针灸配合中药灌肠治疗溃疡性结肠炎近远期疗效及安全性分析

摘要

目的 探讨针灸配合中药灌肠治疗溃疡性结肠炎近远期疗效及安全性分析.方法 选取2010年9月至2016年9月确诊并治疗的溃疡性结肠炎200例,依据随机数表法随机分为中医组和常规组,每组100例,常规组患者给予水电解质平衡纠正、补液等常规治疗和1g柳氮磺胺吡啶片口服治疗,中医组患者依据是否进行针灸治疗分为灌肠组和结合组,灌肠组患者在常规组基础上,仅给予200 ml中药(白头翁汤)灌肠治疗,结合组患者在灌肠组基础上给予针灸治疗,采用酶联免疫吸附法(ELISA)检测血浆中C-反应蛋白(CRP),同时检测红细胞沉降率(ESR)、中性粒细胞(PMN)水平,随访1年,统计分析所有患者治疗疗效、腹痛、血便、腹泻等临床症状消失时间、治疗前后血浆中CRP、ESR、PMN水平、治疗期间不良反应发生和治疗后3、6、12个月的累积复发情况.结果 结合组患者治疗有效率明显高于灌肠组,灌肠组患者治疗有效率明显高于常规组,差异有统计学意义(P<0.05);结合组患者临床症状消失时间均明显低于灌肠组,灌肠组患者临床症状消失时间均明显低于常规组,差异有统计学意义(P<0.05);结合组患者治疗后血浆中CRP、ESR、PMN水平明显低于灌肠组,灌肠组患者治疗后血浆中CRP、ESR、PMN水平均明显低于常规组,差异有统计学意义(P<0.05);灌肠组、结合组和结合组患者治疗期间不良反应发生率基本相同,差异无统计学意义(P>0.05);结合组患者治疗后6、12个月的累积复发率明显低于灌肠组,灌肠组患者治疗后6、12个月的累积复发率均明显低于常规组,差异有统计学意义(P<0.05).结论 白头翁汤中药灌肠治疗可有效提高溃疡性结肠炎患者的近远期疗效,及可有效改善患者的炎症状态和免疫状态,同时具有良好的安全性,且配合针灸治疗具有更为良好的治疗效果,值得临床作进一步推广.%Objective To investigate the The short-term and long-term curative effects and safety of acupuncture combined with traditional Chinese medicine (TCM) enema in treatment of ulcerative colitis.Methods Two hundred patients with ulcerative colitis who were diagnosed and treated in our hospital from September 2010 to September 2016 were enroled in the study. According to random number table,all the patients were divided into TCM therapy group and conventional therapy group,with 100 patients in each group.Moreover the patients in TCM therapy group were redivided into enema therapy group and combination therapy group (enema+acupuncture).The patients in conventional therapy group were treated by correcting water and electrolyte balance, fluid infusion and sulfasalazine tablets (1g) oral medication,however,the patients in TCM therapy group,on the basis of conventional therapy group, were treated by TCM (Baitouweng decoction 200g) enema, moreover,the patients in combination therapy group,on the basis of enema group, were treated by acupuncture. The enzyme-linked immunosorbent (ELISA) was used to detect the serum levels of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), neutrophil (PMN) levels. The patients were followed up for 1 year. the curative effects and disappearing time of abdominal pain, bloody stools and diarrhea were statistically analyzed. Moreover the plasma levels of CRP, ESR and PMN before and after treatment,the incidence of adverse reactions during treatment,and accumulation relapse rates on 3m,6m,12m after treatment were observed and compared among the three groups. Results The effective rate in combination therapy group was significantly higher than that in enema therapy group,moreover,which in enema therapy group was significantly higher than that in conventional therapy group (P<0.05).The disappearing time of clinical symptoms in combination therapy group was significantly shorter than that in enema therapy group, which in the latter was significantly shorter than that in conventional therapy group (P<0.05). After treatment the plasma levels of CRP, ESR and PMN in combination therapy group were significantly lower than those in enema therapy group,which in the latter were significantly lower than those in conventional therapy group(P<0.05).There were no significant differences in incidence rates of adverse reactions among the three groups (P >0. 05). Moreover the accumulation relapse rates on 6m,12m after treatment in combination therapy group were significantly lower than those in enema therapy group,which in the latter were significantly lower than those in conventional therapy group (P < 0. 05). Conclusion Baitouweng decoction enema treatment can effectively improve the short-term and long-term curative effects on ulcerative colitis,which can effectively improve the inflammation and immune status of patients,with safety, furthermore,combined treatment with acupuncture and moxibustion has better curative effects,therefor which is worth using widely in clinical practice.