龙血竭散联合美沙拉嗪缓释片灌肠治疗溃疡性结肠炎

赵　敏，王振军，许艳春

( 1.首都医科大学全科医学与继续教育学院、延庆医院普外科，北京 102100；2.首都医科大学附属北京

朝阳医院普通外科，北京 100020；3.中国人民解放军第251医院 河北 张家口 075000)



龙血竭散联合美沙拉嗪缓释片灌肠治疗溃疡性结肠炎

赵敏1，王振军2*，许艳春3

( 1.首都医科大学全科医学与继续教育学院、延庆医院普外科，北京 102100；2.首都医科大学附属北京

朝阳医院普通外科，北京 100020；3.中国人民解放军第251医院 河北 张家口 075000)

摘要：目的观察美沙拉嗪缓释片联合龙血竭散灌肠对溃疡性结肠炎(UC)的疗效。方法收集70例UC患者，随机分为观察组和对照组,各35例，2组均给予相应调节酸碱失衡、水电解质紊乱及改善营养状况等治疗。对照组以美沙拉嗪缓释片1．0 g口服，4次/d，观察组在对照组基础上给予龙血竭散1．0 g溶于生理盐水150 mL进行灌肠，肠道保留1 h,1次/d,均连续治疗4周。观察治疗前后IL-8、IL-10、TNF-α、红细胞压积、纤维蛋白原、全血黏度水平，并进行疗效评价。结果治疗后IL-8、TNF-α明显降低，IL-10明显升高，且观察组优于对照组(P<0．05)；治疗后红细胞压积、纤维蛋白原、全血黏度水平观察组降低程度优于对照组(P<0．05)；观察组总有效率91．4%，对照组71．4%(P<0．05)。结论美沙拉嗪口服联合龙血竭散灌肠可以明显减轻UC患者炎性反应，改善血液高凝状态，提高治疗效果，改善患者生活质量。

关键词：美沙拉嗪缓释片；血竭散；保留灌肠；溃疡性结肠炎

溃疡性结肠炎(UC)是非特异性慢性结肠炎症病变，其原因与免疫、感染、遗传、环境、精神等有关，发病机制认为是自身免疫、炎症反应参与着UC的发病过程[1-2]。研究[3-4]认为，UC患者存在血液高凝状态，导致血栓的形成，造成肠黏膜损伤加重病情，治疗以改善血液高凝状态、减轻炎症反应为重点。笔者采用口服美沙拉嗪缓释片联合龙血竭散灌肠进行治疗，效果满意。报道如下。

1资料与方法

1．1一般资料收集2014年8月-2015年8月收治的70例UC患者，随机分为观察组和对照组，观察组35例，男19例，女16例；年龄25～62岁，平均(41．2±3．7)岁；病程5个月～8年，平均(4．2±1．3)年；直肠16例，乙状结肠13例，降结肠6例。对照组35例，男20例,女15例；年龄25～64岁，平均(41．8±3．8)岁；病程5个月～8年，平均(4．3±1．4)年；直肠15例，乙状结肠13例，降结肠7例。2组一般资料比较，差异无统计学意义(P>0．05)。

1．2诊断标准符合《对我国炎症性肠病诊断治疗规范共识意见》UC诊断标准[5]；结肠镜活检病理报告确诊UC；近30 d内无美沙拉嗪缓释片、中药、激素等相关药物治疗史，无相关药物过敏史。

1．3方法2组均给予相应调节酸碱失衡、水电解质紊乱及改善营养状况等治疗。对照组以美沙拉嗪缓释片，辉凌国际制药(瑞士)1．0 g口服，4次/d。观察组在对照组基础上给予龙血竭散1．0 g溶于生理盐水150 mL进行灌肠，肠道保留1 h，1次/d。均连续治疗4周。

1．4观察指标于入院第2天及治疗后清晨空腹采集肘静脉血，离心分离血浆，采用ELISA法测定白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平，采用MVIS 2035全自动血流变分析仪测定血液流变学指标红细胞压积、纤维蛋白原、全血黏度水平，并进行疗效评价。

1．5疗效标准症状消失，结肠镜示肠黏膜正常为治愈；症状基本消失，结肠镜下部分假息肉形成及黏膜轻度炎症为显效；症状有所改善，结肠镜下黏膜病变有所好转为有效；症状及结肠镜下黏膜无改善或加重为无效。

2结果

2．12组治疗前后炎性细胞因子水平比较见表1。

2．22组治疗前后血液流变学指标比较见表2。

2．32组临床疗效结果比较见表3。

±s，n=35)

注：与对照组比较,#P<0．05

±s，n=35)

注：与对照组比较，#P<0．05

表3　2组临床疗效结果比较(n=35)　 例(%)

注：与对照组比较，#P<0．05

3小结

美沙拉嗪治疗UC通过抑制TNF-α基因转录水平，减少其产生释放，减轻引起肠道黏膜的损伤，抑制TNF-α刺激下产生IL-8等细胞因子的释放[6-13]。龙血竭散具有活血化瘀及抗炎之功，对UC可起生新止血、祛腐生肌之效[14-15]。本研究中单用美沙拉嗪治疗UC总有效率为71．4%，联合龙血竭散灌肠总有效率达91．4%，说明美沙拉嗪联合龙血竭散可以有效缓解UC症状，促进溃疡愈合。本研究观察组治疗后IL-8、TNF-α明显降低，而IL-10明显升高，且观察组优于对照组，说明美沙拉嗪联合龙血竭散灌肠治疗UC能够明显降低炎性因子水平，增强抗炎作用。

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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)

文章编号：2095-6258(2016)01-0115-03

中图分类号：R256.35

文献标志码：A

*通信作者：王振军，教授，主任医师，博士研究生导师，电子信箱-zhaomt1979@163.com

作者简介：赵敏(1979-)，女，硕士研究生，主治医师，主要从事肛肠外科疾病研究。

基金项目：北京军区医疗成果项目(2009229)。

DOI:10.13463/j.cnki.cczyy.2016.01.038