雷公藤多苷抑制炎症性肠病炎症活动的临床研究  

Tripterygium wilfordii Polyglycoside Inhibited Inflammation Activity of Inflammatory Bowel Disease Patients

作　　者：钦丹萍[1] 王耀东 倪桂宝[2] 张春丽[2] 毛玉萍[2] 方国栋 徐立宇 胡小玉 乔樵[1] 朱曙东[1] 杨强 岑刚 QIN Dan-ping;WANG Yao-dong;NI Gui-bao;ZHANG Chun-li;MAO Yu-ping;FANG Guo-dong;XU Li-yu;HU Xiao-yu;QIAO Qiao;ZHU Shu-dong;YANG Qiang;CEN Gang(Department of Gastroenterology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310006;Department of Pathology, First Affiliated Hospital, Zhejiang Chinese Medicine University, Hangzhou 310006;First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053)

机构地区：[1]浙江中医药大学附属第一医院消化内科,杭州310006 [2]浙江中医药大学附属第一医院病理科,杭州310006 [3]浙江中医药大学第一临床医学院,杭州310053

出　　处：《中国中西医结合杂志》2018年第7期779-785,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81273903;No.81673798)

摘　　要：目的观察雷公藤多苷(TWP)对炎症性肠病(IBD)炎症活动的疗效。方法选择类固醇激素抵抗或依赖或使用其他免疫抑制剂后出现不良反应不能耐受的IBD患者32例,包括克罗恩病(CD)19例,溃疡性结肠炎(UC)13例。在原有氨基水杨酸治疗基础上(4 g/d)给予TWP口服治疗(60 mg/d),疗程24个月,观察临床表现、内镜下黏膜病变(SES-CD、MES评分)、组织炎症及纤维化、血液指标的变化;并对TWP治疗后IBD患者的黏膜愈合、应答程度及不良反应进行分析。结果 TWP治疗后:(1)IBD患者腹痛、腹泻、便血、里急后重等症状显著改善(P<0.05)。(2)IBD患者内镜下SES-CD、MES评分较治疗前显著下降(P<0.01),CD患者内镜下黏膜愈合7例(36.84%),UC患者内镜下黏膜愈合8例(61.54%)。(3)黏膜炎症损伤评分和黏膜纤维化评分均下降(P<0.05);共有11例患者达到显微镜下黏膜愈合。(4)CD、UC患者ESR、CRP、PLT水平降低(P<0.05,P<0.01),ALB水平升高(P<0.05);UC患者ALB水平升高(P<0.05)。(5)32例IBD患者中,完全应答患者25例,部分应答7例。(6)激素依赖患者(21例),应用TWP 12周顺利停用激素,并对TWP治疗具有应答反应。(7)有12例次出现与TWP相关的不良反应,生殖腺抑制10例,轻度骨髓抑制1例、轻度肝功能损害2例,TWP减量后恢复正常。结论TWP可明显缓解IBD临床表现,抑制炎症活动,促进黏膜愈合,并对黏膜纤维化可能具有某种抑制作用,同时TWP对激素依赖患者能使激素顺利减量至停用,并使其获得对治疗的应答与缓解。Objective To observe the effect of Tripterygium wilfordii Polyglycoside（ TWP） on intestinal inflammation in inflammatory bowel disease（ IBD） patients. Methods Totally 32 IBD patients,19 Crohn＇s disease（ CD） and 13 ulcerative colitis（ UC）,with steroid hormones resistance or dependence or taking other immunosuppressive agents with intolerable side effects,were recruited. They took TWP（ 60 mg per day） on the basis of primary aminosalicylic acid treatment（ 4 g per day）. The treatment course was 24 months. Clinical manifestations,endoscopic mucosal lesions（ SES-CD,MES score）,tissue inflammation and fibrosis,changes of blood indicators were observed. Mucosal healing,response level,and toxic adverse reactions were analyzed in TWP treated IBD patients. Results After TWP treatment,（ 1） The symptoms of IBD patients,including abdominal pain,diarrhea,hematochezia,tenesmus,and other symptoms were significantly improved（P〈0. 05）;（ 2） The scores of endoscopic SES-CD and MES were significantly decreased more than before treatment（ P〈0. 01）. Seven cases of CD patients achieved endoscopic mucosal healing（ 36. 84%）,and 8 cases of UC patients achieved endoscopic mucosal healing（ 61. 54%）;（ 3） The score of mucosal inflammation injury and mucosal fibrosis score in IBD patients decreased（P〈0. 05）. Totally 11 patients achieved microscope mucosal healing.（ 4） The levels of ESR,CRP,and PLT decreased（P〈0. 05,P〈0. 01）,the level of ALB increased（P〈0. 05,P〈0. 01） in CD and UC patients.The level ALB increased in UC patients（P〈0. 05）.（ 5） Of all 32 IBD patients,25 patients had complete response to TWP after treatment,and 7 had partial response.（ 6） Hormone dependent patient（ 21 patients） successfully discontinued hormone after taking TWP for 12 weeks and had complete response to TWP treatment.（ 7） TWP associated adverse reactions occurred in 12 cases,gonadal suppression in 10 cases,mild bone marrow suppression in 1 case,mild liver damag

关 键 词：炎症性肠病 雷公藤多苷 炎症活动 黏膜愈合 

分 类 号：R259[医药卫生—中西医结合]