安肠愈疡汤联合美沙拉秦对溃疡性结肠炎不同肠段内镜下及组织病理学表现的影响  

Endoscopic and Histological Manifestations in Different Intestinal Segments of Patients with Ulcerative Colitis Treated with Anchang Yuyang Deocotion(安肠愈疡汤)and Mesalazine

作　　者：迟莉丽[1] 樊静娜 孙大娟[1] 赵继亭 闫华[1] 苗秀明 王帅[1] 梁峻尉[1] CHI Lili;FAN Jingna;SUN Dajuan;ZHAO Jiting;YAN Hua;MIAO Xiuming;WANG Shuai;LIANG Junwei(The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学附属医院,山东济南250014 [2]山东中医药大学,山东济南250355

出　　处：《山东中医杂志》2020年第9期936-943,共8页Shandong Journal of Traditional Chinese Medicine

基　　金：济南市科技发展计划临床研究方案(编号:201602180)。

摘　　要：目的:评价安肠愈疡汤联合美沙拉秦对脾虚毒蕴型溃疡性结肠炎不同肠段内镜下及组织病理学层面的疗效。方法:采用治疗前后自身对照研究,纳入溃疡性结肠炎脾虚毒蕴证患者44例,其中E1型(直肠型)24例,E2型(左半结肠型)20例,E1型给予安肠愈疡汤口服联合美沙拉秦栓纳肛,E2型给予安肠愈疡汤联合美沙拉秦肠溶片口服,疗程均为12周。分别对E1型、E2型治疗前后内镜Baron积分进行比较;分别对E1型、E2型治疗前各肠段之间及各肠段治疗前后组织病理学Geboes评分进行比较;分别对E1型、E2型治疗后各肠段组织病理学Geboes评分降幅进行比较。同时对安全性进行评价。结果:E1型治疗后直肠内镜Baron积分较治疗前显著下降(P<0.01),E2型治疗后直肠、乙状结肠、降结肠内镜Baron积分均较治疗前显著下降(P<0.01)。E1型治疗前各肠段病理Geboes评分由高到低排序:直肠>乙状结肠>降结肠、横结肠、升结肠;E1型治疗后各肠段病理Geboes评分均较治疗前下降(P<0.01或P<0.05);E1型治疗后各肠段病理Geboes评分降幅由高到低排序为:直肠>乙状结肠、降结肠、横结肠、升结肠,乙状结肠>横结肠、升结肠。E2型治疗前各肠段病理Geboes评分由高到低排序:直肠>乙状结肠>降结肠>横结肠、升结肠;E2型治疗后各肠段病理Geboes评分均较治疗前降低(P<0.01);E2型各肠段病理Geboes评分降幅由高到低排序为:直肠、乙状结肠、降结肠>横结肠、升结肠。治疗期间两组患者均未发生不良反应。结论:不论E1型还是E2型,内镜下正常黏膜(Baron积分=0)肠段其组织病理学仍存在不同程度的炎症表现;以黏膜愈合作为评价疗效的主要终点,全肠段多段、多点活检进行病理评估方能准确评价肠黏膜深度愈合情况;安肠愈疡汤联合美沙拉秦治疗溃疡性结肠炎可增效减毒,实现全肠段内镜及组织病理学层面的缓解,促进黏膜深度愈合。Objective:To evaluate the effect of Anchang Yuyang Deocotion ( 安肠愈疡汤 ) combined with mesalazine on different intestinal segments of patients with ulcerative colitis(UC) of spleen deficiency and toxin accumulation syndrome at the level of endscopic and histological manifestations. Methods:Forty four patients with UC of spleen deficiency and toxin accumulation syndrome were included for the before-after study in the same patient. There were 24 cases of E1 type(ulcerative proctitis) and 20 cases of E2 type(left-sided ulcerative colitis). E1 type was given Anchang Yuyang Deocotion combined with mesalazine suppository. E2 type was given Anchang Yuyang Deocotion combined with mesalazine enteric-coated tablets.The treatment lasted for 12 weeks. The endoscopic Baron scores before and after treatment of E1 and E2 types were compared. Also,the histopathological Geboes scores before treatment in each intestinal segment treatment were compared,and the histopathological Geboes scores before and after treatment of each intestinal segment were compared. Reduction of histopathological Geboes scores after treatment of each intestinal segment were compared. And the safety was also evaluated. Results:The Baron scores of rectum after treatment was significantly lower than that before treatment in E1 type(P <0.01). The Baron scores of rectum,sigmoid colon and descending colon after treatment were significantly lower than those of before treatment in E2 type(P <0.01). E1 type :the Geboes scores of each intestinal segment before treatment ranked from high to low:rectum > sigmoid colon > descending colon,transverse colon,ascending colon.After treatment,the Geboes scores of each intestinal segment were lower than those of before treatment(P<0.01 or P<0.05). The score reduction of each intestinal segment ranked from high to low of E1 type:rectum > sigmoid colon,descending colon,transverse colon,ascending colon;sigmoid colon > transverse colon,ascending colon. E2 type:the Geboes scores of each intestinal segment before treatment

关 键 词：溃疡性结肠炎 安肠愈疡汤 美沙拉秦 Baron评分 Geboes评分 黏膜愈合 

分 类 号：R259.746.2[医药卫生—中西医结合]