理肠清湿和营汤联合益生菌、美沙拉嗪治疗溃疡性结肠炎的疗效及对炎症因子与肠道功能的影响

Effects of Lichang Qingshi Heying Decoction combined with probiotics and mesalazine on inflammatory factors and intestinal function in ulcerative colitis

摘要

目的 探讨理肠清湿和营汤联合益生菌制剂、美沙拉嗪对溃疡性结肠炎(UC)患者炎性因子及肠道功能的影响。方法 以2022年9月至2025年9月江南大学附属医院、常熟市中医院收治的129例UC患者为研究对象, 采用随机数字表法分为对照组(予以美沙拉嗪治疗)、益生菌组(予以益生菌制剂、美沙拉嗪治疗)、中西医结合组(予以理肠清湿和营汤联合益生菌制剂、美沙拉嗪治疗), 每组43例, 三组患者均治疗4周, 后随访6个月。统计三组治疗4周后的临床疗效、随访期间复发情况及治疗期间不良反应发生情况, 比较三组治疗前和治疗4周后中医证候积分、血清炎症因子水平及肠道功能。结果 治疗4周后, 对照组、益生菌组、中西医结合组总有效率呈升高趋势(P<0.05); 随访期间, 中西医结合组复发率低于对照组、益生菌组(P<0.05)。治疗4周后三组腹痛、腹泻、便下黏液脓血、肛门灼热、里急后重、身热、口臭、口干口苦、小便短赤评分与治疗前比较, 均较治疗前降低, 且三组呈逐渐降低趋势(P<0.05)。治疗4周后三组血清转化生长因子β₁、P选择素、细胞间黏附分子1水平与治疗前比较, 均较治疗前降低, 且三组呈逐渐降低趋势(P<0.05)。治疗4周后三组血清D乳酸、二胺氧化酶、内毒素水平与治疗前比较, 均较治疗前降低, 且三组呈逐渐降低趋势(P<0.05)。治疗期间, 对照组、益生菌组、中西医结合组总不良反应发生率比较, 差异均无统计学意义(P>0.05)。结论 理肠清湿和营汤联合益生菌制剂、美沙拉嗪可有效缓解UC患者中医证候, 降低机体炎症反应, 改善其肠道功能, 降低患者复发的风险, 具有良好的临床疗效, 同时安全性良好。

Abstract

Objective To explore the effects of Lichang Qingshi Heying Decoction combined with probiotic preparation and mesalazine on inflammatory factors and intestinal function in patients with ulcerative colitis (UC). Methods A total of 129 UC patients admitted to Affiliated Hospital of Jiangnan University and Changshu Hospital of Traditional Chinese Medicine from September 2022 to September 2025 were randomly divided into the control group (treated with mesalazine), the probiotic group (treated with probiotic preparation and mesalazine), and the integrated traditional Chinese and western medicine group (treated with Lichang Qingshi Heying Decoction combined with probiotic preparation and mesalazine), with 43 patients in each group, and all three groups were treated for 4 weeks and followed up for 6 months. The clinical efficacy after 4 weeks of treatment, recurrence during the follow-up period and adverse reactions during the treatment of the three groups were statistically analyzed, and the traditional Chinese medicine syndrome points, serum inflammatory factor levels and intestinal function were compared between the three groups before and after 4 weeks of treatment. Results After 4 weeks of treatment, the total effective rate of the control group, the probiotic group and the integrated traditional Chinese and western medicine group increased (P<0.05). During the follow-up period, the recurrence rate of the integrated traditional Chinese and western medicine group was lower than that of the control group and the probiotic group (P<0.05). After 4 weeks of treatment, the scores of abdominal pain, diarrhea, mucus and pus in the stool, burning anus, tenesmus, body heat, halitosis, dry mouth and bitter taste, and short and red urine in the three groups decreased compared with those before treatment, and the scores in the three groups showed a gradually decreasing trend (P<0.05). After 4 weeks of treatment, the serum levels of transforming growth factor-β₁, P-selectin and intercellular adhesion molecule-1 in the three groups decreased compared with those before treatment, and the levels in the three groups showed a gradually decreasing trend (P<0.05). After 4 weeks of treatment, the serum levels of D-lactic acid, diamine oxidase and endotoxin in the three groups decreased compared with those before treatment, and the levels in the three groups showed a gradually decreasing trend (P<0.05). During the treatment, there was no significant difference in the incidence of total adverse reactions among the control group, the probiotic group and the integrated traditional Chinese and western medicine group (P>0.05). Conclusion Lichang Qingshi Heying Decoction combined with probiotic preparation and mesalazine can effectively relieve the traditional Chinese medicine syndromes of UC patients, reduce the inflammatory reaction of the body, improve their intestinal function and reduce the risk of recurrence, which has good clinical efficacy and good safety.

