of the efficacy among the 3 groups was insignificant(P>0.05).(4)After treatment,the levels of anti-inflammatory factors of IL-4 and IL-10 were increased significantly(P<0.05),and the levels of pro-inflammatory factors of IL-6 and TNF-αwere decreased significantly in the 3 groups in comparison with those before treatment(P<0.05).The effects on increasing IL-4 levels and on decreasing IL-6 level in the integrated Chinese and Western medicine group were stronger than those in the TXT group and mesalazine group(P<0.05).(5)During the trial,no obvious adverse reaction was found in the patients except that one patient had the stomachache.Conclusion TXT exert certain curative effect for the treatment of mild-to-moderate ulcerative colitis through increasing the levels of anti-inflammatory factors of IL-4 and IL-10,and by reducing the levels of pro-inflammatory factors of IL-6 and TNF-α.