中药超声导入治疗溃疡性结肠炎的疗效

刘芳 孔鹏飞 郑和平

摘要  目的：探討中药超声导入治疗溃疡性结肠炎（UC）的临床疗效。方法：选取2015年2月至2016年2月川北医学院附属医院收治的UC患者73例作为研究对象，按照随机数字表法随机分为对照组（ n =36）和观察组（ n =37）。对照组给予美沙拉嗪肠溶片治疗，观察组在对照组基础上超声导入参苓白术散治疗，2组均连续治疗3个月。统计2组临床疗效及不良反应;比较2组治疗前后血清炎性反应递质水平。结果：观察组临床治疗有效率（86.49%）高于对照组（58.33%），差异有统计学意义（ P <0.05）;治疗后2组患者腹痛、腹泻、黏膜脓血便症状积分及Southerland DAI、Baron评分降低，除腹泻积分外，观察组均低于对照组，差异有统计学意义（ P <0.05）;与治疗前比较，治疗后观察组腹痛、黏膜脓血便重度及腹泻中度患者比例降低，轻度患者比例升高;且治疗后2组腹痛轻、重度患者，腹泻及黏膜脓血便轻度患者比例，差异有统计学意义（ P <0.05）;与治疗前比较，治疗后2组血清IL-17、IL-23及TNF-α水平降低，且观察组低于对照组，差异有统计学意义（ P <0.05）;观察组不良反应发生率（8.11%）低于对照组（27.78%），差异有统计学意义（ P <0.05）。结论：中药超声导入治疗UC可明显改善患者临床症状，降低机体炎性反应递质水平，减轻肠道黏膜损伤，且较常规治疗效果显著。

关键词  溃疡性结肠炎;参苓白术散;超声导入;美沙拉嗪;临床症状;炎性反应递质;疗效;不良反应

Analysis of Therapeutic Effects of Ultrasound Introduction of Traditional Chinese Medicine in the Treatment of Ulcerative Colitis

LIU Fang1， KONG Pengfei1， ZHENG Heping2

（1 Proctology Department， the Affiliated Hospital of North Sichuan Medical College， Nanchong 637000， China; 2 Department of Integrated Traditional Chinese and Western Medicine， Nanchong Central Hospital Affiliated to North Sichuan Medical College， Nanchong 637000， China）

Abstract Objective： To explore the therapeutic effects of ultrasound introduction of traditional Chinese medicine in the treatment of ulcerative colitis（UC）.  Methods： A total of 73 patients with UC admitted to the Affiliated Hospital of North Sichuan Medical College were randomly divided into a control group（ n =36）and an observation group（ n =37）. The control group was treated with mesalazine enteric-coated tablets， and the observation group was treated with Shenling Baizhu Powder by ultrasound on the basis of the control group. Both groups were treated continuously for 3 months. The therapeutic effects and adverse reactions in clinics were counted in 2 groups and the levels of serum inflammatory cytokines were compared between the 2 groups before and after treatment.  Results： The total clinical effective rate of the observation group（86.49%）was significantly higher than that of the control group（58.33%）（ P <0.01）; from 1 month to 3 months of treatment， the scores of abdominal pain， diarrhea， mucous pus and bloody stools symptom scores and the Southerland DAI and Baron′s scores in the 2 groups significantly were reduced， and except for the diarrhea score， the scores in the observation group were significantly lower than those in the control group（ P <0.05 or  P <0.01）. Compared with those before treatment， the proportion of patients with severe abdominal pain， mucosal purulent stool and moderate diarrhea in the observation group after treatment decreased， and the proportion of mild patients increased; and after treatment， there were significant difference in the proportion of patients with mild and severe abdominal pain， diarrhea and mild mucosal purulent stool in the 2 groups（ P <0.05 or  P <0.01）. Compared with before treatment， the levels of serum IL-17， IL-23 and TNF-α in the 2 groups significantly reduced after treatment， and the observation group was significantly lower than the control group（ P <0.01）. The incidence of adverse reactions in the observation group（8.11%）was significantly lower than that in the control group（27.78%）（ P <0.05）.  Conclusion： Ultrasound introduction of traditional Chinese medicine for the treatment of UC can significantly improve the clinical symptoms of patients， reduce the level of inflammatory cytokines and reduce the damage of intestinal mucosa， which is more effective than conventional treatment.

Keywords  Ulcerative colitis; Shenling Baizhu Powder; Ultrasound introduction; Mesalazine; Clinical symptoms; Inflammatory factors; Therapeutic effects; Adverse reactions

中图分类号：R289.4;R574.6 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.023

溃疡性结肠炎（Ulcerative Colitis，UC）是一种慢性非特异性肠道炎症性疾病，病变常累及黏膜及黏膜下层，临床主要表现为腹痛、腹泻、脓血便、里急后重等，其与肠道克罗恩病均属炎症性肠病范畴，且多发于欧洲、美洲等国家[1-2]。目前有关UC的病因、病机等尚未明确，病情呈进行性发展，临床症状迁延不愈、易反复发作，病程长，尚无特异性的治疗方案。中医学疗法治疗UC常以健脾疏肝、温肾健脾、寒热并用等为主，在诱导与维持缓解、降低不良反应及改善生命质量等方面均有一定优势[3]。超声导入是一种新发现的体外经皮给药方式，可避免肝脏的首过消除，减少药物不良反应，具有安全、有效且无创伤等优点[4]。本研究采用中药超声导入治疗UC，旨在探讨其治疗UC的临床疗效及相关细胞因子水平变化。现报道如下。……