白头翁汤对溃疡性结肠炎黏膜愈合的影响及部分机制研究

摘要

目的：检测溃疡性结肠炎（UC）患者血清肿瘤坏死因子-α（TNF-α）和白细胞介素-10（IL-10）水平，探讨白头翁汤治疗UC的临床疗效、对结肠黏膜愈合的影响及其机制。方法将66例UC患者随机分为治疗组和对照组，分别给予白头翁汤内服联合灌肠及口服美沙拉嗪缓释颗粒，疗程4周。采用Mayo评分系统及Baron内镜评分法评定UC活动度及临床疗效，采用ELISA检测血清TNF-α、IL-10水平，并与20名健康对照者进行比较。结果治疗组内镜缓解率为51.4%（19/35），高于对照组的25.8%（8/31），差异有统计学意义（P＜0.05）；治疗组临床缓解率和有效率分别为74.2%和88.6%，对照组分别为45.1%和64.5%，差异有统计学意义（P＜0.05）；治疗组组织学缓解率和有效率分别为25.7%和54.3%，对照组分别为16.1%和35.5%，差异无统计学意义（P＞0.05）。血清TNF-α水平与Mayo评分、Baron评分及组织学评分均呈明显正相关（r分别为0.836、0.735、0.527，P＜0.01），血清IL-10水平与Mayo评分、Baron评分及组织学评分均呈明显负相关（r分别为-0.704、-0.695、-0.509，P＜0.01）；治疗组治疗后血清TNF-α水平较治疗前明显降低（P＜0.05），血清IL-10水平较治疗前明显升高（P＜0.05）。结论白头翁汤内服联合灌肠治疗活动性UC安全有效，其作用可能与改善促炎因子与抗炎因子失衡、促进肠黏膜愈合有关。%Objective To detect the levels of tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10) in the plasma of patients with ulcerative colitis (UC); To investigate the clinical efficacy ofBaitouweng Decoction for UC and its influence on intestinal mucosal healing and partial mechanism.Methods Totally 66 patients with UC were randomly assigned to the treatment group and the control group. Patients in the treatment group were treated with Baitouweng Decoction (oral and enema treatment) and those in the control group took Mesalazine for 4 weeks. Before and after treatment, the therapeutic effects were assessed by Mayo scoring system and the grading of activities was evaluated by Baron Endoscope. Serum levels of TNF-α and IL-10 were detected by ELISA. Besides, another 20 healthy volunteers were recruited as the healthy control group for comparison.Results The endoscopic remission rate was 51.4% (19/35) in treatment group, higher than that of the control group (25.8%, 8/31,P<0.05). The clinical remission rate and efficacy rate in the treatment group were 74.2% and 88.6% respectively, higher than those of the control group (45.1% and 64.5%,P<0.05). The histological remission rate and efficacy rate in the treatment group were 25.7% and 54.3% respectively, higher than those of the control group (16.1% and 35.5%), without statistical significance (P>0.05). Serum levels of TNF-α were obviously positive correlated with Mayo score, Baron score and histology score (r=0.836, 0.735, 0.527,P<0.01). Serum levels of IL-10 were obviously negative correlated with Mayo score, Baron score and histology score (r=-0.704, -0.695, -0.509,P<0.01). Compared with pre-treatment, the serum levels of TNF-α significantly decreased (P<0.01), while the serum levels of IL-10 significantly increased (P<0.01) after treatment withBaitouweng Decoction.ConclusionBaitouweng Decoction (oral and enema treatment) is effective and safe in patients with UC. Its effects might be involved in regulating the imbalance of pro-inflammatory factors and anti-inflammatory factors, and promoting mucosal healing.