关键词

溃疡性结肠炎 / 美沙拉嗪 / 益生菌 / 理肠清湿和营汤 / 炎性因子 / 肠道功能 / 治疗结果 / 中医证候

Key words

ulcerative colitis / mesalamine / probiotics / Lichang Qingshi Heying Decoction / inflammatory cytokines / intestinal function / treatment outcome / traditional Chinese medicine syndrome

参考文献

[1] 彭小婕, 张昌越, 周代超, 等. 前列腺素E2介导的EP4受体通路通过抑制内质网应激减轻溃疡性结肠炎黏膜损伤的研究[J]. 解放军医学院学报, 2024, 45(1): 78-83, 105. DOI: 10.12435/j.issn.2095-5227.2024.013.

[2] WANGCHUK P, YESHI K, LOUKAS A. Ulcerative colitis: clinical biomarkers, therapeutic targets, and emerging treatments[J]. Trends Pharmacol Sci, 2024, 45(10): 892-903. DOI: 10.1016/j.tips.2024.08.003.

[3] DAMIANOS J A, OSIKOYA O, BRENNAN G. Upadacitinib for acute severe ulcerative colitis: a systematic review[J]. Inflamm Bowel Dis, 2025, 31(4): 1145-1149. DOI: 10.1093/ibd/izae191.

[4] TAN L Y, LI Z Q, WU J Z, et al. Ginsenoside Rk2 provides multidimensional relief for ulcerative colitis by improving intestinal barrier function, reshaping gut microbiota, and regulating Th17/treg balance[J]. J Agric Food Chem, 2025, 73(40): 25340-25357. DOI: 10.1021/acs.jafc.5c04210.

[5] 范永强, 陈林, 徐玉峰, 等. 白头翁汤灌肠治疗溃疡性结肠炎的疗效及对患者氧化应激水平的影响[J]. 川北医学院学报, 2026, 41(1): 57-61. DOI: 10.3969/j.issn.1005-3697.2026.01.012.

[6] 王秋晓, 唐学贵, 唐诗宇, 等. 甘草泻心汤加减联合美沙拉嗪对溃疡性结肠炎肠道功能屏障及色氨酸代谢的影响分析[J]. 中华中医药学刊, 2024, 42(7): 112-115. DOI: 10.13193/j.issn.1673-7717.2024.07.025.

[7] 李丽萍, 袁星星, 李婧. 解毒化瘀汤治疗溃疡性结肠炎活动期(大肠湿热证)的临床观察[J]. 中国中医急症, 2026, 35(2): 182-185. DOI: 10.3969/j.issn.1004-745X.2026.02.013.

[8] 商娟娟, 程晓昱, 葛岚, 等. 热瘀散口服联合灌肠方及美沙拉嗪治疗溃疡性结肠炎的临床疗效观察[J]. 时珍国医国药, 2025, 36(20): 3914-3918. DOI: 10.70976/j.1008-0805.SZGYGY-2025-2017.

[9] 常熠, 刘英军, 金辉. 参苓薏苡三七方联合止血生肌汤灌肠对脾虚湿热证溃疡性结肠炎患者的临床疗效[J]. 中成药, 2024, 46(6): 1862-1866. DOI: 10.3969/j.issn.1001-1528.2024.06.014.

[10] 朱阳阳, 李倩, 刘萌, 等. 苓桂术甘汤调控miR-140-5p/TLR4/NF-κB信号通路对溃疡性结肠炎大鼠肠黏膜屏障及免疫平衡的影响[J]. 重庆医科大学学报, 2024, 49(9): 1086-1094. DOI: 10.13406/j.cnki.cyxb.003586.

[11] 中华中医药学会脾胃病分会. 消化不良中医诊疗共识意见(2009)[J]. 中国中西医结合杂志, 2010, 30(5): 533-537.

[12] 国家中医药管理局. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 96-97.

[13] 叶佳, 刘畅, 朱梅萍. 痛泻汤结合针刺治疗溃疡性结肠炎临床效果及对血清炎症因子、肠道菌群的影响[J]. 辽宁中医杂志, 2024, 51(6): 159-162. DOI: 10.13192/j.issn.1000-1719.2024.06.042.

[14] DE DEO D, DAL BUONO A, GABBIADINI R, et al. Management of proctitis in ulcerative colitis and the place of biological therapies[J]. Expert Opin Biol Ther, 2024, 24(6): 443-453. DOI: 10.1080/14712598.2024.2369189.

[15] RUBIN D T, ANANTHAKRISHNAN A N, SIEGEL C A, et al. ACG clinical guideline update: ulcerative colitis in adults[J]. Am J Gastroenterol, 2025, 120(6): 1187-1224. DOI: 10.14309/ajg.0000000000003463.

