趙　敏，王振軍，許艷春

( 1.首都醫(yī)科大學(xué)全科醫(yī)學(xué)與繼續(xù)教育學(xué)院、延慶醫(yī)院普外科，北京 102100；2.首都醫(yī)科大學(xué)附屬北京

朝陽醫(yī)院普通外科，北京 100020；3.中國(guó)人民解放軍第251醫(yī)院 河北 張家口 075000)

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龍血竭散聯(lián)合美沙拉嗪緩釋片灌腸治療潰瘍性結(jié)腸炎

趙敏1，王振軍2*，許艷春3

( 1.首都醫(yī)科大學(xué)全科醫(yī)學(xué)與繼續(xù)教育學(xué)院、延慶醫(yī)院普外科，北京 102100；2.首都醫(yī)科大學(xué)附屬北京

朝陽醫(yī)院普通外科，北京 100020；3.中國(guó)人民解放軍第251醫(yī)院 河北 張家口 075000)

摘要：目的觀察美沙拉嗪緩釋片聯(lián)合龍血竭散灌腸對(duì)潰瘍性結(jié)腸炎(UC)的療效。方法收集70例UC患者，隨機(jī)分為觀察組和對(duì)照組,各35例，2組均給予相應(yīng)調(diào)節(jié)酸堿失衡、水電解質(zhì)紊亂及改善營(yíng)養(yǎng)狀況等治療。對(duì)照組以美沙拉嗪緩釋片1．0 g口服，4次/d，觀察組在對(duì)照組基礎(chǔ)上給予龍血竭散1．0 g溶于生理鹽水150 mL進(jìn)行灌腸，腸道保留1 h,1次/d,均連續(xù)治療4周。觀察治療前后IL-8、IL-10、TNF-α、紅細(xì)胞壓積、纖維蛋白原、全血黏度水平，并進(jìn)行療效評(píng)價(jià)。結(jié)果治療后IL-8、TNF-α明顯降低，IL-10明顯升高，且觀察組優(yōu)于對(duì)照組(P<0．05)；治療后紅細(xì)胞壓積、纖維蛋白原、全血黏度水平觀察組降低程度優(yōu)于對(duì)照組(P<0．05)；觀察組總有效率91．4%，對(duì)照組71．4%(P<0．05)。結(jié)論美沙拉嗪口服聯(lián)合龍血竭散灌腸可以明顯減輕UC患者炎性反應(yīng)，改善血液高凝狀態(tài)，提高治療效果，改善患者生活質(zhì)量。

關(guān)鍵詞：美沙拉嗪緩釋片；血竭散；保留灌腸；潰瘍性結(jié)腸炎

潰瘍性結(jié)腸炎(UC)是非特異性慢性結(jié)腸炎癥病變，其原因與免疫、感染、遺傳、環(huán)境、精神等有關(guān)，發(fā)病機(jī)制認(rèn)為是自身免疫、炎癥反應(yīng)參與著UC的發(fā)病過程[1-2]。研究[3-4]認(rèn)為，UC患者存在血液高凝狀態(tài)，導(dǎo)致血栓的形成，造成腸黏膜損傷加重病情，治療以改善血液高凝狀態(tài)、減輕炎癥反應(yīng)為重點(diǎn)。筆者采用口服美沙拉嗪緩釋片聯(lián)合龍血竭散灌腸進(jìn)行治療，效果滿意。報(bào)道如下。

1資料與方法

1．1一般資料收集2014年8月-2015年8月收治的70例UC患者，隨機(jī)分為觀察組和對(duì)照組，觀察組35例，男19例，女16例；年齡25～62歲，平均(41．2±3．7)歲；病程5個(gè)月～8年，平均(4．2±1．3)年；直腸16例，乙狀結(jié)腸13例，降結(jié)腸6例。對(duì)照組35例，男20例,女15例；年齡25～64歲，平均(41．8±3．8)歲；病程5個(gè)月～8年，平均(4．3±1．4)年；直腸15例，乙狀結(jié)腸13例，降結(jié)腸7例。2組一般資料比較，差異無統(tǒng)計(jì)學(xué)意義(P>0．05)。

1．2診斷標(biāo)準(zhǔn)符合《對(duì)我國(guó)炎癥性腸病診斷治療規(guī)范共識(shí)意見》UC診斷標(biāo)準(zhǔn)[5]；結(jié)腸鏡活檢病理報(bào)告確診UC；近30 d內(nèi)無美沙拉嗪緩釋片、中藥、激素等相關(guān)藥物治療史，無相關(guān)藥物過敏史。

1．3方法2組均給予相應(yīng)調(diào)節(jié)酸堿失衡、水電解質(zhì)紊亂及改善營(yíng)養(yǎng)狀況等治療。對(duì)照組以美沙拉嗪緩釋片，輝凌國(guó)際制藥(瑞士)1．0 g口服，4次/d。觀察組在對(duì)照組基礎(chǔ)上給予龍血竭散1．0 g溶于生理鹽水150 mL進(jìn)行灌腸，腸道保留1 h，1次/d。均連續(xù)治療4周。

