针刺联合参苓白术散加减治疗脾虚湿热型溃疡性结肠炎的临床观察

Clinical Observation Opposing Needling Combined with Modified Shenling Baizhu Powder in the Treatment of Ulcerative Colitis of Damp-heat Due to Spleen Deficiency Type

【目的】观察针刺联合参苓白术散加减治疗脾虚湿热型溃疡性结肠炎的临床疗效。【方法】将118例脾虚湿热型溃疡性结肠炎患者随机分为对照组和观察组,每组各59例,对照组给予西药常规治疗,观察组在对照组治疗的基础上给予针刺联合参苓白术散加减治疗。2周为1个疗程,连续治疗6个疗程。治疗后3个月后,评价2组患者的临床疗效,观察2组患者脓血便、腹泻、腹痛等主要症状的消失时间,比较2组患者治疗前后内毒素、D-乳酸、二胺氧化酶(DAO)以及改良梅奥(Mayo)、炎症性肠病患者生活质量分析表(IBDQ)、Baron评分的变化情况,并观察2组患者治疗前后外周血辅助性T细胞17(Th17)、调节性T细胞(Treg)、辅助性T细胞17/调节性T细胞(Th17/Treg)以及血清中肿瘤坏死因子α(TNF-α)、高迁移率族蛋白1(HMGB-1)、缺氧诱导因子1α(HIF-1α)、胰岛素样生长因子1(IGF-1)水平的变化情况,并评价2组患者不良反应的发生情况。【结果】(1)观察组总有效率为94.92%(56/59),对照组为77.97%(46/59)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,观察组患者的脓血便、腹泻、腹痛的消失时间均明显缩短,与对照组比较,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的内毒素、D-乳酸及DAO含量均明显改善(P<0.05),且观察组在改善内毒素、D-乳酸及DAO含量方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的改良Mayo、IBDQ量表、Baron评分均明显改善(P<0.05),且观察组在改善改良Mayo、IBDQ量表、Baron评分方面明显优于对照组,差异有统计学意义(P<0.05)。(5)治疗后,2组患者的Th17、Treg、Th17/Treg水平均明显改善(P<0.05),且观察组在改善Th17、Treg、Th17/Treg水平方面明显优于对照组,差异均有统计学意义(P<0.05)。(6)治疗后,2组患者的TNF-α、HMGB-1、HIF-1α、IGF-1含量均明显改善(P<0.05),且观察组在改善TNF-α、HMGB-1、HIF-1α、IGF-1含量方面明显优于对照组,差异均有统计学意义(P<0.05)。(7)对照组不良反应发生率为10.17%(6/59),观察组为5.08%(3/59),2组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】针刺联合参苓白术散加减治疗脾虚湿热型溃疡性结肠炎,能明显改善患者的临床症状,保护肠黏膜屏障,有效地控制病情,从而提高患者的生活质量,疗效显著。

Objective To observe the clinical efficacy of acupuncture combined with modified Shenling Baizhu Powder in the treatment of ulcerative colitis(UC)of damp-heat due to spleen deficiency type.Methods A total of118 cases of UC patients with damp-heat due to spleen deficiency type were randomly divided into control group and observation group,with 59 cases in each group.The control group was given conventional treatment of western medicine,and the observation group was given acupuncture combined with modified Shenling Baizhu Powder on the basis of control group.Two weeks as a course of treatment and lasted for 6 continuous courses.Three months after treatment,the clinical efficacy of the two groups was evaluated,and the extinction time for the main symptoms such as pus and blood stool,diarrhea and abdominal pain in the two groups were observed.The changes of endotoxin,D-lactic acid,diamine oxidase(DAO),modified Mayo,Inflammatory Bowel Disease Questionnaire(IBDQ)and Baron score were compared between the two groups before and after treatment.The changes of peripheral blood helper T cells 17(Th17)and regulatory T cells(Treg),helper T cell 17/regulatory T cell(Th17/Treg),and serum levels of tumor necrosis factor-α(TNF-α),high mobility group protein-1(HMGB-1),hypoxia-inducible factor-1α(HIF-1α),and insulin-like growth factor-1(IGF-1)were observed in the two groups before and after treatment,and the incidence of adverse reactions in two groups was evaluated.Results(1)The total effective rate was 94.92%(56/59)in the observation group and 77.97%(46/59)in the control group.The curative effect of observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the extinction time for the main symptoms such as pus and blood stool,diarrhea and abdominal pain in the observation group was significantly shortened,and the difference was statistically significant compared with the control group(P<0.05).(3)After treatment,the contents of endotoxin,D-lactic acid and DAO in two groups were significantly improved(P<0.05),and the improvement of the observation group was significantly superior to that of the control group,the difference being statistically significant(P<0.05).(4)After treatment,the modified Mayo scale,IBDQ scale and Baron score in two groups were significantly improved(P<0.05),and the improvement of the observation group was significantly superior to that of the control group,the difference being statistically significant(P<0.05).(5)After treatment,Th17,Treg and Th17/Treg in both groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(6)After treatment,the contents of TNF-α,HMGB-1,HIF-1αand IGF-1 in the two groups were significantly improved(P<0.05),and the improvement of the observation group was significantly superior to that of the control group,the difference being statistically significant(P<0.05).(7)The incidence of adverse reactions was 10.17%(6/59)in the control group,and 5.08%(3/59)in the observation group,and there was no significant statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Acupuncture combined with Shenling Baizhu Powder in the treatment of UC has significant effect in improving the clinical symptoms of patients,protecting the intestinal mucosal barrier,effectively controlling the disease,thus improving the quality of life of patients.