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目的:观察愈肠煎保留灌肠配合美沙拉嗪治疗(大肠湿热证)溃疡性结肠炎(UC)的临床疗效及对血清白介素(IL)-17,IL-21的影响。方法:将120例UC患者随机按数字表法分为对照组和综合组各60例。对照组给予美沙拉嗪肠溶片,1 g/次,4次/d,吞服勿咀嚼。综合组在对照组治疗的基础上加用愈肠煎,1次/d,保留灌肠。两组疗程均为4周。进行治疗前后Baron内镜评分法评分;采用肠黏膜病变活动指数(Sutherland DAI)对疾病严重度与活动度进行评价;记录治疗前后主要症状、体征;进行治疗前后炎症性肠病问卷(IBDQ)评分;检测治疗前后血清IL-17,IL-21水平。结果:综合组临床疗效总有效率为90%,对照组为76.67%,综合组优于对照组(P<0.05);综合组Baron评分和Sutherland DAI疾病活动性指数评价均低于对照组(P<0.01);综合组腹泻、脓血便、腹痛和腹胀评分均低于对照组(P<0.01);综合组IBDQ量表肠道症状、全身症状、情感能力及社会能力评分及总分均高于对照组(P<0.01);治疗后两组血清IL-17,IL-21水平均较治疗前下降(P<0.01),综合组血清IL-17,IL-21水平均低于对照组(P<0.05)。结论:愈肠煎保留灌肠联合美沙拉嗪治疗(大肠湿热证)溃疡性结肠炎能减轻症状,控制疾病活动,临床疗效优于单纯美沙拉嗪,其作用机制可能与调节炎症因子有关。
Objective: To observe the clinical curative effect and serum interleukin (IL) -17, IL-21 of patients with ulcerative colitis (UC) treated with intestine retention intestine and mesalazine. Methods: 120 cases of UC patients were randomly divided into control group and 60 cases in combination group. The control group was given mesalazine enteric-coated tablets, 1 g / time, 4 times / d, swallowing do not chew. The combined group in the control group based on the addition of more intestine fried, 1 / d, retention enema. Two courses of treatment were 4 weeks. Baron endoscopy score before and after treatment was scored. Sutherland DAI was used to evaluate the severity and activity of the disease. The main symptoms and signs before and after treatment were recorded. IBDQ score Serum IL-17 and IL-21 levels were measured before and after treatment. Results: The total effective rate was 90% in the combined group and 76.67% in the control group, and the comprehensive group was better than the control group (P <0.05). Baron score and Sutherland DAI index of activity in the combined group were lower than those in the control group (P <0.01). The scores of diarrhea, purulent blood stool, abdominal pain and abdominal distension in the combined group were lower than those in the control group (P <0.01). The IBDQ scale of integrative group was higher than the score of intestinal symptoms, systemic symptoms, emotional ability and social competence (P <0.01). The levels of serum IL-17 and IL-21 in the two groups after treatment were lower than those before treatment (P <0.01). The levels of IL-17 and IL-21 in the combined group were lower than those in the control group <0.05). Conclusion: The treatment of ulcerative colitis with intestine retention enema combined with mesalazine (dampness syndrome of dampness of the intestine) can relieve the symptoms and control the disease activity. The clinical curative effect is better than that of mesalazine alone. Its mechanism may be related to the regulation of inflammatory factors.