抗栓灵含片治疗伴有血小板活化的难治性溃疡性结肠炎  

Treatment of refractory ulcerative colitis with Kangshuangling

作　　者：江学良[1] 权启镇[1] 孙自勤[1] 王要军[1] 尚瑞莲[1] 齐风[1] 

机构地区：[1]中国人民解放军济南军区总医院消化科,山东省济南市250031

出　　处：《世界华人消化杂志》2003年第8期1214-1218,共5页World Chinese Journal of Digestology

基　　金：山东省卫生厅青年基金项目,No.2001CA2EFB2

摘　　要：目的:研究抗栓灵含片治疗伴有血小板活化的难治性溃疡性结肠炎(UC)的疗效和机制。方法:常规应用激素和/或柳氮磺吡啶(SASP)治疗1mo以上无效或恶化的UC患者18例(男8例,女10例,平均年龄32.4岁),加用抗栓灵含片,2片(相当于2 400 U低分子肝素钠)含化,2次/d,观察大便次数、便血情况、自觉症状、肠黏膜肠镜下和组织病理学改变,并在治疗前和治疗后4wk用流式细胞仪测定血液中黏附分子P选择素(CD62p),溶酶体膜糖蛋白(CD63),血液和组织中细胞间黏附分子(CD54),多药耐药基因(MDR)产物P-糖蛋白170(Pgp-170),用放射免疫法测定血栓素A2代谢产物TXB2含量,用血小板黏附仪测定血小板黏附率。结果:应用抗栓灵含片治疗后,与治疗前相比,大便次数(1.6 vs 8.2次/d)、便血情况(范围 0-3,0.3 vs 2.7分)、肠镜下情况(范围 0-3,1.1 vs 2.6分)、病理组织学观察(范围 0-15,5.0 vs 12.0分)、自觉症状(范围 0-5,0.7 vs3.9分)均明显改善或缓解(P<0.05)。CD62p(4.1±1.8％ vs8.0±3.1％,),CD63(3.2±1.6％ vs 6.3±2.1％),TXA2(390±67ng/L vs 548±85ng/L),血小板黏附率(34.8±8.1％vs 43.2±10.7％),体外血栓形成长度(1.8±0.3cm vs2.3±0.6cm),血液中CD54(14.4±5.1％ vs 26.9±6.9％),组织中CD54(23.1±4.1％ vs 51.1±6.2％),血液中多药抗性基因(MDR)产物P-糖蛋白170(Pgp-170)(10.4±2.7％vs 18.9±3.9％),组织中Pgp-170(10.2±2.3％ vs 16.5±3.2％)明显下降(P<0.01或0.05)。结论:抗栓灵含片治疗伴有血小板活化的难治性溃疡性结肠炎有效,可抑制血小板活化和高凝状态,减轻炎症,抑制多药耐药基因表达。AIM: To study the therapeutic effects and mechanism of Kangshuanling in patients with refractory ulcerative colitis (UC). METHODS: Eighteen patients (8 males, 10 females) with refractory UC unresponsive to high-dose prednisolone and sulfasalazine therapy for more than one month were treated with Kangshuanling (7 200 U/d). Prednisolone was gradually stopped and sulfasalazine maintained. Stool frequency, rectal bleeding, colonoscopy and histology, as well as general well-being were observed and CD62p, CD63, CD54, Pgp-170 (flow cytometry),TXA2 (RIA), blood platelet aggregation rate and thrombosis tength in vitro were assessed. RESULTS: After more than 4 weeks of combined Kangshuanling and sulfasalazine therapy, sixteen patients achieved clinical remission, with a highly significant statistical difference (P<0.01) between pre-and post-treatment mean scores for all disease parameters: stool frequency (8.2/d vs 1.6/d), rectal bleeding (2.7 vs 0.3), colonoscopy (2.6 vs 1.1), histology (12.0 vs 5.0), general well being (4.0 vs 0.6). And CD62p (8.0±3.1 % vs 4.1±1.8 %), CD63 (6.3±2.1 % vs 3.2±1.6 %), TXA2 (548±85 ng/L vs 390±67 ng/L), platelet aggregation rate (43.2±10.7 % vs 34.8±8.1 %), thrombosis length in vitro (2.3±0.6 cm vs 1.8±0.3 cm), CD54 in blood (26.9±6.9 % vs 14.4±5.1 %), CD54 in tissues (51.1±6.2 % vs 23.1±4.1 %), Pgp -170 in blood (10.4±2.7 % vs 18.9±3.9 %), Pgp -170 in tissues (10.2±2.3 % vs 16.5±3.2 %) decreased significantly (P<0.01 or 0.05). CONCLUSION: Kangshuanling may be effective in treating refractory UC, the mechanism is partly related to inhibition of platelet activation, hypercoagulative state, MDR expression and anti-inflammatory effects.

关 键 词：抗栓灵含片 治疗 血小板活化 难治性溃疡性结肠炎 疗效 柳氮磺吡啶 肝素类药物 

分 类 号：R574.62[医药卫生—消化系统] R973.2[医药卫生—内科学]