血竭地榆合剂灌肠联合美沙拉秦口服下调IL-17对溃疡性结肠炎黏膜愈合的影响

发布时间：2018-07-04 07:47

本文选题：溃疡性结肠炎 + IL-17细胞　；参考：《北京中医药大学》2014年硕士论文

【摘要】：研究目的：本课题运用中药血竭地榆合剂对血瘀肠络型UC患者进行局部保留灌肠,联合美沙拉秦口服,分别对治疗前后患者肠黏膜愈合情况进行评分,检测Th17细胞相关细胞因子IL-17在血清中的表达浓度,探讨血竭地榆合剂局部保留灌肠治疗血瘀肠络型UC在促进黏膜愈合与缓解中医证候方面的优势,根据血清IL-17浓度分析其对肠黏膜愈合的影响。研究方法：诊断标准参照2012年中华医学会消化病学分会炎症性肠病学组制定的《炎症性肠病诊断与治疗的共识意见(2012年·广州)》及2010年中国中西医结合学会消化系统疾病专业委员会制定的《溃疡性结肠炎中西医结合诊疗指南》,选取24位血瘀肠络型溃疡性结肠炎患者纳入试验,随机分为血竭地榆合剂灌肠联合美沙拉秦口服治疗组、美沙拉秦口服对照组(各12例)。予患者疾病活动指数评分、肠镜下肠黏膜分级,并给予中医证候量化分级。两组基础治疗均口服美沙拉秦缓释颗粒剂1.0g,每日3次,4周为一个疗程。取治疗后患者外周血清,采用酶联免疫吸附法(ELISA)检测Th17细胞分泌的相关细胞因子IL-17的浓度；治疗前后采用Rachmilewitz计分法对患者肠黏膜进行肠镜下评分；将治疗前后患者予疾病活动指数评分、中医证候量化分级。所得数据整理后进行统计学分析,观察血竭地榆合剂局部保留灌肠对血瘀肠络型UC的临床疗效,探讨UC患者肠黏膜愈合度与血清IL-17浓度之间的关系。研究结果： IL-17浓度比较：治疗组IL-17浓度15.88±1.87pg/ml,对照组22.03±2.32pg/ml,有统计学意义(P0.05),治疗组IL-17浓度低于对照组；肠镜下黏膜Rachmilewitz积分比较：治疗组3.58±1.83,对照组7.33±1.67,有统计学意义(P0.05),治疗组肠黏膜愈合情况优于对照组；疾病活动指数比较：治疗组积分2.00±1.64,对照组4.25±1.66,有统计学意义(P0.05),治疗组疗效优于对照组；中医证候量化分级积分比较：治疗组8.00±2.70,对照组16.75±4.39,有统计学意义(P0.05),治疗组中医证候疗效优于对照组。研究结论：血竭地榆合剂局部保留灌肠治疗血瘀肠络型溃疡性结肠炎临床有效,血竭地榆合剂灌肠联合美沙拉秦口服治疗效果要优于单纯口服美沙拉秦制剂治疗。治疗组IL-17浓度低于对照组,差异有统计学意义,证实血竭地榆合剂灌肠能有效降低IL-17在UC发展进程中的表达。推断IL-17浓度与UC患者肠黏膜愈合度相关,IL-17降低可减缓肠黏膜损伤进程,促进病变局部炎性细胞因子的平衡,促使黏膜愈合。
[Abstract]:Objective: to evaluate the healing of intestinal mucosa of patients with blood stasis and intestinal collaterals by local retention enema with traditional Chinese medicine Deiyu mixture, combined with mezalazin oral administration, before and after treatment. To detect the expression of Th17 cytokine IL-17 in serum, and to explore the advantages of local retention enema of Dieyu mixture in promoting mucosal healing and relieving TCM syndrome in the treatment of blood stasis and intestinal collaterals type UC. According to the concentration of serum IL-17, the effect of IL-17 on intestinal mucosal healing was analyzed. Methods: the diagnostic criteria were based on the consensus opinion on diagnosis and treatment of inflammatory bowel disease (Guangzhou, 2012) formulated by the inflammatory enteropathy group of the Chinese medical association of digestive diseases in 2012 and the Chinese traditional and western medicine in 2010 The "guidelines for the diagnosis and treatment of Ulcerative Colitis" developed by the Professional Committee on Digestive Diseases of the Society selected 24 patients with ulcerative colitis with blood stasis and intestinal collaterals. The rats were randomly divided into two groups: the control group (n = 12) and the control group (n = 12). The patients were evaluated with disease activity index, intestinal mucosa under enteroscopy, and TCM syndromes were quantified. Two groups of basic treatment were orally Medalazine sustained release granules 1.0 g, 3 times a day for 4 weeks as a course of treatment. The concentration of IL-17 secreted by Th17 cells was detected by enzyme-linked immunosorbent assay (Elisa), and the intestinal mucosa was evaluated by Rachmilewitz scoring method before and after treatment. Patients before and after treatment with disease activity index score, TCM syndromes quantitative grading. To observe the clinical effect of local retention enema of Deiyu mixture on UC with blood stasis and intestinal collaterals, and to explore the relationship between the degree of intestinal mucosal healing and the concentration of serum IL-17 in patients with UC. Results: the concentration of IL-17 was 15.88 卤1.87pg / ml in the treatment group and 22.03 卤2.32pg / ml in the control group (P0.05). The concentration of IL-17 in the treatment group was lower than that in the control group. Comparison of mucosal Rachmilewitz score under enteroscopy: the treatment group (3.58 卤1.83) and the control group (7.33 卤1.67) had statistical significance (P0.05). The healing of intestinal mucosa in the treatment group was better than that in the control group. Disease activity index comparison: the treatment group score 2.00 卤1.64, the control group 4.25 卤1.66, has statistical significance (P0.05), the treatment group is better than the control group; Comparison of TCM syndromes quantitative grading integral: the treatment group 8.00 卤2.70, the control group 16.75 卤4.39, there was statistical significance (P0.05), the treatment group TCM syndrome efficacy is better than the control group. Conclusion: local retention enema with Xue Deiyu mixture is effective in treating ulcerative colitis with blood stasis and collaterals. The concentration of IL-17 in the treatment group was lower than that in the control group, and the difference was statistically significant. It was proved that the enema of Diyu mixture could effectively reduce the expression of IL-17 in the development of UC. It is inferred that the decrease of IL-17 concentration associated with the degree of intestinal mucosal healing in UC patients can slow down the process of intestinal mucosal injury, promote the balance of inflammatory cytokines and promote mucosal healing.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.62

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