美沙拉嗪内服外用联合高压氧治疗非特异性溃疡性直肠炎53例疗效观察

Clinical observation on 53 cases of non-specific ulcerative proctitis treated with oral and external use of mesalazine combined with hyperbaric oxygen therapy

目的探讨美沙拉嗪内服外用联合高压氧治疗非特异性溃疡性直肠炎(NSUP)的临床疗效及其作用机制。方法选取2019年3月至2022年3月烟台市烟台山医院消化内科收治的106例NSUP患者作为研究对象。采用随机数字表法将106例患者分为联用组(n=53)和对照组(n=53)。对照组患者予以美沙拉嗪颗粒治疗的同时采用美沙拉嗪栓剂进行纳肛治疗。联用组在对照组治疗的基础上再予以高压氧治疗。治疗4个疗程后统计2组患者的临床疗效和临床症状评分;比较2组患者治疗前和治疗28 d、3个月和6个月的溃疡性肠炎活动指数(DAI)评分。采用酶联免疫吸附法检测血清白细胞介素-8(IL-8)、高迁移率族蛋白1(HMBG1)、肿瘤坏死因子-α(TNF-α)、IL-10的表达水平。结果联用组患者的治疗总有效率(94.34%)明显高于对照组(83.02%),差异有统计学意义(χ^(2)=4.436,P=0.027)。与治疗前比较,2组患者治疗28 d后频繁便意评分、肛门坠胀感评分、黏液脓血便评分、直肠指检疼痛评分、直肠镜检评分、直肠黏膜病理评分均明显低于对照组,且联用组治疗后明显低于对照组(P<0.05或P<0.01)。联用组患者治疗后28 d、3个月和6个月的DAI评分明显低于对照组(P<0.05)。联用组患者治疗28 d的血清IL-10水平明显高于对照组,IL-8、TNF-α及HMBG1水平明显低于对照组(P<0.05)。结论美沙拉嗪内服外用联合高压氧治疗NSUP能够减轻直肠肠壁炎症反应,减轻肠黏膜水肿,促进溃疡愈合,可临床推广应用。

Objective To study the clinical efficacy and mechanism of action of combination of oral and external use of mesalazine and hyperbaric oxygen in the treatment of non-specific ulcerative proctitis(NSUP).MethodA total of 106 NSUP patients admitted to the Gastroenterology Department of Yantai Mountain Hospital from March 2019 to March 2022 were selected as the study subjects and divided into combination group(n=53)and control group(n=53)using the random number table method.The control group patients were treated with oral mesalazine granules and mesalazine suppositories per anum.The combination group was treated with hyperbaric oxygen on the basis of the treatment of the control group.After four courses of treatment,the clinical efficacy and symptom scores of the patients in the two groups were statistically analyzed;the activity index(DAI)scores of ulcerative colitis between two groups of patients before treatment and at 28 days,3 months,and 6 months of treatment were compared.The serum levels of interleukin-8(IL-8),high mobility group protein 1(HMBG1),tumor necrosis factor-α(TNF-α),and interleukin-10(IL-10)were detected using enzyme-linked immunosorbent assay.ResultThe total effective rate of the combination group(94.34%)was significantly higher than that of the control group(83.02%),and the difference was statistically significant(χ^(2)=4.436,P=0.027).Compared with those before treatment,the two groups of patients had significantly lower scores of frequent bowel movements,anal distension,mucopurulent and bloody stools,pain in digital rectal examination,under rectal endoscopy,and rectal mucosal pathology after 28 days of treatment were significantly lower than those of the control group,and the combination group had significantly lower scores after treatment compared to the control group(P<0.05 or P<0.01).The DAI scores of the combination group were significantly lower than those of the control group at 28 days,3 months,and 6 months after treatment(P<0.05).The serum level of IL-10 of patients in the combination group after 28 days of treatment were significantly higher than that in the control group,while the levels of IL-8,TNF-α,and HMBG1 were significantly lower than those of the control group(P<0.05).Conclusion The combination of oral and external use of mesalazine and hyperbaric oxygen treatment for NSUP can reduce the inflammatory response of the rectal wall,reduce intestinal mucosal edema,and promote ulcer healing,which is worthy of clinical application.