摘要
目的观察四君子汤加味治疗溃疡性结肠炎(Ulcerative colitis,UC)患者的临床疗效及对其肠道菌群的调节作用。方法回顾性分析2020年1月—2022年6月期间重庆大学附属三峡医院肛肠科收治的UC患者106例,根据治疗方案的不同分为对照组和观察组,每组各53例。对照组给予常规西医综合治疗,观察组在对照组基础上加用四君子汤加味治疗。治疗12周后,观察比较两组患者临床疗效(证候疗效、黏膜病变疗效)、不良反应发生率、随访情况,治疗前后主要结局指标评分(肠镜黏膜表现、组织学病理)、次要结局指标[Sutherland疾病活动指数(Disease Activity Index,DAI)、中医证候评分、生活质量评分(Inflammatory bowel disease questionnaire,IBDQ)]、肠道菌群检测(双歧杆菌、乳杆菌、大肠杆菌及肠球菌)。结果治疗后观察组中医证候疗效总有效率96.23%(51/53)明显高于对照组83.02%(44/53),差异有统计学意义(χ^(2)=8.016,P=0.005)。治疗后观察组黏膜病变疗效总有效率92.45%(49/53)明显高于对照组81.13%(43/53),差异有统计学意义(χ^(2)=4.645,P=0.031)。治疗后两组患者中医证候及病变程度(DAI、肠镜评分、组织病理学)评分均较治疗前降低,IBDQ评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组中医证候及病变程度(DAI、肠镜、组织病理学)评分均较对照组明显降低,IBDQ评分较对照组明显升高,差异有统计学意义(P<0.05)。治疗后两组患者双歧杆菌、乳杆菌两大菌群含量均较治疗前升高,大肠杆菌及肠球菌两菌群含量均较治疗前降低,差异有统计学意义(P<0.05);且观察组双歧杆菌、乳杆菌两大菌群含量均较对照组明显升高,大肠杆菌及肠球菌两菌群含量均较对照组明显降低,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.141,P=0.707)。随访6个月,观察组复发率3.92%(2/51)明显低于对照组22.73%(10/44),差异有统计学意义(χ^(2)=14.321,P<0.001)。结论四君子汤加味治疗UC能够调节肠道菌群,促进症状缓解及肠黏膜修复,提高近期疗效并降低复发率。
Objective To observe the clinical efficacy of modified Sijunzi Decoction in the treatment of patients with ulcerative colitis(UC)and its regulatory effect on the intestinal flora.Methods The clinical data of 106 patients with chronic UC admitted to Department of Proctology of Chongqing University Three Gorges Hospital from January 2020 to June 2022 were retrospectively analyzed.According to the different treatment plans,They were divided into two groups a control group and an observation group,with 53 cases in each group.The control group received conventional Western medicine comprehensive treatment,while the observation group received modified Sijunzi Decoction treatment in addition to the treatment in the control group.After 12 weeks of treatment,T clinical efficacy a(syndromic efficacy,mucosal lesion efficacy),incidence of adverse reactions,follow-up outcomes,and major outcome indicators before and after treatment(colonoscopic mucosal presentation,histopathology),secondary outcome indicators[Sutherland Disease Activity Index(DAI),traditional Chinese medicine syndrome score,Inflammatory Bowel Disease Questionnaire(IBDQ)],and intestinal flora detection(Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus)was compared and analyzed.Results After treatment,the total effective rate of traditional Chinese medicine syndrome efficacy in the observation group were 96.23%(51/53),significantly higher than 83.02%(44/53)in the control group,with a statistically significant difference(χ^(2)=8.016,P=0.005).The total effective rate of mucosal lesion efficacy in the observation group was 92.45%(49/53),significantly higher than 81.13%(43/53)in the control group,with a statistically significant difference(χ^(2)=4.645,P=0.031).After treatment,both groups showed a decrease in traditional Chinese medical syndrome and lesion scores(DAI,colonoscopy score,and histopathological score),and increase in IBDQ score compared to before treatment,with statistically significant differences(P<0.05).The observation group had significantly lower scores for traditional Chinese medicine syndrome and lesion severity(DAI,colonoscopy,histopathology)and significantly higher IBDQ scores compared to the control group,with statistically significant differences(P<0.05).After treatment,both groups showed an increase in the content of Bifidobacterium and Lactobacillus,and a decrease in the content of Escherichia coli and Enterococcus,with statistically significant differences(P<0.05).The observation group had a significantly higher content of Bifidobacterium and Lactobacillus,and a significantly lower content of Escherichia coli and Enterococcus compared to the control group,with statistically significant differences(P<0.05).During the treatment period,the incidence of adverse reactions was comparable between the two groups,with no statistically significant difference(χ^(2)=0.141,P=0.707).At a 6-month follow-up,the recurrence rate in the observation group was 3.92%(2/51),significantly lower than 22.73%(10/44)in the control group,with a statistically significant difference(χ^(2)=14.321,P<0.001).Conclusion Modified Sijunzi Decoction can regulate intestinal flora,promote symptom relief and intestinal mucosal repair,improve short-term efficacy and reduce recurrence rate in the treatment of chronic UC.
作者
杨年美
王镇澜
杨碧英
贾道勇
汪爱平
龚亮
廖健
李进安
YANG Nian-mei;WANG Zhen-lan;YANG Bi-ying;JIA Dao-yong;WANG Ai-ping;GONG Liang;LIAO Jian;LI Jin-an(Department of Proctology,Chongqing University Three Gorges Hospital,Chongqing 404000)
出处
《世界中西医结合杂志》
2024年第1期134-139,144,共7页
World Journal of Integrated Traditional and Western Medicine
基金
重庆市卫生计生委中医药科技项目(201708268)。
关键词
溃疡性结肠炎
四君子汤
肠道菌群
疗效
复发
Ulcerative colitis
Sijunzi Decoction
Intestinal flora
Efficacy
Recurrence
