改良灌肠袋直肠滴入肠炎灵1号方治疗激素抵抗型重症溃疡性结肠炎疗效及对肠道菌群和炎症因子的影响

Effect of Changyanling No.1 decoction by rectal instillation from modified enema bag on hormone resistant severe ulcerative colitis and its effect on intestinal bacteria flora and inflammatory factors

目的观察改良灌肠袋直肠滴入肠炎灵1号方治疗激素抵抗型重症溃疡性结肠炎(SUC)的疗效及对肠道菌群和炎症因子的影响。方法将2016年4月—2018年3月新疆维吾尔自治区中医医院治疗的80例激素抵抗型SUC患者随机分为观察组和对照组,每组40例。对照组给予美沙拉嗪肠溶片、环孢素A治疗,观察组在对照组治疗基础上采用改良灌肠袋进行肠炎灵1号方直肠滴入治疗,2组疗程均为8周。观察2组治疗前后中医症状积分、改良Mayo评分、Baron内镜评分和生活质量评分情况,检测2组治疗前后肠道菌群和炎症因子水平,比较2组疗效。结果2组治疗后中医症状积分、改良Mayo评分、Baron内镜评分均较治疗前显著降低(P均<0.05),观察组治疗后以上评分均显著低于对照组(P均<0.05);2组治疗后炎症性肠病生存质量问卷(IBDQ)评分较治疗前显著升高(P均<0.05),观察组治疗后评分显著高于对照组(P<0.05)。2组治疗后粪便中乳酸杆菌和双歧杆菌计数较治疗前显著增加(P均<0.05),且观察组显著高于对照组(P均<0.05);2组肠球菌和肠杆菌计数显著降低(P均<0.05),且观察组显著低于对照组(P均<0.05)。2组治疗后血清CRP、IL-6、IL-8、TNF-α水平显著降低(P均<0.05),观察组治疗后以上指标水平均显著低于对照组(P均<0.05)。观察组和对照组治疗总有效率分别为92.5%(37/40)和75.0%(30/40),观察组显著高于对照组(P<0.05)。结论在西医治疗基础上采用改良灌肠袋进行肠炎灵1号方直肠滴入治疗可显著改善激素抵抗型SUC患者临床症状,提高生活质量,其机制可能与改善肠道菌群失调、下调炎症因子表达水平有关。

Objective It is to observe the efficacy of Changyanling No.1 decoction by rectal instillation from modified enema bag on hormone resistant severe ulcerative colitis(SUC)and its effect on intestinal bacteria flora and inflammatory factors.Methods Eighty patients with hormone-resistant SUC treated in Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from April 2016 to March 2018 were randomly divided into observation group and control group,with 40 cases in each group.The control group was treated with mesalazine enteric-coated tablets and cyclosporine A,and the observation group was given Changyanling No.1 decoction by rectal instillation from modified enema bag on the basis of the treatment of the control group.Both groups were treated for 8 weeks.The TCM symptom score,modified Mayo score,Baron endoscopic score,and score of quality of life before and after treatment were observed in the two groups,the levels of intestinal bacteria flora and inflammatory factor before and after treatment were determined,and the efficacy between the two groups were compared.Results The TCM symptom score,modified Mayo score,and Baron endoscopic score after treatment of the two groups were significantly lower than those before treatment(P<0.05),and the above scores in the observation group were significantly lower than those in the control group(P<0.05).The score of inflammatory bowel disease questionnair(IBDQ)after treatment was significantly higher than those before treatment in the two groups(P<0.05),and the score in the observation group was significantly higher than that in the control group(P<0.05).After treatment,the counts of lactobacillus and bifidobacteria were increased significantly while the counts of enterococci and enterobacteria were significantly reduced in the two groups(P<0.05),and the decrease or increase in the observation group was more significant than the control group(P<0.05).The levels of serum CRP,IL-6,IL-8,and TNF-αwere significantly reduced in the two groups after treatment(P<0.05),and the levels of the above indicators in the observation group were significantly lower than those in the control group(P<0.05).The total effective rate in the observation group was 92.5%(37/40),which was significantly higher than 75.0%in the control group(P<0.05).Conclusion Changyanling No.1 decoction by rectal instillation from modified enema bag based on western medicine can significantly improve the clinical symptoms and quality of life of patients with hormone-resistant SUC.The mechanism may be related to improving the intestinal flora imbalance and down-regulating the expression of inflammatory factors.