郭志伟 徐跃军 唐迎春 车浩 陈艳 黄婷 孙易娜

摘要 目的：觀察肠炎1号中药液对肝郁脾虚型溃疡性结肠炎患者的疗效。方法：选取2017年8月至2018年8月武汉市第八医院收治的肝郁脾虚型溃疡性结肠炎患者70例作为研究对象，按随机数字表法随机分为对照组和观察组，每组35例。对照组于美沙拉嗪缓释颗粒常规治疗，观察组在对照组基础上加用肠炎1号中药液。治疗后评估患者治疗前后的临床症状及疗效。检测并比较患者外周血清中T细胞相关炎性反应递质的水平，比较2组治疗前后免疫组织化学阳性细胞分布面积。结果：治疗后，对照组治疗有效率为42.86%，明显高于观察组的65.71%，差异有统计学意义（P<0.05）;2组患者白细胞介素-17（IL-4）和IL-4和IL-10水平较治疗前升高，IL-17和γ干扰素（IFN-γ）水平降低，IFN-γ/IL-4和IL-17/IL-10的比值较治疗前降低，但观察组降幅更明显，差异有统计学意义（P<0.05）。2组患者NLRP-6、Caspase-1、IL-18基因降低，观察组比对照组降低更明显，差异有统计学意义（P<0.05）。结论：肠炎1号中药液对肝郁脾虚型溃疡性结肠炎具有较好的治疗效果，并能够促使T细胞Th1/Th2及Th17/Treg介导炎性反应递质朝炎性抑制方向转化。

关键词 肠炎1号中药液;肝郁脾虚型;溃疡性结肠炎;症状积分;IFN-γ/IL-4比值;IL-17/IL-10比值;炎性抑制;治疗效果

Abstract Objective：To observe the effects of Traditional Chinese medicine （TCM） solution of enteritis No.1 on patients with ulcerative colitis of liver stagnation and spleen deficiency.Methods：A total of 70 patients with liver stagnation and spleen deficiency type ulcerative colitis treated in Wuhan No.8 Hospital from August 2017 to August 2018 were selected as the research subjects，and were divided into a control group and an observationgroup according to the random number table method，with 35 cases in each group.The control group received conventional treatment with mesalazine sustained-release granules，and the observation group was supplemented with enteritis No.1 TCM solution on the basis of the control group.After the treatment，the clinical symptoms and efficacy of patients before and after treatment were evaluated.The contents of T-cell-related inflammatory cytokines in the serum of peripheral blood of patients were detected and compared，and the distribution area of immunohistochemically positive cells before and after treatment was compared between the 2 groups.Results：After treatment，the effective rate of treatment was 42.86% in the control group，significantly higher than 65.71% in the observation group （P<0.05）.The levels of IL-4 and IL-10 in the serum of the 2 groups were higher than those before treatment，and the levels of IL-17 and IFN-γ were lower than those before treatment.The ratio of IFN-γ/IL-4 and IL-17/IL-10 in the 2 groups was lower than that before treatment，but the reduction in the observation group was more significant （P<0.05）.The NLRP-6，Caspase-1，and IL-18 genes were decreased in the 2 groups，but observation group was more significantly reduced than the control group （P<0.05）.Conclusion：Enteritis No.1 TCM solution has a good therapeutic effects on ulcerative colitis with liver stagnation and spleen deficiency，and can promote T1 / Th2 and Th17 / Treg-mediated transformation of inflammatory cytokines towards inflammatory inhibition.

Keywords Enteritis No.1; Traditional Chinese medicine liquid; Liver stagnation and spleen deficiency type; Ulcerative colitis; Symptom scores; IFN-γ / IL-4 ratio; IL-17 / IL-10 ratio; Inflammatory inhibition; Therapeutic effects

中图分类号：R289.5;R574.62文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.13.023

溃疡性结肠炎（Ulcerative Colitis，UC）好发于大肠黏膜层，临床中患者常以腹痛、腹泻、脓血便等作为首诊症状[1]。研究表明UC的发病机制涉及到遗传、免疫、生活环境及肠道菌群等多种方面，既往研究得出T细胞介导的Th1/Th2，Th17/Treg免疫平衡失调则被公认为UC发病最重要的免疫因素[2]。UC患者在中医中被归属为病变在肠的“痛”“泻”范畴。中医相关研究还表明，溃疡性结肠炎发病多为脾肾虚弱，血瘀气滞为标，UC患者多有情志不畅，肝气郁结[3]。肠炎1号中药液方剂源自《伤寒论》加减，由白头翁、黄柏、黄芪、金银花、地榆炭、侧柏叶、荆芥炭、枳壳、槐花、小薊、柴胡、党参、升麻、当归、陈皮等组成，功效为清热利湿，消肿止痛，益气健脾，收涩止泻，凉血止血，化腐生肌，促进溃疡愈合，治疗效果较好[4-5]，其作用机制目前考虑为利用中医药来调节T细胞介导的炎性反应。……