加味肠风饮保留灌肠对急性放射性直肠炎患者Th1/Th2的调节作用
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摘要
目的:探讨加味肠风饮保留灌肠治疗急性放射性直肠炎的疗效及对辅助性T细胞(Th) 1/Th2调节作用。方法:将128例患者随机分为对照组和观察组各64例。对照组采用蒙脱石散3. 0 g+地塞米松10 mg+生理盐水100 mL,保留灌肠;观察组采用加味肠风饮(肠风饮+锡类散+珍珠粉)保留灌肠。两组患者均每晚1次灌肠,共连续治疗4周。进行治疗前后各主要症状评分、直肠镜检查、大便常规+隐血、生活质量KPS评分;检测治疗前后Th1细胞因子[白细胞介素(IL)-1β,IL-8,γ-干扰素(IFN-γ)]和Th2细胞因子(IL-4,IL-10)。结果:观察组临床综合疗效总有效率为95. 31%,高于对照组82. 81%(χ2=5. 132,P <0. 05);观察组各项症状评分和总积分均低于对照组(P <0. 01);观察组直肠黏膜损伤程度轻于对照组(Z=2. 764,P <0. 05);观察组直肠黏膜损伤评分低于对照组(P <0. 01),观察组KPS评分高于对照组(P <0. 05);观察组血清IL-1β,IL-8,IFN-γ水平均低于对照组,IL-4,IL-10水平均高于对照组(P <0. 01)。结论:加味肠风饮能进一步的减轻急性放射性直肠炎症状,促进直肠黏膜愈合,提高生活质量,并能调节Th1/Th2细胞因子,能很好的修复肠黏膜。
Objective: To discuss the efficacy of Jiawei Changfengyin with retention enema therapy for acute radiation proctitis and investigate its influence on regulating levels of helper T cell(Th) 1/Th2. Method:One hundred and twenty-eight patients were randomly divided into control group and observation group by random number table. Patients in control group(64 cases) got montmorillonite powder(3. 0 g),dexamethasone(10 mg)and normal saline(100 mL),with retention enema therapy. Patients in observation group(64 cases) got Jiawei Changfengyin(Changfengyin + Xileisan + pearl powder),with retention enema therapy. Both groups of patients received enema once every night,and the treatment course was 4 weeks in both groups. Before and after treatment,scores of main symptoms,proctoscopy,routine examination of stool + occult blood,and KPS scores of quality of life were graded. Levels of Th1 cell factors [interleukin(IL)-1β,IL-8 and interferon-γ(IFN-γ) ],Th2 cell factors(IL-4 and IL-10) were detected. Result: The total effective rate for comprehensive clinical efficacy was 95. 31%in observation group,higher than 82. 81% in control group(χ2= 5. 132,P < 0. 05). Scores of each symptom and the total scores in observation group were lower than those in control group(P < 0. 01). Degree of rectal mucosa injury in observation group was lighter than that in control group(Z = 2. 764,P < 0. 05). Score of rectal mucosal injury was lower than that in control group(P < 0. 01),but score of KSP was higher than that in control group(P < 0. 05). Levels of IL-1β,IL-8 and IFN-γ in observation group were lower than those in control group,while levels of IL-4 and IL-10 were higher than those in control group(P < 0. 01). Conclusion: Jiawei Changfengyin can relieve symptoms of acute radiation proctitis,promote healing of rectal mucosa,improve quality of life,and regulate Th1/Th2 cytokines,with good repairing effect for intestinal mucosa.
Objective: To discuss the efficacy of Jiawei Changfengyin with retention enema therapy for acute radiation proctitis and investigate its influence on regulating levels of helper T cell(Th) 1/Th2. Method:One hundred and twenty-eight patients were randomly divided into control group and observation group by random number table. Patients in control group(64 cases) got montmorillonite powder(3. 0 g),dexamethasone(10 mg)and normal saline(100 mL),with retention enema therapy. Patients in observation group(64 cases) got Jiawei Changfengyin(Changfengyin + Xileisan + pearl powder),with retention enema therapy. Both groups of patients received enema once every night,and the treatment course was 4 weeks in both groups. Before and after treatment,scores of main symptoms,proctoscopy,routine examination of stool + occult blood,and KPS scores of quality of life were graded. Levels of Th1 cell factors [interleukin(IL)-1β,IL-8 and interferon-γ(IFN-γ) ],Th2 cell factors(IL-4 and IL-10) were detected. Result: The total effective rate for comprehensive clinical efficacy was 95. 31%in observation group,higher than 82. 81% in control group(χ2= 5. 132,P < 0. 05). Scores of each symptom and the total scores in observation group were lower than those in control group(P < 0. 01). Degree of rectal mucosa injury in observation group was lighter than that in control group(Z = 2. 764,P < 0. 05). Score of rectal mucosal injury was lower than that in control group(P < 0. 01),but score of KSP was higher than that in control group(P < 0. 05). Levels of IL-1β,IL-8 and IFN-γ in observation group were lower than those in control group,while levels of IL-4 and IL-10 were higher than those in control group(P < 0. 01). Conclusion: Jiawei Changfengyin can relieve symptoms of acute radiation proctitis,promote healing of rectal mucosa,improve quality of life,and regulate Th1/Th2 cytokines,with good repairing effect for intestinal mucosa.
引文
[1]王毓国,秦丽,窦永起.放射性直肠炎的中医临床与实验研究进展[J].解放军医学院学报,2016,37(2):198-200.
