益氣健脾清熱解毒法治療潰瘍性結(jié)腸炎臨床研究

1、益氣健脾清熱解毒法治療潰瘍性結(jié)腸炎臨床研究         11-05-15 11:07:00     編輯：studa20              作者：張四方,朱偉光,何明大,楊建剛,李燦【摘要】  目的 觀察益氣健脾清熱解毒法對(duì)潰瘍性結(jié)腸炎的臨床療效以及中醫(yī)臨床證候改善情況。方法 將99例潰瘍性結(jié)腸炎患者隨機(jī)分為中藥組(n=51)

2、和西藥組(n=48),分別給予益氣健脾清熱解毒法立方的中藥內(nèi)服和灌腸以及常規(guī)西藥內(nèi)服和灌腸治療,療程4周,比較2組臨床療效以及中醫(yī)臨床證候改善情況,并對(duì)影響臨床療效的因素進(jìn)行Pearson相關(guān)分析。結(jié)果 中藥組有效率為96.1%,優(yōu)于西藥組79.2%(2=6.639,P<0.05)；治療后中藥組較西藥組在腹脹、納差、乏力的改善上更為明顯(P<0.05或P<0.01)；相關(guān)分析結(jié)果顯示,臨床療效與病變部位、病情分級(jí)、臨床分型和中藥干預(yù)顯著性相關(guān)(相關(guān)系數(shù)為0.300.37,P<0.05或P<0.01)。結(jié)論 益氣健脾清熱解毒法能有效改善潰瘍性結(jié)腸炎患者的中醫(yī)證候,提

3、高臨床療效和患者的生活質(zhì)量。 【關(guān)鍵詞】  潰瘍性結(jié)腸炎；益氣健脾；清熱解毒；中醫(yī)藥療法    Abstract：Objective To investigate the therapeutic effect on ulcerative colitis by methods of reinforcing qi, strengthing spleen and clearing heat antitoxicant. Methods 99 patients were divided into two groups randomly：the treatment

4、group for oral and enteroclyste use with TCM following in the principle mentioned above, the control group for oral and enteroclyste use with western medicine following in the common practice. Comparative studies on the total therapeutic effect and the improvement of TCM syndromes between the two gr

5、oups were made. Meanwhile, the Pearson correlation analysis were made to explore the relationship between the clinical effectiveness and impact factors in two groups. Results There were significant differences in the total curative effect and the improvement of TCM syndromes between two groups (P<

6、;0.05, P<0.01), with the higher proportion of the TCM group being bettered. The Pearson correlation analysis showed that the clinical effectiveness was significantly highly correlated to diseased region, clinical stages, clinical classification and TCM intervention. Conclusion Methods of reinforc

7、ing qi, strengthing spleen and clearing heat antitoxicant, which were proved to be a good clinical effect on ulcerative colitis, would be a better choice on the treatment of ulcerative colitis and has a prospective future in the clinical application.    Key words：ulcerative colitis；re

8、inforcing qi, strengthing spleen；clearing heat antitoxicant；TCM therapy    潰瘍性結(jié)腸炎(UC)又稱慢性非特異性潰瘍性結(jié)腸炎,系原因不明的大腸黏膜慢性炎癥和潰瘍性病變,臨床以腹瀉、黏液膿血便、腹痛為特征。我們采用益氣健脾、清熱解毒法組方治療潰瘍性結(jié)腸炎取得較好療效,現(xiàn)報(bào)道如下。1  資料與方法1.1  一般資料    本科門診及病房于2002年6月2006年2月收治UC患者120例,其中男性68例,女性52例,年齡1563歲,平均36歲,病程

9、0.520年,平均11年；初發(fā)型38例,慢性復(fù)發(fā)型61例,慢性持續(xù)型21例；按臨床嚴(yán)重程度分級(jí)其中輕度48例,中度72例。按數(shù)字表法隨機(jī)分為中藥組和西藥組,每組60例。治療前2組患者年齡、性別、病程、分型、病情輕重經(jīng)均衡性檢驗(yàn)均無(wú)顯著性差異(P<0.05),具有可比性。1.2  診斷標(biāo)準(zhǔn)    參照2000年全國(guó)炎癥性腸病學(xué)術(shù)會(huì)議UC診斷標(biāo)準(zhǔn)1。排除細(xì)菌性痢疾、阿米巴痢疾、慢性血吸蟲病、腸結(jié)核等感染性結(jié)腸炎及結(jié)腸克羅恩病、缺血性結(jié)腸炎、放射性結(jié)腸炎等。1.3  治療方法1.3.1  中藥組 中藥內(nèi)服。按益氣健脾、清熱解

10、毒法確立基本方：黃芪30 g,白術(shù)10 g,茯苓10 g,防風(fēng)炭10 g,三七粉5 g, 蒲公英12 g,枳殼10 g,敗醬草10 g,黃連6 g,黃芩10 g,甘草5 g。加減：大腸濕熱證明顯、里急后重者去枳殼、茯苓,加葛根10 g、土茯苓15 g、木香6 g；大便膿血較多者加紫珠草、地榆炭各10 g；大便白凍黏液較多者去炒白術(shù),加蒼術(shù)10 g、薏苡仁15 g；腹痛較甚者加延胡索10 g理氣止痛；大便夾不消化食物者加神曲10 g；兼見脾腎陽(yáng)虛者加干姜、補(bǔ)骨脂各10 g；兼見肝郁脾虛證者加郁金、香附各10 g；兼見血瘀腸絡(luò)證者加當(dāng)歸10 g、赤芍15 g；脾胃氣虛證明顯者加黨參20 g；兼見陰

11、血虧虛證者加當(dāng)歸、白芍各15 g。日1劑,水煎服,取汁300 mL,分2次服,療程4周。中藥灌腸。方藥：苦參20 g,黃柏15 g,大黃10 g,忍冬藤15 g。依據(jù)病變涉及直腸、直乙狀結(jié)腸、左半結(jié)腸、全結(jié)腸的不同分別取汁100300 mL,采取左側(cè)臥位,臀部墊高10 cm、轉(zhuǎn)跪式胸膝位抬高臀部5 cm灌腸,隨后臥床抬高臀部休息30 min,保留2 h以上。每日1次,療程4周。1.3.2  西藥組 口服美沙拉嗪(5-氨基水楊酸,艾迪莎)1.0 g,每日1次,療程4周。柳氮磺胺吡啶(SASP)2.0 g,粉碎后依據(jù)病變部位不同加入3738 的生理鹽水100200 mL中灌腸,灌腸方法同上,每日1次,療程4周。1.4  觀察指標(biāo)    2組患者治療前、治療后2周及治療后4周分別測(cè)定血常規(guī)、肝功能,同時(shí)觀察記錄2組治療前后臨床癥狀和體