青藤碱缓释胶囊联合粪菌移植疗法治疗炎症性肠病的疗效观察  

The curative effect of sinomenine combined with fecal bacteria transplantation therapy in the treatment of inflammatory bowel disease

作　　者：邓卫平[1] 管志远 郑红梅[3] 马德强[2] 

机构地区：[1]湖北医药学院附属太和医院消化内科,湖北十堰442000 [2]湖北医药学院附属太和医院肝胆外科,湖北十堰442000 [3]湖北医药学院附属太和医院技能培训中心,湖北十堰442000

出　　处：《西部医学》2018年第1期110-113,119,共5页Medical Journal of West China

基　　金：湖北省教育指导科研项目(B2016125)

摘　　要：目的观察青藤碱缓释胶囊(Sinom enine,SN)联合粪菌移植(Fecal microbiota transplantation,FMT)疗法治疗炎症性肠病(Inflammatory bowel disease,IBD)的临床疗效并探讨治疗机制。方法将210例IBD患者随机分为FMT组、SN组和联合治疗组(Combined treatment group,CTG)三组,每组各70例。FMT组口服美沙拉嗪肠溶片(4g/d),并将健康供者粪菌混悬液输注到患者消化道;SN组口服SN120mg/d;CTG组为以上两组联合治疗;三组疗程均为3周。分别检验IBD患者粪便脆弱拟杆菌、梭状芽孢杆菌、乳酸杆菌、分段丝状细菌和双歧杆菌;检验肠黏膜组织白介素-1(Interleukin-1,IL-8)、IL-17、IL-35及静脉血一氧化氮(Nitric oxide,NO)和超氧化物歧化酶(Superoxide dism utase,SOD)活性;并采用流式细胞仪检验静脉血T细胞(Treg)CD4^+T及其亚群Th1/Th17占T淋巴细胞百分率,治疗结束后结合肠镜黏膜病理检查评定临床疗效。结果 CTG组治疗后粪便脆弱拟杆菌、梭状芽孢杆菌、乳酸杆菌、分段丝状细菌和双歧杆菌明显高于SN组,差异有统计学意义(P<0.05);肠黏膜组织IL-8和IL-17及外周血Th17%降低,肠黏膜组织IL-35及外周血CD4^+T%提高,与FMT组和SN组比较,差异有统计学意义(P<0.05);患者外周血NO降低、SOD提高,与FMT组比较差异有统计学意义(P<0.05),与SN组比较差异无统计学意义(P>0.05),CTG组临床综合疗效与FMT组和SN组比较差异有统计学意义(P<0.05)。结论口服SN可能提高效应性CD4^+T T细胞在肠黏膜组织集聚,增强SOD活性,降低Th17、NO及致炎因子IL-8、IL-17对肠黏膜组织破坏,提高IL-35对肠黏膜的保护作用,FMT疗法可重建肠道菌群,保护肠黏膜,两者联合应用发挥综合作用可明显提高炎症性肠病的临床疗效。Objective To observe the effect of sinomenine （Sinom enine, SN） combined with fecal bacteria transplantation （Fecal microbiota transplantation, FMT） therapy in the treatment of inflammatory bowel disease （Inflammatory bowel disease, IBD） and discuss the treatment mechanism.Methods Methods 210 IBD patients were randomly divided into FMT group, SN group and combined treatment group. The FMT group received Mesalazin Entericcoated Tablets（4 g / D）, the healthy donor fecal suspension infusion in patients with digestive tract. SN group oral was treated with SN （120mg / D）. The combined treatment group was treated with the methods of FMT group and SN group. The three groups were treated for 3 weeks. Patients were tested for IBD fecal bacteroides, clostridium, lactobacillus, bifidobacterium, segmented filamentous bacteria, intestinal mucosa of interleukin1 （Interleukin1 IL-8）, IL-17, IL-35, blood nitric oxide （nitric oxide NO） and superoxide dismutase （superoxide dism, utase, SOD）. The flow cytometry was used to test T blood cells （Treg）, Th1/Th17 and CD4＋T accounted for the percentage of T lymphocyte subsets. The endoscopic mucosa pathological examination and assessment of clinical efficacy of treatment of patients were observed. Results The fecal bacteroides, clostridium, lactobacillus, bifidobacterium and segmented filamentous bacteria of combined treatment group after treatment were significantly higher than that of group SN （P〈0.05）. IL-8 and IL-17 in intestinal mucosa, peripheral blood Th1/Th17 and NO of combined treatment group decreased, and the intestinal mucosa, peripheral blood IL-35 CD4＋T% and SOD of combined treatment group increased, compared with group FMT and SN group （P〈0.05）. The curative effect of combined treatment group was different from that of FMT group and SN group（P〈0.05）. Conclusion SN may improve the effect of oral administration of CD4＋T T cells in the intestinal mucosa agglomeration, enhance the a

关 键 词：炎症性肠病 青藤碱缓释胶囊 粪菌移植疗法 联合治疗 

分 类 号：R574.62[医药卫生—消化系统]