五味苦参肠溶胶囊联合沙利度胺片治疗难治性溃疡性结肠炎的疗效观察及对炎症因子、免疫功能和氧化应激的影响

Efficacy of Five-Flavor Sophora flavescens Enteric-Coated Capsules Combined with Thalidomide Tablets in the Treatment of Refractory Ulcerative Colitis and its Effects on Inflammatory Factors,Immune Function and Oxidative Stress

目的:探究五味苦参肠溶胶囊联合沙利度胺片治疗难治性溃疡性结肠炎(UC)的疗效及对炎症因子、免疫功能和氧化应激的影响。方法:选取2018年6月~2022年6月于某院就诊的86例难治性UC患者为研究对象,采用随机数字表法分为对照组及观察组,每组43例。对照组患者仅给予沙利度胺片治疗,观察组给予沙利度胺片联合五味苦参肠溶胶囊治疗,两组均连续治疗4周。观察并比较两组患者治疗前后的外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+))水平、炎症因子水平[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子1(VCAM-1)及白介素-10(IL-10)]及氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]水平、改良Mayo内镜评分、临床疗效及临床症状(腹痛、腹泻、脓血便、肛门灼热)改善时间。结果:治疗后,两组患者CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均较治疗前升高,且观察组高于对照组(P<0.05);CD8^(+)水平较治疗前降低,且观察组低于对照组(P<0.05);hs-CRP、TNF-α、ICAM-1及VCAM-1水平均较治疗前降低,且观察组低于对照组(P<0.05);IL-10水平较治疗前升高,且观察组高于对照组(P<0.05);SOD水平较治疗前升高,MDA水平较治疗前降低(P<0.05),且观察组的改善程度优于对照组(P<0.05)。两组患者改良Mayo内镜评分较治疗前降低,且观察组低于对照组(P<0.05)。观察组的临床治疗总有效率(93.02%)高于对照组(79.07%,P<0.05);腹痛、腹泻、脓血便以及肛门灼热等临床症状改善时间均短于对照组(P<0.05)。结论:与单用沙利度胺片相比,五味苦参肠溶胶囊联合沙利度胺片可进一步改善难治性UC患者的临床症状,缩短症状改善时间,调节患者体内外周血T淋巴细胞水平,改善炎症因子水平以及氧化应激水平,具有较好的治疗前景,值得临床推广。

Objective:To explore the efficacy of Five-Flavor Sophora flavescens enteric-coated capsules combined with thalidomide tablets in the treatment of refractory ulcerative colitis(UC)and its effects on inflammatory factors,immune function and oxidative stress.Methods:A total of 86 patients with refractory UC treated in a hospital from June 2018 to June 2022 were selected and divided into the control group and observation group by random number table method,with 43 patients in each group.The control group was treated with thalidomide tablets alone,whereas the observation group with thalidomide tablets combined with Five-Flavor Sophora flavescens enteric-coated capsules,and both groups were continuously treated for 4 weeks.The pre-and post-treatment levels of peripheral blood T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)),levels of inflammatory factors[hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1)and interleukin-10(IL-10)]and levels of oxidative stress markers[superoxide dismutase(SOD),malondialdehyde(MDA)],modified Mayo endoscopic scores,clinical responses,times to improvement of clinical symptoms(abdominal pain,diarrhea,bloody purulent stool,burning sensation around the anus)were observed and compared between the two groups.Results:After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in both groups were increased from respective levels before treatment,and were higher in the observation group as compared with the control group(P<0.05),while the CD8^(+)level was decreased from the figure before treatment,and was lower in the observation group as compared with the control group(P<0.05).After treatment,the levels of hs-CRP,TNF-α,ICAM-1 and VCAM-1 in both groups were decreased from respective levels before treatment,and were lower in the observation group as compared with the control group(P<0.05),while the IL-10 level was increased from the figure before treatment,and was higher in the observation group as compared with the control group(P<0.05).As compared with respective levels before treatment,the SOD level was increased after treatment while the MDA level was decreased(P<0.05)in both groups with greater degree of change in the observation group(P<0.05).After treatment,the modified Mayo endoscopic score in both groups was lower than that before treatment,and was lower in the observation group as compared with the control group(P<0.05).The total response rate was higher in the observation group(93.02%)as compared with the control group(79.07%,P<0.05).After treatment,the time to improvement of such clinical symptoms as abdominal pain,diarrhea,bloody purulent stool and burning sensation around the anus in the observation group was shorter than that in the control group(P<0.05).Conclusion:Compared with thalidomide tablets alone,the combination treatment with Five-Flavor Sophora flavescens enteric-coated capsules and thalidomide tablets can improve the clinical symptoms in patients with refractory UC,shorten the time to symptom improvement,regulate the levels of peripheral blood T lymphocytes,improve the levels of inflammatory factors and oxidative stress,demonstrating a promising therapeutic prospect.Hence,it is worthy of clinical application.