運用“土郁奪之”理論指導治療濕熱內蘊型潰瘍性結腸炎的系統評價

朱葉珊++陳建權++劉建平

[摘要] 目的 觀察運用“土郁奪之”理論指導治療濕熱內蘊型潰瘍性結腸炎的臨床效果并對其進行可能的機制探討。 方法 將2015年1月～2016年6月河北省玉田縣醫院及河北省唐山市中醫醫院收治的濕熱內蘊型潰瘍性結腸炎患者74例，將其隨機分為治療組（37例）陳皮、茯苓、梔子、半夏、黃芩、黃柏、連翹、竹茹、阿膠、伏龍肝等）口服治療，對照組給予美沙拉嗪腸溶片口服和安慰劑口服治療，兩組均以4周為1個療程。觀察兩組的臨床癥狀療效、結腸鏡療效和血清IL-17、IL-23及IL-10的含量。 結果 治療1個療程后，治療組的臨床癥狀療效、結腸鏡療效的總有效率分別為94.59%和97.30%，對照組分別為81.08%和86.49%，治療組的臨床癥狀療效和結腸鏡療效均優于對照組（P < 0.05）。治療后，兩組患者血清IL-17、IL-23含量較治療前顯著降低，差異有統計學意義（P < 0.05），且治療后，治療組血清IL-17、IL-23含量顯著低于對照組，差異有統計學意義（P < 0.05）；治療后，兩組患者血清IL-10含量均顯著高于治療前（P < 0.05），且治療組治療后血清IL-10含量高于對照組，差異有統計學意義（P < 0.05）。治療過程中，兩組患者均未出現嚴重的不良反應。 結論 運用“土郁奪之”理論指導治療濕熱內蘊型潰瘍性結腸炎的臨床癥狀效果和結腸鏡效果均顯著，其作用機制可能與降低血清IL-17、IL-23水平和升高血清IL-10的含量有關，且無不良反應，值得臨床推廣使用和進行下一步的深入研究。

[關鍵詞] 土郁奪之；濕熱內蘊型；潰瘍性結腸炎；系統評價

[中圖分類號] R574.05 [文獻標識碼] A [文章編號] 1673-7210（2017）04（a）-0109-04

[Abstract] Objective To observe the clinical effect of "Tuyu Duozhi" in the treatment of ulcerative colitis with damp-heat syndrome and to explore its possible mechanism. Methods Seventy-four patients of ulcerative colitis with damp-heat syndrome were randomly divided into treatment group （37 cases） and control group （37 cases）. The patients were treated in Yutian County Hospital and Tangshan Traditional Chinese Medicine Hospital from January 2015 to June 2016. The treatment group was given Mesalazine Enteric-coated Tablets combined with traditional Chinese medicine decoction （using the theory of "Tuyu Duozhi" theory cube Qingzhong Decoction： Coptidis Rhizoma， Citri Reticulatae Pericarpium， Poria， Gardeniae Fructus， Pinelliae Rhizoma， Scutellariae Radix， Phellodendri Chinensis Cortex， Forsythiae Fructus， Bambusae Caulis In Taenias， Asini Corii Colla， Terra Flavausta， etc.） oral treatment， the control group was given Mesalazine Enteric-coated Tablets and placebo oral treatment， two groups were taken 4 weeks as a course of treatment. The clinical symptoms effect， colonoscopy effect， the contents of serum IL-17， IL-23 and IL-10 were observed in the two groups. Results After one course of treatment， the total effective rates of the clinical symptoms effect and colonoscopy effect were 94.59% and 97.30% in the treatment group respectively， which were 81.08% and 86.49% in the control group， the clinical symptoms effect and colonoscopy effect of the treatment group were better than the control group （P < 0.05）. After treatment， the serum levels of IL-17 and IL-23 in the two groups were significantly lower than those before treatment （P < 0.05）， after treatment， the levels of serum IL-17 and IL-23 in the treatment group were lower than the control group （P < 0.05）， after treatment， the levels of serum IL-10 in the two groups were significantly higher than those before treatment （P < 0.05）， after treatment， the level of serum IL-10 in the treatment group was higher than that in the control group， the difference was statistically significant （P < 0.05）. In the course of treatment， there were no serious adverse reactions in the two groups. Conclusion The clinical symptoms effect and colonoscopy effect of "Tuyu Duozhi" in the treatment of ulcerative colitis with damp-heat syndrome are significant. The mechanism may be related to the decrease of serum IL-17， IL-23 levels and the increase of serum IL-10 levels， with no adverse reactions， it is worthy of clinical use and the next step in-depth study.