杨周雨+贲定严+易展+何永恒

摘要：目的 探讨隔药饼灸治疗脾虚湿蕴证轻中度溃疡性结肠炎（UC）的临床疗效及作用机制。方法 采用随机数字表法将60例患者分为观察组和对照组各30例。对照组予美沙拉嗪栓剂，每次1栓，每日1次，置入直肠；观察组在上述基础上加用隔药饼灸。将药饼（制附子、党参、黄连、丹参、延胡索、木香3︰3︰2︰2︰2︰1配制）置于穴位（第1組为脾俞、中脘、足三里，第2组为大肠俞、天枢、上巨虚，每次取1组，2组交替使用），将艾炷置于药饼上，每壮灸5 min，每次灸3壮，每日1次。疗程均为8周。观察治疗前后主要症状（腹泻、腹痛、脓血便）评分及总分、肠镜Baron评分和血清CC亚族趋化因子配体20（CCL20）蛋白表达水平，评价临床疗效，观察不良反应。结果 观察组和对照组的总有效率分别为93.33%（28/30）、76.67%（23/30），观察组优于对照组（P<0.05）；2组治疗后主要症状评分及总分、肠镜Baron评分及血清CCL20蛋白表达水平较治疗前下降（P<0.05），与对照组比较，观察组治疗后各指标改善更明显（P<0.05）；观察组、对照组分别出现1、2例不良反应，差异无统计学意义（P>0.05）。结论 隔药饼灸治疗脾虚湿蕴证轻中度UC安全有效，其作用可能与调节CCL20蛋白表达水平有关。

关键词：溃疡性结肠炎；脾虚湿蕴证；隔药饼灸；美沙拉嗪栓剂；血清CC亚族趋化因子配体20

DOI：10.3969/j.issn.1005-5304.2017.04.009

中图分类号：R259.746.2 文献标识码：A 文章编号：1005-5304（2017）04-0032-04

Clinical Study on Medicinal-cake-separated Moxibustion Treatment for Mild-to-moderate Ulcerative Colitis of Spleen Deficiency and Dampness Type YANG Zhou-yu1， BI Ding-yan2， YI Zhan2， HE Yong-heng3 （1. Changsha Hospital of Chinese Medicine， Changsha 410100， China； 2. Hunan University of Chinese Medicine， Changsha 410208， China； 3. The Second Hospital of Hunan University of Chinese Medicine， Changsha 410005， China）

Abstract： Objective To explore clinical efficacy and mechanisms of medicinal-cake-separated moxibustion treatment for mild-to-moderate ulcerative colitis （UC） of spleen deficiency and dampness type. Methods Totally 60 cases were randomly divided into observation group and control group according to a random digits table， with 30 cases in each group. The control group was inserted into the anus with mesalamine suppository 1 g once a day， while the observation group was given medicinal-cake-separated moxibustion treatment once a day based on the treatment for the control group. Medicinal cake （Aconiti Lateralis Radix Praeparata： Codonopsis Radix： Coptidix Rhizoma： Salviae Miltiorrhizae Radix et Rhizoma： Corydalis Rhizoma： Aucklandiae Radix=3：3：2：2：2：1） was put on the acupoints （Pishu， Zhongwan and Zusanli for the first group， Dachangshu， Tianshu and Shangjuxu for the second group， one group for each time， and 2 groups were used interchangeably）. One wormwood cylinder was put on medicinal cake， 5 min each time， 3 doses each time， once a day. The treatment course for all was 8 weeks. The main symptom scores （diarrhea， bellyache， pus and blood stool） and total scores， colonoscopy Baron score and serum CC chemokine ligand 20 （CCL20） expression level were compared between before and after treatment in the two groups. The clinical efficacy was evaluated and the adverse reactions were observed. Results The total effective rate in observation group was 93.33% （28/30） and significantly higher than that of the control group of 76.67% （23/30）. After the treatment， the main symptom scores and total scores， colonoscopy Baron score and serum CCL20 expression level were significantly lower than those of pre-treatment in the same one group （P<0.05）， which of the observation group were remakably lower than those of the control group （P<0.05）； there was one case occured adverse reaction in the observation group and two cases in the control group， with no statistical significance between the two groups （P>0.05）. Conclusion Medicinal-cake-separated moxibustion treatment is effective and safe in patients with mild-to-moderate UC of spleen deficiency and dampness type， which effects might be involved in regulating the expression of serum CCL20.endprint

Key words： ulcerative colitis； spleen deficiency and dampness type； medicinal-cake-separated moxibustion treatment； mesalamine suppository； serum CC chemokine ligand 20

潰疡性结肠炎（ulcerative colitis，UC）具有迁延不愈、反复发作的特点，发病机制目前尚不明确，大多数研究认为与肠道黏膜免疫紊乱、肠道微生态有关[1]。趋化因子作为促炎细胞因子，在UC发病发展中起着重要作用。有研究指出，UC患者CC亚族趋化因子配体20（CCL20）mRNA及蛋白表达水平明显高于正常对照组，且与肠道炎症程度呈正相关，可作为治疗UC的评价指标[2-3]。目前西药治疗UC近期疗效较好，但长期服用易产生耐药性，停药后易复发，并存在一定的不良反应。……