谭朝晖 刘荣火 邹立华 曹平 胡红松

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。

关键词：溃疡性结肠炎；白头翁汤；肿瘤坏死因子-α；白细胞介素-10

DOI：10.3969/j.issn.1005-5304.2016.07.008

中图分类号：R259.741 文献标识码：A 文章编号：1005-5304（2016）07-0030-05

Effects of Baitouweng Decoction on Intestinal Mucosal Healing of Ulcerative Colitis and Study on Partial Mechanism TAN Zhao-hui， LIU Rong-huo， ZOU Li-hua， CAO Ping， HU Hong-song （Longgang District Peoples Hospital of Shenzhen， Shenzhen 518172， China）

Abstract： 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 of Baitouweng 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 with Baitouweng Decoction. Conclusion Baitouweng 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

基金项目：深圳市科技计划项目（JCYJ20150402164314698）

factors and anti-inflammatory factors， and promoting mucosal healing.

Key words： ulcerative colitis； Baitouweng Decoction； tumor necrosis factor-α； interleukin-10

溃疡性结肠炎（ulcerative colitis，UC）是一种原因不明的慢性非特异性炎症性肠病，病变主要累及黏膜及黏膜下层，其临床主要表现为腹泻、黏液脓血便、腹痛和里急后重。UC症状反复、迁延难愈，并有癌变可能，被世界卫生组织列为现代难治病之一。目前西药治疗方法单一，不良反应大、复发率高。中医药在促进溃疡愈合、减轻临床症状、降低疾病活动指数及复发率方面有独到优势[1]。本研究通过观察白头翁汤内服联合灌肠治疗UC临床疗效及对结肠黏膜愈合及细胞因子的影响，探讨白头翁汤防治UC的可能作用机制，为治疗UC筛选有效药物及方法提供依据。

1 资料与方法

1.1 诊断及辨证标准

UC诊断依据中国中西医结合学会消化系统疾病专业委员会2010《溃疡性结肠炎中西医结合诊疗指南（草案）》[2]。……