清化消痈方治疗术前湿热下注型克罗恩病肛瘘的临床疗效评价  

Clinical efficacy evaluation of Qinghua Xiaoyong Formula in treatment of pre‑operative Crohn's disease perianal fistula with dampness‑heat diffusing downward type

作　　者：刘文霞 芦亚峰[1] 刘肃志 陆宏[1] 梅祖兵[1] 彭云花[1] 张志君[1] 羊琪琪 瞿胤 张巍[1] 裴艳妮 杜培欣[1] 王坚[1] 杨巍[1] LIU Wenxia;LU Yafeng;LIU Suzhi;LU Hong;MEI Zubing;PENG Yunhua;ZHANG Zhijun;YANG Qiqi;QU Yin;ZHANG Wei;PEI Yanni;DU Peixin;WANG Jian;YANG Wei(Anorectal Department,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肛肠科,上海201203

出　　处：《上海中医药大学学报》2025年第2期57-62,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市科委科研项目(22Y11922300);上海市卫健委科研项目(202140379)。

摘　　要：目的:评价清化消痈方治疗术前湿热下注型克罗恩病肛瘘患者的临床疗效。方法:纳入62例湿热下注型克罗恩病肛瘘患者,随机分为治疗组和对照组,每组各31例。两组患者均予静脉滴注英夫利西单抗治疗,在此基础上,治疗组患者给予清化消痈方口服治疗,直至克罗恩病活动指数(CDAI)评分<150分,患者进入缓解期。治疗第4周结束后,比较两组CDAI评分<150分的患者比例及中医证候疗效;比较两组患者达到CDAI评分<150分所需的用药周数;治疗前及初入缓解期,比较两组患者的肛周克罗恩病活动指数(PDAI)评分、炎症性肠病量表(IBDQ)评分及C反应蛋白(CRP)、血沉水平。结果:①治疗第4周结束后,治疗组中CDAI评分<150分的患者比例明显高于对照组(P<0.05);治疗组患者达到CDAI评分<150分所需的用药周数明显少于对照组(P<0.01)。②治疗第4周结束时,治疗组患者的中医证候疗效总有效率为96.8%,对照组为71.0%,治疗组的疗效优于对照组(P<0.05)。③初入缓解期,两组患者的PDAI评分较治疗前均下降(P<0.05)、IBDQ评分较治疗前均升高(P<0.05),而两组PDAI、IBDQ评分组间比较,其差异无统计学意义(P>0.05)。④初入缓解期,两组患者的CRP、血沉水平较治疗前均明显降低(P<0.05),且治疗组患者的血沉水平低于对照组(P<0.05)。结论:清化消痈方联合常规西药可明显改善湿热下注型克罗恩病肛瘘患者的全身炎症,缓解肠道炎症,减轻肛周炎症,缩短达到克罗恩病缓解期的时间,进而缩短达到手术指征的时间,从而减轻患者痛苦,提高患者的生活质量。Objective:To evaluate the clinical efficacy of Qinghua Xiaoyong Formula in the treatment of pre-operative Crohn's disease perianal fistula with dampness-heat diffusing downward type.Methods:Sixty-two patients of Crohn's disease perianal fistula with dampness-heat diffusing downward type were included and randomly divided into the treatment group and control group,31 cases in each group.The patients in both groups were treated with intravenous infusion of infliximab,and based on above,the patients in the treatment group were orally treated with Qinghua Xiaoyong Formula.The treatment was continued until the Crohn's Disease Activity Index(CDAI)score was less than 150 points,and the patients entered the remission period.After the end of the 4th week of treatment,the proportion of patients with CDAI score<150 points and the curative effects of traditional Chinese medicine syndrome were compared between the two groups.The number of weeks required for the patients to achieve CDAI score<150 points was compared between the two groups.Before treatment and after entering the remission period,the Perianal Crohn's Disease Activity Index(PDAI)score,the Inflammatory Bowel Academic Journal of Shanghai University of Traditional Chinese Medicine Vol.39 No.2 Mar.2025 Disease Questionnaire(IBDQ)score,and the levels of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were compared between the two groups.Results:①After the end of the 4th week of treatment,the proportion of patients with CDAI score<150 points in the treatment group was significantly higher than that in the control group(P<0.05).The number of weeks required for the patients to achieve CDAI score<150 points in the treatment group was significantly less than that in the control group(P<0.01).②After the end of the 4th week of treatment,the total effective rate of traditional Chinese medicine syndrome was 96.8%in the treatment group and 71.0%in the control group,and the curative effect of the treatment group was better than that of the control group(P<0.05)

关 键 词：克罗恩病 肛瘘 湿热下注型 清化消痈方 炎症反应 中医药疗法 

分 类 号：R259[医药卫生—中西医结合]