| 摘要: |
| 目的：观察糜蛋白酶联合锡类散保留灌肠疗法对溃疡性结肠炎（UC）的临床疗效，以及对血清炎症因子和外周血辅助性 T 细胞（Th17）、调节性 T 细胞（Treg）的影响。方法：收集 158 例 UC 患者临床资料，随机数字表法分为治疗组83 和对照组 75 例。对照组给予美沙拉嗪肠溶片口服、保留灌肠，同时灌肠液中加入庆大霉素、氟美松，治疗组在对照组基础上加用糜蛋白酶、锡类散保留灌肠。根据 Mayo 评分标准，两组患者分为轻、中、重度 3 个亚组。治疗两个疗程后评价两组患者临床有效率、Mayo 评分、内镜评分改善情况。检测正常人群和治疗前后两组患者血清炎症因子（ESR、CRP、TNF-α、IL-6）的表达，流式细胞仪检测 Th17 细胞和 Treg 细胞的表达。结果：治疗组患者总有效率为 94.0%，观察组为77.3%，治疗组有效率高于对照组（P<0.05）。治疗后治疗组患者 Mayo 评分、内镜 Baron 评分为（2.25±1.39）、（1.13±0.95），对照组为（3.61±1.61）、（1.60±0.99），治疗组变化更明显（P<0.05）。TNF-α 和 IL-6 表达水平、Th17 细胞数与 UC 分级呈显著正相关，Treg 细胞数与 UC 分级呈显著负相关（P<0.01）。治疗后血清 ESR、CRP、TNF-α、IL-6 表达值下降，治疗组为（11.17±8.01）mm/h、（6.55±5.47）mg/L、（56.42±19.97）ng/L、（154.81±32.29）ng/mL，观察组为（18.07±8.62）mm/h、（16.49±8.32）mg/L、（74.08±20.07）ng/L、（177.47±30.01）ng/mL。Th17 细胞数减少：治疗组（3.18±1.02）、观察组（4.20±1.08）；Treg 细胞数增加：治疗组（8.61±1.52）、观察组（7.50±1.67）；治疗组较对照组变化更明显（P<0.05）。结论：糜蛋白酶联合锡类散保留灌肠疗法治疗 UC 临床效果显著，能明显减轻 UC 患者炎症反应，调节免疫功能。 |
| 关键词: 糜蛋白酶 锡类散 溃疡性结肠炎 血清炎性因子 Th17 细胞 Treg 细胞 |
| DOI：10.3969/j.issn.1007-6948.2019.06.024 |
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| 基金项目: |
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| Clinical Effects of Chymotrypsin Combined with Xilei Powder in Treatmen of Patients with Ulcerative Colitis and its Effect on Inflammatory Response and Immune Function |
| SONG Dong-xu,HE Hong-qin,ZHANG Wen-ling |
| Gastroenterological Surgery, Cangzhou People’s Hospital, Cangzhou (061000), China |
| Abstract: |
| Objective To observe the clinical effificacy of chymotrypsin combined with Xilei Powder retention enema therapy for treatment of ulcerative colitis (UC) and to investigate its effects on serum inflflammatory factors, Th17 cells and Treg cells. Methods The data of 158 patients with UC diagnosed in our hospital from Jan. 2013 to Jul. 2017 were collected. And they were assigned into treatment group and control group according to random number table. The patients in control group were treated with mesalazine enteric-coated tablets orally and retention enema, meanwhile gentamicin and flumethasone were added into the enema solution. And the patients in the treatment group were treated with chymotrypsin and Xilei Powder retention enema therapy based on treatment of the control group. The two groups of patients were divided into three subgroups of light, moderate and severe according to the Mayo score. To evaluate the clinical effificiency, Mayo score and endoscopic score were evaluated after two treatment sessions. The expression levels of ESR, CRP, TNF-α and IL-6 in peripheral blood were detected before and after treatment, and the number of Th17 cells and Treg cells were measured by flflow cytometer. Results After treatment, the levels of Mayo score and Baron score in the two groups were significantly lower than those before treatment, and the changes of the treatment group were more significant than those of the control group (P<0.05). And the difference was statistically signifificant (P<0.05). The expression levels of ESR, CRP, TNF-α, IL-6 and the number of Th17 cells were signifificantly positively correlated with UC grade, while the number of Treg cells was signifificantly negatively correlated with UC grade, and the difference was statistically signifificant (P<0.05). After treatment, the expression of ESR, CRP, TNF-α and IL-6 decreased. Meanwhile the number of Th17 cells decreased, but the number of Treg cells increased, and the changes of the treatment group were more obvious than those of the control group (P<0.05). Conclusion Chymotrypsin combined with Xilei Powder retention enema has a signifificant clinical effect, which can signifificantly reduce the inflflammatory response and regulate the immune function of UC patients. |
| Key words: Chymotrypsi Xilei Powder ulcerative colitis serum inflflammatory cytokines Th17 cells Treg cells |
