摘要
目的:观察槐花散合桃花汤加减治疗溃疡性结肠炎(UC)活动期寒热错杂证的疗效及对免疫功能和炎症反应的调节作用。方法:将112例符合要求的患者按照随机数字表法分为观察组和对照组各56例。对照组轻度、中度患者,口服美沙拉嗪肠溶片,1.0 g/次,3次/d;重度或轻、中度患者服药4周后仍然疗效不佳者,采用醋酸泼尼松片,0.75 mg·kg-1·d-1,分3次口服。观察组西医治疗同对照组,并采用槐花散合桃花汤加减内服,1剂/d。两组疗程均为连续治疗4周。缓解期采用美沙拉嗪肠溶片,0.5 g/次,3次/d,长期维持治疗。采用改良mayo评分评价疾病活动情况,并记录临床缓解和临床有效情况,进行寒热错杂证评分,进行肠镜下黏膜表现评分和黏膜组织学的Geboes指数评分,检测外周血肿瘤坏死因子-α(TNF-α),白细胞介素-8(IL-8),IL-10;检测T淋巴细胞亚群水平(CD4+,CD8+),以上指标治疗前后各评价1次,并记录治疗期间的不良反应,治疗后随访6个月,记录复发情况。结果:采用秩和检验分析中医证候疗效,观察组优于对照组(Z=1.915,P<0.05);观察组临床有效率为98.04%(50/51),临床缓解率为94.12%(48/51),黏膜愈合率为96.08%(49/51),均分别高于对照组的84.00%(42/50),78.00%(39/50)和82.00%(41/50)(P<0.05);观察组患者mayo,寒热错杂证、结肠黏膜和Geboes指数评分均低于对照组(P<0.01);观察组患者TNF-α,IL-8均低于对照组(P<0.01),IL-10水平高于对照组(P<0.01);观察组患者CD4+,CD4+/CD8+均高于对照组,CD8+较对照组低(P<0.01);观察组6个月内的复发率为10.42%(5/48),低于对照组的30.77%(12/39)(χ2=5.669,P<0.05);两组不良反应比较无统计学差异。结论:槐花散合桃花汤加减用于UC活动期寒热错杂证患者,可诱导UC进入缓解,抑制疾病的活度,减轻临床症状,并能调节免疫功能和炎症因子表达,减轻炎症反应,促进肠黏膜愈合,并能维持临床缓解和减少复发,临床疗效优于5-氨基水杨酸(5-ASA)/糖皮质激素的西医治疗方案。
Objective:To observe effect of addition and subtraction therapy of Huaihuasan combined with Taohuatang to ulcerative colitis with cold-heat complicated syndrome at active stage,and to study regulation effec to immune function and inflammatory response.Method:One hundred and twelve patients were randomly divided into control group and observation group by random number table.Patients with light and middle symptoms in control group got mesalazine slow release tablets,1.0 g/time,3 times/days,patients with severe symptoms or whose symptoms were not changed after getting for 4 weeks in control group got prednisone acetate tablets,0.75 mg·kg-1·d-1for 3 times.Based on the treatment in control group,patients in observation group added Huaihuasan combined with Taohuatang,1 dose/day.The course of treatment was 4 weeks.At remission period,mesalazine slow release tablets were used for maintain long-term maintenance therapy,0.5 g/times,3 times/days.Scores of disease activities were graded by improvement mayo,and clinical remission and clinical efficacy were recorded,scores of cold-heat complicated syndrome,mucous membrane under enteroscopy and histology of mucosa belongs to Geboes were graded.And levels of tumor necrosis factor-α(TNF-α)in peripheral blood,interleukin-8(IL-8),IL-10,T lymphocyte subsets(CD4+,CD8+),and adverse reactions,6 months’follow-up and recurrence were also be recorded.Result:Therapeutic effect of traditional Chinese medicine syndromes were analyzed by rank sum test,which in observation group was better than that in control group(Z=1.915,P<0.05).Clinical effect in observation group was 98.04%(50/51)higher than 84.00%(42/50)in control group,clinical remission rate was 94.12%(48/51)higher than 78.00%(39/50)in control group,and mucosal healing rate was96.08%(49/51)higher than 82.00%(41/50)in control group(P<0.05).Scores of mayo,cold-heat complicated syndrome,colonic mucosa and index scores of Geboes were all lower than those in control group(P<0.01).And levels of TNF-α,IL-8 and CD8+were lower than those in control group(P<0.01),and levels of IL-10,CD4+and CD4+/CD8+were higher than those in control group(P<0.01).Recurrence rate during 6 months in observation group was 10.42%(5/48)lower than 30.77%(12/39)in control group(χ2=5.669,P<0.05),as for adverse reactions,there was no significant difference between two groups.Conclusion:Huaihuasan combined with Taohuatang can induce UC to remission period,inhibit the activity of disease,alleviate clinical symptoms,regulate immune function and expression of inflammatory factors,alleviate inflammatory reaction,promote intestinal mucosal healing,and can maintain clinical remission and reduce recurrence.The clinical efficacy is superior to that of 5-ASA/glucocorticoid in Western medicine.
作者
雷娜
孔鹏飞
陈思敏
唐学贵
LEI Na;KONG Peng-fei;CHEN Si-min;TANG Xue-gui(Anorectal of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;Anorectal of Affiliated Hospital of North Sichuan Medical College,Nanchong 637002,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2020年第7期86-91,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(81573990).
关键词
溃疡性结肠炎
寒热错杂证
槐花散
桃花汤
T细胞亚群
炎症因子
ulcerative colitis
cold-heat complicated syndrome
Huaihuasan
Taohuatang
T cell subsets
inflammatory factors
作者简介
第一作者:雷娜,在读硕士,医师,从事肛肠疾病中西医结合临床诊治和研究工作,E-mail:805055027@qq.com;通信作者:唐学贵,博士,教授,博士生导师,从事中西医结合消化疾病的临床、教学与科研工作,E-mail:Txg668nc@sohu.com
