李倩倩 金玲肖 夏晨梅 王雨银 陈霞

[摘要] 目的 探討替普瑞酮联合美沙拉嗪对溃疡性结肠炎（UC）临床疗效及其作用机制。 方法 选取2018年1月至2019年12月在温岭市第一人民医院就诊的溃疡性结肠炎活动期患者80例，采用随机数字表法将患者分为美沙拉嗪组与联合组，每组各40例，疗程为2个月。利用Mayo评分系统记录患者用药前后症状变化及不良反应。治疗前后分别测定患者血清中CRP、ESR、IL-2、IL-6、IL-10、TNF-α、HSP70的水平变化。 结果 ①联合组治疗后临床Mayo评分较美沙拉嗪组下降更明显（P<0.05），且并无增加不良反应发生。②两组治疗后CRP、ESR水平较治疗前下降（P<0.05），且联合组较美沙拉嗪组下降更明显（P<0.05）。③在炎症因子方面，治疗后促炎因子IL-2、IL-6、TNF-α表达水平下降（P<0.05），抑炎因子IL-10水平升高（P<0.05），与美沙拉嗪组相比联合组效果更加明显（P<0.05）。④联合组较美沙拉嗪组HSP70水平升高更显著，两组比较差异有统计学意义（P<0.05）。 结论 替普瑞酮联合美沙拉嗪治疗溃疡性结肠炎的疗效优于美沙拉嗪单药组，其机制可能为通过增加肠道黏膜HSP70表达水平，更有效地抑制炎症反应，阻止UC进展，为临床治疗提供新方案。

[关键词] 溃疡性结肠炎;替普瑞酮;炎症因子;热休克蛋白

[中图分类号] R573.1          [文献标识码] B          [文章编号] 1673-9701（2021）07-0057-05

The clinical efficacy of teprenone combined with mesalazine in treatment of ulcerative colitis

LI Qianqian   JIN Lingxiao   XIA Chenmei   WANG  Yuyin   CHEN Xia

Department of Gastroenterology，the First People′s Hospital of Wenling in Zhejiang Province， Wenling   317500， China

[Abstract] Objective To explore the clinical efficacy and action mechanism of teprenone combined with mesalazine on ulcerative colitis（UC）. Methods From January 2018 to December 2019， a total of 80 patients with active UC admitted to the First People′s Hospital of Wenling were collected. The patients were randomLy divided into the mesalazine group（n=40） and combined group（n=40） by random number table，and the course of treatment is 2 months.The Mayo scoring system was used to record the symptom changes and adverse reactions （ADRs） before and after medication. Serum CRP， ESR， IL-2， IL-6， IL-10， TNF-α and HSP70 were determined before and after treatment. Results ①After treatment， the clinical Mayo score of the combined group decreased significantly than the mesalazine group（P<0.05）， and there was no increase in ADRs. ②The levels of CRP and ESR in the two groups decreased after treatment（P<0.05）， especially in the combined group than the mesalazine group（P<0.05）. ③In terms of inflammatory factors， after treatment， the expression levels of pro-inflammatory factors IL-2， IL-6 and TNF-α decreased （P<0.05）， while the level of anti-inflammatory factor IL-10 increased（P<0.05）， and the efficacy of the combined group was more obvious than that of than the mesalazine group（P<0.05）.④HSP70 level in the combined group was higher than that in the mesalazine group， and the difference between the two groups was statistically significant（P<0.05）. Conclusion The efficacy of teprenone combined with mesalazine in the treatment of UC is better than that of mesalazine alone， and its mechanism increases the expression level of HSP70 in intestinal mucosa， inhibits inflammatory reaction more effectively，prevents the progress of UC， and provides a new scheme for clinical treatment.

[Key words] Ulcerative colitis; Teprenone; Inflammatory factor; Heat shock protein

溃疡性结肠炎（Uncleractive colitis，UC）是一种不明原因的慢性非特异性肠道炎性疾病，属于炎症性肠病（Inflammatory bowel disease，IBD）的一种。临床表现为腹泻、腹痛、黏液血便、里急后重等肠道症状及贫血、发热、营养不良等全身症状，多数患者病情反复、病程长，严重影响其正常工作及生活[1]。

目前UC的病因及发病机制尚不完全清楚，既往研究表明其主要由免疫反应介导，并与感染、遗传、环境因素密切相关，炎症因子在其中发挥重要作用[2-3]。近来年有研究显示，热休克蛋白70（Heat shock protein 70，HSP70）与肠道炎症相关，是肠道黏膜对炎症损伤的保护反应，可能在UC的发生发展过程中发挥作用[4-5]。替普瑞酮作为消化道黏膜保护剂促进HSP70的表达是其重要机制之一[6]。目前关于替普瑞酮对UC的临床疗效的研究甚少，因此本研究旨在探讨替普瑞酮联合美沙拉嗪对UC患者的临床疗效，并分析其对炎症因子的影响，为临床UC的治疗提供新思路，现报道如下。……