乌梅丸治疗化疗性肠黏膜炎的临床疗效及机制研究  

Clinical Efficacy and Mechanism of Wumei Pill in the Treatment of Chemotherapy-induced Intestinal Mucositis

作　　者：卢冬雪 严晶[2] 孙志广[1] 李烜[3] 刘峰 王亚军 葛飞 LU Dong-xue;YAN Jing;SUN Zhi-guang;LI Xuan;LIU Feng;WANG Ya-jun;GE Fei(The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China;The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China;The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, China;Department of Orthopedics and Traumatology, Pukou Hospital of Traditional Chinese Medicine, Nanjing, 211800, China;Hai'an TCM Hospital Affiliated to Hanlin College, Nanjing University of Chinese Medicine, Nantong, 226600, China)

机构地区：[1]南京中医药大学第二附属医院,江苏南京210023 [2]南京中医药大学第一临床医学院,江苏南京210023 [3]南京中医药大学附属医院,江苏南京210009 [4]南京浦口中医院骨伤科,江苏南京211800 [5]南京中医药大学翰林学院附属海安市中医院,江苏南通226600

出　　处：《南京中医药大学学报》2021年第3期371-375,共5页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：国家自然科学基金(81603578,81503536,81673795,81903974);江苏省自然科学基金(BK20181235);江苏省中医药局科技项目(YB2017066);全国中医药创新骨干人才培训项目;南通市“226高层次人才培养工程”项目。

摘　　要：目的观察乌梅丸对化疗性肠黏膜炎(CIM)腹泻的影响及其可能的作用机制。方法选取海安市中医院化疗性肠黏膜炎腹泻门诊患者50例,按照随机数字表法分为治疗组和对照组各25例。对照组予以口服洛哌丁胺治疗,治疗组予以乌梅丸中药汤剂口服,疗程4周,观察患者的腹泻发生率、总有效率,评估中医证候积分,检测血清炎症因子和肠黏膜屏障相关指标,并进行粪便菌群培养。结果治疗后,2组腹泻发生率、中医证候积分均降低(P<0.05,P<0.01),治疗组优于对照组(P<0.01),治疗组临床有效率高于对照组(P<0.05);2组血清白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、二胺氧化酶(DAO)、内皮素(ET)及D-乳酸水平均降低(P<0.05,P<0.01),白介素-10(IL-10)水平升高(P<0.01),肠道致病菌丰度降低、益生菌丰度增加(P<0.05,P<0.01),治疗组优于对照组(P<0.01)。结论乌梅丸可以显著改善化疗性肠黏膜炎腹泻相关症状,其可能机制与中药复方多靶点作用下的抗炎症反应、改善肠黏膜屏障以及调节肠道菌群有关。OBJECTIVE To observe the effect of Wumei pill on diarrhea in chemotherapy-induced intestinal mucositis(CIM)and its possible mechanism of action.METHODS We selected 50 CIM outpatients with diarrhea in Hai'an TCM Hospital,and divided them into the treatment group with 25 cases and the control group with 25 cases in accordance with the random number table.In the control group,oral loperamide was administered,while as for the treatment group,Chinese herbal decoction Wumei pill was given.The total course of treatment was four weeks.The incidence rate of diarrhea and the total effective rate of the patients were observed,and the scores of traditional Chinese medicine(TCM)syndrome were evaluated.In addition,we measured serum inflammatory factors and After treatment,the incidence rate of diarrhea and the scores of TCM syndrome were decreased in both groups(P<0.05,P<0.01),and results in the treatment group were better than those in the control group(P<0.01).The clinical efficacy rate of the treatment group was higher than that of the control group(P<0.05).The levels of serum interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),diamine oxidase(DAO),endothelin(ET)and D-lactate were decreased(P<0.05,P<0.01),while the levels of interleukin 10(IL10)were increased(P<0.01).The abundances of enteropathogenic bacteria were reduced while the abundances of probiotics were increased(P<0.05,P<0.01),and the treatment group were better than the control group(P<0.01).CONCLUSION Wumei pill can significantly improve the symptoms associated with diarrhea of CIM,and the mechanism may be related to the anti-inflammatory response,improvement of intestinal mucosal barrier function and regulation of intestinal flora under the multi-target effect of the Chinese herbal compound.

关 键 词：乌梅丸 化疗性肠黏膜炎 腹泻 炎症反应 肠道菌群 

分 类 号：R273[医药卫生—中西医结合]