[16] 姜洪宇, 陈萌, 关露春, 等. 从“肠道黏膜屏障完整性”角度探讨黄芩汤治疗溃疡性结肠炎的机制[J]. 中华中医药学刊, 2024, 42(3): 113-118. DOI: 10.13193/j.issn.1673-7717.2024.03.021.

[17] 胡选亚, 杨丛家, 徐录梅, 等. 自拟肠宁方联合美沙拉嗪调控PERK/NF-κB通路治疗溃疡性结肠炎[J]. 华中科技大学学报(医学版), 2025, 54(2): 255-260. DOI: 10.3870/j.issn.1672-0741.24.03.016.

[18] 郑小娟, 叶旭星, 胡雨飞, 等. 清热渗湿汤化裁调节TLR4/NF-κB信号通路改善溃疡性结肠炎的作用机制研究[J]. 中华中医药学刊, 2025, 43(12): 157-161. DOI: 10.13193/j.issn.1673-7717.2025.12.028.

[19] 王熙丹, 严安, 黄海阳, 等. 基于代谢组学探讨消食白头翁汤治疗溃疡性结肠炎的疗效及机制[J]. 中药新药与临床药理, 2025, 36(7): 1123-1130. DOI: 10.19378/j.issn.1003-9783.2025.07.010.

[20] 李晓玲, 吴玉泓, 李海龙, 等. IL-6/JAK2/STAT3通路中葛花解酲汤对脾虚湿热型溃疡性结肠炎“炎癌转化”的预防作用[J]. 中国免疫学杂志, 2024, 40(7): 1454-1460, 1466. DOI: 10.3969/j.issn.1000-484X.2024.07.018.

[21] 吴静珠, 刘志朝, 胡斌杰, 等. 中药白头翁汤联合氨基水杨酸治疗溃疡性结肠炎的疗效和不良反应: 一项更新的荟萃分析[J]. 世界科学技术中医药现代化, 2024, 26(9): 2355-2373. DOI: 10.11842/wst.20230802006.

[22] 段晓鑫, 黄深, 杨桃, 等. 安肠汤调控P2X7R/NF-κB/NLRP3/GSDMD通路对溃疡性结肠炎大鼠炎症和细胞焦亡的影响[J]. 时珍国医国药, 2025, 36(23): 4429-4435. DOI: 10.70976/j.1008-0805.SZGYGY-2025-2304.

[23] 高猎防, 马俊远, 郑梦晓, 等. 基于Nrf2/SLC7A11/GPX4通路调控铁死亡探讨黄连厚朴汤对溃疡性结肠炎模型小鼠的影响[J]. 海南医科大学学报, 2025, 31(21): 1630-1638. DOI: 10.13210/j.cnki.jhmu.20250221.005.

[24] 陈天, 王泽惠, 彭云花, 等. 加味葛根芩连汤联合针刺对大肠湿热型溃疡性结肠炎患者的临床疗效[J]. 中成药, 2025, 47(2): 453-457.

[25] 李瑞萍, 王世宇, 魏秀楠, 等. 基于miR-21/SOCS1/JAK1/STAT6信号通路探讨黄芪败酱薏仁汤对溃疡性结肠炎大鼠肠黏膜屏障的修复作用[J]. 中国实验方剂学杂志, 2025, 31(16): 96-104. DOI: 10.13422/j.cnki.syfjx.20242440.

[26] 占彦雯, 胡丽霞, 徐伟鸿, 等. 黄芩汤调控Keap1/Nrf2通路对溃疡性结肠炎铁死亡的影响[J]. 中华中医药学刊, 2026, 44(1): 171-174, 282-284. DOI: 10.13193/j.issn.1673-7717.2026.01.034.

[27] 王翊文, 夏裔灵, 刘尔乐, 等. 芍药汤通过调控糖代谢重编程影响Th17/Treg细胞平衡治疗溃疡性结肠炎[J]. 中国实验方剂学杂志, 2025, 31(13): 78-85. DOI: 10.13422/j.cnki.syfjx.20250604.

[28] 刘帅, 冯欢欢, 李昂. 不同益生菌制剂对溃疡性结肠炎患者血清TMAO、凝血功能和肠道黏膜屏障功能的影响比较[J]. 现代消化及介入诊疗, 2024, 29(7): 799-804. DOI: 10.3969/j.issn.1672-2159.2024.07.009.

[29] 朱文颖, 袁瑞兴. 益生菌辅助清肠愈疡汤联合康复新液保留灌肠对溃疡性结肠炎疗效、免疫炎症和氧化应激的影响[J]. 现代消化及介入诊疗, 2024, 29(6): 726-730. DOI: 10.3969/j.issn.1672-2159.2024.06.015.

基金资助

江苏省中医药科技发展计划项目青年人才项目(QN202513)