1．4觀察指標(biāo)于入院第2天及治療后清晨空腹采集肘靜脈血，離心分離血漿，采用ELISA法測(cè)定白細(xì)胞介素-8(IL-8)、白細(xì)胞介素-10(IL-10)、腫瘤壞死因子-α(TNF-α)水平，采用MVIS 2035全自動(dòng)血流變分析儀測(cè)定血液流變學(xué)指標(biāo)紅細(xì)胞壓積、纖維蛋白原、全血黏度水平，并進(jìn)行療效評(píng)價(jià)。

1．5療效標(biāo)準(zhǔn)癥狀消失，結(jié)腸鏡示腸黏膜正常為治愈；癥狀基本消失，結(jié)腸鏡下部分假息肉形成及黏膜輕度炎癥為顯效；癥狀有所改善，結(jié)腸鏡下黏膜病變有所好轉(zhuǎn)為有效；癥狀及結(jié)腸鏡下黏膜無改善或加重為無效。

2結(jié)果

2．12組治療前后炎性細(xì)胞因子水平比較見表1。

2．22組治療前后血液流變學(xué)指標(biāo)比較見表2。

2．32組臨床療效結(jié)果比較見表3。

±s，n=35)

注：與對(duì)照組比較,#P<0．05

±s，n=35)

注：與對(duì)照組比較，#P<0．05

表3　2組臨床療效結(jié)果比較(n=35)　 例(%)

注：與對(duì)照組比較，#P<0．05

3小結(jié)

美沙拉嗪治療UC通過抑制TNF-α基因轉(zhuǎn)錄水平，減少其產(chǎn)生釋放，減輕引起腸道黏膜的損傷，抑制TNF-α刺激下產(chǎn)生IL-8等細(xì)胞因子的釋放[6-13]。龍血竭散具有活血化瘀及抗炎之功，對(duì)UC可起生新止血、祛腐生肌之效[14-15]。本研究中單用美沙拉嗪治療UC總有效率為71．4%，聯(lián)合龍血竭散灌腸總有效率達(dá)91．4%，說明美沙拉嗪聯(lián)合龍血竭散可以有效緩解UC癥狀，促進(jìn)潰瘍愈合。本研究觀察組治療后IL-8、TNF-α明顯降低，而IL-10明顯升高，且觀察組優(yōu)于對(duì)照組，說明美沙拉嗪聯(lián)合龍血竭散灌腸治療UC能夠明顯降低炎性因子水平，增強(qiáng)抗炎作用。

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Longxuejie powder in combined with mesalazine tablets enema in treatment of ulcerative colitis

ZHAO Min1,WANG Zhenjun2*,XU Yanchun3

(1.General Surgery Department,Yanqing Hospital,General Practice and Further Education College,Capital Medical University,Beijing 102100,China;2.General Surgery Department,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;3.The 251st Hospital of Chinese People’s Liberation Army,Zhangjiakou 075000,Hebei Province,China)

Abstract：ObjectiveTo analyze the effect of Longxuejie powder in combined with mesalazine tablets enema in the treatment of ulcerative colitis(UC).MethodsA total of 70 patients with UC who were admitted in our hospital from August,2014 to August,2015 were included in the study and randomized into the observation group and the control group.The patients in the two groups were given corresponding adjustment of acid-base imbalance and water and electrolyte disturbance,and the improvement of nutritional status.The patients in the control group were orally given mesalazine tablets(1.0 g),four times a day.On this basis,the patients in the observation group were given Longxuejie powder(1.0 g),dissolving in 150mL normal saline for enema,retaining in the intestinal tract for 1h,once a day.The patients in the two groups were given a continuous 4-week treatment.The levels of IL-8,IL-10,TNF-α,HCT,fibrinogen,and whole blood viscosity before and after treatment in the two groups were observed,and the efficacy was evaluated.ResultsAfter treatment,the levels of IL-8 and TNF-α were significantly reduced,while the IL-10 level was significantly elevated,moreover,the degree in the observation group was significantly superior to that in the control group(P<0.05).The decreased degree of the levels of HCT,fibrinogen,and whole blood viscosity after treatment in the observation group was significantly superior to that in the control group(P<0.05).The total effective rate in the observation group(91.4%)was significantly higher than that in the control group(71.4%)(P<0.05).ConclusionLongxuejie powder in combined with mesalazine tablets enema in the treatment of UC can significantly reduce the inflammatory reaction,improve the hypercoagulable state,enhance the therapeutic effect,and improve the patients’ living qualities.

Keywords：mesalazine tablets;Longxuejie powder;enema;UC

(收稿日期:2015-10-30)

文章編號(hào)：2095-6258(2016)01-0115-03

中圖分類號(hào)：R256.35

文獻(xiàn)標(biāo)志碼：A

*通信作者：王振軍，教授，主任醫(yī)師，博士研究生導(dǎo)師，電子信箱-zhaomt1979@163.com

作者簡(jiǎn)介：趙敏(1979-)，女，碩士研究生，主治醫(yī)師，主要從事肛腸外科疾病研究。

基金項(xiàng)目：北京軍區(qū)醫(yī)療成果項(xiàng)目(2009229)。

DOI:10.13463/j.cnki.cczyy.2016.01.038