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[4]陈宇杰,石志敏.肠风饮灌肠治疗肠风伤络型宫颈癌放疗所致急性放射性直肠炎临床观察[J].中国实验方剂学杂志,2018,24(3):197-201.
[5]黄羚,吴芊,崔人匀,等.锡类散临床拓展应用研究进展[J].中国中医基础医学杂志,2016,22(3):444-447.
[6]王毓国,窦永起,秦丽.黛黄芍药散对放射性直肠炎大鼠Th1/Th2细胞因子影响[J].辽宁中医药大学学报,2017,19(2):16-19.
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[8]中国抗癌协会.新编常见恶性肿瘤诊治规范[M].北京:中国协和医科大学出版社,1999.
[9]中国中西医结合学会消化系统疾病专业委员会.胃肠疾病中医症状评分表[J].中国中西医结合消化杂志,2011,19(1):66-68.
[10]徐富星.下消化道内镜学[M].上海:上海科学技术出版社,2003:297-299.
[11] Tas S,Ozkul F,Arik M K,et al. The effect of amifostine on bacterial translocation after radiation induced acute enteritis[J]. Acta Cirurgica Brasileira,2016,31(3):156-160.
[12]何新颖,孙云川,袁香坤,等.安肠方保留灌肠治疗急性放射性肠炎的临床疗效观察[J].中国中西医结合消化杂志,2015,23(1):31-32.
[13]薛美平,王晞星,李宜放,等.放射性直肠炎中医临证思路探讨[J].光明中医,2015,30(2):221-223.
[14]王馨曼,安颂歌,张磊,等.中药保留灌肠治疗放射性直肠炎疗效的系统评价[J].护理研究,2016,30(1):59-62.
[15]袁庆延,丁曙晴.中医药防治放射性肠炎研究进展[J].世界中医药,2016,11(11):2490-2494.
[16]赵建杰,李刚,高贵峰.锡类散抗炎镇痛实验研究[J].上海中医药杂志,2011,45(2):69-71.
[17]何汶峰,刘宗俊麟,周钰娟,等.锡类散联合消痔灵对慢性放射性直肠炎大鼠TNF-α,IL-6的影响[J].中西医结合心血管病电子杂志,2017,5(18):60-61.
[18]莫明月,林江,韦明婵.珍珠粉解毒生肌作用与临床应用研究进展[J].广西中医药大学学报,2015,18(3):77-79.
[2]刘燕君,史海霞,魏玮.中医药多途径治疗放射性肠炎经验[J].世界中西医结合杂志,2015,10(2):236-239.
[3]李宇飞,贝绍生,李华山.中药保留灌肠治疗放射性直肠炎[J].北京中医药,2017,36(8):727-729.
[4]陈宇杰,石志敏.肠风饮灌肠治疗肠风伤络型宫颈癌放疗所致急性放射性直肠炎临床观察[J].中国实验方剂学杂志,2018,24(3):197-201.
[5]黄羚,吴芊,崔人匀,等.锡类散临床拓展应用研究进展[J].中国中医基础医学杂志,2016,22(3):444-447.
[6]王毓国,窦永起,秦丽.黛黄芍药散对放射性直肠炎大鼠Th1/Th2细胞因子影响[J].辽宁中医药大学学报,2017,19(2):16-19.
[7] Cox J D,Stetz J,Pajak T F. Toxicity criteria of the radiation therapy oncology group(RTOG)and the european organization for research and treatment of cancer(EORTC)[J]. Int J Radiat Oncol Biol Phys,1995,31(5):1341-1346.
[8]中国抗癌协会.新编常见恶性肿瘤诊治规范[M].北京:中国协和医科大学出版社,1999.
[9]中国中西医结合学会消化系统疾病专业委员会.胃肠疾病中医症状评分表[J].中国中西医结合消化杂志,2011,19(1):66-68.
[10]徐富星.下消化道内镜学[M].上海:上海科学技术出版社,2003:297-299.
[11] Tas S,Ozkul F,Arik M K,et al. The effect of amifostine on bacterial translocation after radiation induced acute enteritis[J]. Acta Cirurgica Brasileira,2016,31(3):156-160.
[12]何新颖,孙云川,袁香坤,等.安肠方保留灌肠治疗急性放射性肠炎的临床疗效观察[J].中国中西医结合消化杂志,2015,23(1):31-32.
[13]薛美平,王晞星,李宜放,等.放射性直肠炎中医临证思路探讨[J].光明中医,2015,30(2):221-223.
[14]王馨曼,安颂歌,张磊,等.中药保留灌肠治疗放射性直肠炎疗效的系统评价[J].护理研究,2016,30(1):59-62.
[15]袁庆延,丁曙晴.中医药防治放射性肠炎研究进展[J].世界中医药,2016,11(11):2490-2494.
[16]赵建杰,李刚,高贵峰.锡类散抗炎镇痛实验研究[J].上海中医药杂志,2011,45(2):69-71.
[17]何汶峰,刘宗俊麟,周钰娟,等.锡类散联合消痔灵对慢性放射性直肠炎大鼠TNF-α,IL-6的影响[J].中西医结合心血管病电子杂志,2017,5(18):60-61.
[18]莫明月,林江,韦明婵.珍珠粉解毒生肌作用与临床应用研究进展[J].广西中医药大学学报,2015,18(3):77-79.