芍药四君健脾方联合中药灌肠治疗脾虚湿热型激素依赖溃疡性结肠炎疗效及对炎性因子和激素撤退的影响

Efficacy of Shaoyao Sijun Jianpi Decoction combined with traditional Chinese medicine enema on hormone-dependent ulcerative colitis of spleen-deficiency damp-heat type and its effect on inflammatory factors and withdrawal of hormones

目的观察芍药四君健脾方联合中药灌肠治疗激素依赖型溃疡性结肠炎患者的临床疗效及激素撤退情况。方法将2019年6月—2020年7月在石家庄市中医院肛肠科治疗的106例脾虚湿热证激素依赖型溃疡性结肠炎患者随机分为2组,对照组53例在原激素治疗基础上给予美沙拉嗪肠溶片口服,治疗组53例在原激素治疗基础上给予芍药四君健脾方口服联合中药灌肠治疗,2组疗程均为6周。观察2组患者治疗后中医症状积分、Baron评分、血清炎性相关指标[白细胞介素-10(IL-10)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)]变化,比较2组患者激素撤退率及近期疗效。结果治疗后,2组患者中医症状积分、Baron评分和血清IL-17、TNF-α水平均明显低于治疗前(P均<0.05),且治疗组均明显低于对照组(P均<0.05);2组患者血清IL-10水平均明显高于治疗前(P均<0.05),且治疗组明显高于对照组(P<0.05)。对照组激素撤退率、总有效率分别为58.5%(31/53)、81.1%(43/53),治疗组分别为90.6%(48/53)、94.3%(50/53),治疗组均明显高于对照组(P均<0.05)。结论芍药四君健脾方联合中药灌肠可更有效缓解激素依赖型溃疡性结肠炎症状,促进肠系膜修复及激素撤退,其机制可能与升高血清IL-10水平,降低血清IL-17、TNF-α水平,从而减轻炎症反应有关。

Objective It is to observe the clinical effect of Shaoyao Sijun Jianpi Decoction combined with traditional Chinese medicine enema in the treatment of patients with hormone-dependent ulcerative colitis and their hormone withdrawal.Methods A total of 106 patients with hormone-dependent ulcerative colitis with spleen deficiency and damp-heat syndrome who were treated in the Department of Anorectal,Shijiazhuang Hospital of Traditional Chinese Medicine from June 2019 to July 2020 were randomly divided into 2 groups.53 patients in the control group was given mesala enteric-coated tablets orally on the basis of hormone therapy,and 53 patients in the treatment group were given Shaoyao Sijun Jianpi Decoction by oral administration combined with traditional Chinese medicine enema on the basis of hormone therapy.The course of treatment in both groups was 6 weeks.The changes in the traditional Chinese medicine symptom score,Baron score,and serum inflammatory-related indexes[interleukin-10(IL-10),interleukin-17(IL-17),tumor necrosis factor-α(TNF-α)]after treatment were observed in the two groups,and the hormone withdrawal rate and the short-term treatment efficacy were compared between the two groups.Results After treatment,traditional Chinese medicine symptom score,Baron score,and serum IL-17 and TNF-αlevels in the two groups were significantly lower than those before treatment(all P<0.05),and the observation group was significantly lower than the control group(P<0.05);the levels of serum IL-10 in the two groups were significantly higher than those before treatment(P<0.05),and the observation group was significantly higher than the control group(P<0.05).The hormone withdrawal rate and total effective rate were 58.5%(31/53)and 67.9%(36/53)in the control group,and 90.6%(48/53)and 84.9%(45/53)in the observation group,respectively,the treatment group was significantly higher than the control group(P<0.05).Conclusion Shaoyao Sijun Jianpi Decoction combined with traditional Chinese medicine enema can effectively improve clinical symptoms,promote mesentery repair and improve hormone dependence after hormone withdrawal.Its mechanism may be related to increasing the level of serum IL-10 and reducing the levels of serum IL-17 and TNF-α,thereby reducing the inflammatory response.