运用“土郁夺之”理论指导治疗湿热内蕴型溃疡性结肠炎的系统评价

摘要

目的 观察运用“土郁夺之”理论指导治疗湿热内蕴型溃疡性结肠炎的临床效果并对其进行可能的机制探讨.方法 将2015年1月～2016年6月河北省玉田县医院及河北省唐山市中医医院收治的湿热内蕴型溃疡性结肠炎患者74例,将其随机分为治疗组(37例)和对照组(37例).治疗组给予美沙拉嗪肠溶片口服联合中药汤剂(运用“土郁夺之”理论立方清中汤加减:黄连、陈皮、茯苓、栀子、半夏、黄芩、黄柏、连翘、竹茹、阿胶、伏龙肝等)口服治疗,对照组给予美沙拉嗪肠溶片口服和安慰剂口服治疗,两组均以4周为1个疗程.观察两组的临床症状疗效、结肠镜疗效和血清IL-17、IL-23及IL-10的含量.结果 治疗1个疗程后,治疗组的临床症状疗效、结肠镜疗效的总有效率分别为94.59％和97.30％,对照组分别为81.08％和86.49％,治疗组的临床症状疗效和结肠镜疗效均优于对照组(P＜0.05).治疗后,两组患者血清IL-17、IL-23含量较治疗前显著降低,差异有统计学意义(P＜0.05),且治疗后,治疗组血清IL-17、IL-23含量显著低于对照组,差异有统计学意义(P＜0.05);治疗后,两组患者血清IL-10含量均显著高于治疗前(P＜0.05),且治疗组治疗后血清IL-10含量高于对照组,差异有统计学意义(P＜0.05).治疗过程中,两组患者均未出现严重的不良反应.结论 运用“土郁夺之”理论指导治疗湿热内蕴型溃疡性结肠炎的临床症状效果和结肠镜效果均显著,其作用机制可能与降低血清IL-17、IL-23水平和升高血清IL-10的含量有关,且无不良反应,值得临床推广使用和进行下一步的深入研究.%Objective To observe the clinical effect of "Tuyu Duozhi" in the treatment of ulcerative colitis with dampheat syndrome and to explore its possible mechanism.Methods Seventy-four patients of ulcerative colitis with dampheat syndrome were randomly divided into treatment group (37 cases) and control group (37 cases).The patients were treated in Yutian County Hospital and Tangshan Traditional Chinese Medicine Hospital from January 2015 to June 2016.The treatment group was given Mesalazine Enteric-coated Tablets combined with traditional Chinese medicine decoction (using the theory of "Tuyu Duozhi" theory cube Qingzhong Decoction:Coptidis Rhizoma,Citri Reticulatae Pericarpium,Poria,Gardeniae Fructus,Pinelliae Rhizoma,Scutellariae Radix,Phellodendri Chinensis Cortex,Forsythiae Fructus,Bambusae Caulis In Taenias,Asini Corii Colla,Terra Flavausta,etc.) oral treatment,the control groupwas given Mesalazine Enteric-coated Tablets and placebo oral treatment,two groups were taken 4 weeks as a course of treatment.The clinical symptoms effect,colonoscopy effect,the contents of serum IL-17,IL-23 and IL-10 were observed in the two groups.Results After one course of treatment,the total effective rates of the clinical symptoms effect and colonoscopy effect were 94.59％ and 97.30％ in the treatment group respectively,which were 81.08％ and 86.49％ in the control group,the clinical symptoms effect and colonoscopy effect of the treatment group were better than the control group (P ＜ 0.05).After treat ment,the serum levels of IL-17 and IL-23 in the two groups were significantly lower than those before treatment (P ＜ 0.05),after treatment,the levels of serum IL-17 and IL-23 in the treatment group were lower than the control group (P ＜ 0.05),after treatment,the levels of serum IL-10 in the two groups were significantlY higher than those before treatment (P ＜ 0.05),after treatment,the level of serum IL-10 in the treatment group was higher than that in the control group,the difference was statistically significant (P ＜ 0.05).In the course of treatment,there were no serious adverse reactions in the two groups.Conclusion The clinical symptoms effect and colonoscopy effect of "Tuyu Duozhi" in the treatment of ulcerative colitis with damp-heat syndrome are significant.The mechanism may be related to the decrease of serum IL-17,IL-23 levels and the increase of serum IL-10 levels,with no adverse reactions,it is worthy of clinical use and the next step in-depth study.