主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2019, Vol. 42 ›› Issue (8): 685-690.doi: 10.3969/j.issn.1006-2157.2019.08.013

• 临床研究 • 上一篇    下一篇

溃疡性结肠炎及其中医辨证分型与炎症活动性指标的相关性分析*

张天涵; 沈洪#   

  1. 1 南京中医药大学附属医院 江苏 210029
  • 收稿日期:2019-01-25 出版日期:2019-08-30 发布日期:2019-09-04
  • 通讯作者: 沈洪,男,博士,教授,主任医师,博士生导师,主要研究方向:中医内科脾胃病,E-mail:shenhong999@163.com
  • 作者简介:张天涵,女,在读硕士生
  • 基金资助:
    *国家中医药行业科研专项资助项目(No.201407001),国家重点研发计划资助项目(No.2017YFC1700104)

Ulcerative colitis and its TCM pattern-differentiation classification and inflammatory activity indexes: a correlation analysis*

Zhang Tianhan, Shen Hong#   

  1. Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu 210029, China
  • Received:2019-01-25 Online:2019-08-30 Published:2019-09-04
  • Contact: Prof. Shen Hong, Ph. D., Chief Physician, Doctoral supervisor. Department of Gastroenterology, Jiangsu Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing 210029. E-mail: shenhong999@163.com

摘要: 目的 通过搜集、分析溃疡性结肠炎患者的临床资料,探讨溃疡性结肠炎及其中医辨证分型与其炎症活动性指标的相关性。方法 收集2017年1月-2019年2月于江苏省中医院就诊且符合纳入标准的溃疡性结肠炎患者325例,对纳入患者进行疾病分期活动性分级和病变范围分类,采集临床信息进行中医辨证分型,并收集患者外周血红细胞沉降率(ESR)、C-反应蛋白(CRP)、粪便钙卫蛋白(FC)的数据;运用卡方检验、独立样本t检验、单因素方差分析、Spearman相关分析等方法进行统计,探讨溃疡性结肠炎中医证型及病变范围、疾病分期、活动性分级与炎症活动性指标的相关性。结果 325例溃疡性结肠炎患者的中医证型以大肠湿热证最多见(53%),其次是脾虚湿蕴证(34%)、肝郁脾虚证(13%);大肠湿热证组炎症活动性指标水平(ESR、CRP、FC)均明显高于肝郁脾虚证组、脾虚湿蕴证组,而肝郁脾虚证组ESR、CRP、FC则略高于脾虚湿蕴证组(P<0.05);疾病活动期患者ESR、CRP、FC比临床缓解期明显升高(P<0.05);重度活动组患者明显高于轻度活动组、中度活动组,中度活动组高于轻度活动组(P<0.05)。广泛结肠型炎症活动性指标水平表达最高,左半结肠型次之,直肠型最低(P>0.05)。临床缓解期患者中医证型以脾虚湿蕴证为主,其次是肝郁脾虚证,再次为大肠湿热证;轻度活动期患者以脾虚湿蕴证为主,其次是大肠湿热证,再次为脾虚肝郁证;中度及重度活动期患者均以大肠湿热证为主(P<0.05)。纳入325例患者的ESR、CRP、FC水平与Mayo评分均呈正相关,各证型亚组之中,大肠湿热证患者ESR、CRP、FC与Mayo评分相关度最高(P<0.05)。结论 ESR、CRP、FC水平可客观反映溃疡性结肠炎临床疾病活动及严重程度,其中在大肠湿热证中预测意义最大,可协助临床评估和中医药疗效评估,提高溃疡性结肠炎的诊疗水平。

关键词: 溃疡性结肠炎, 炎症活动性指标, 疾病分期, 中医辨证分型

Abstract: Objective To discuss the correlation among ulcerative colitis (UC), its TCM pattern differentiation and inflammatory activity indexes through collecting and analyzing the clinical materials from UC patients. Methods UC patients (n=325), who visited Jiangsu Hospital of Chinese Medicine and were eligible to internalized standard, were chosen from Jan. 2017 to Feb. 2019. The patients were classified according to disease activity grades and lesion ranges, and their clinical information was collected for TCM pattern differentiation. At the same time the data of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fecal calprotectin (FC) were collected. The data was analyzed statistically by using chi-square test, independent sample t-test, single-factor analysis of variance and Spearman correlation analysis. The correlation among TCM pattern types, lesion ranges, stages, activity classification of UC and inflammatory activity indexes were discussed. Results The TCM pattern types in 325 patients, the most common one was large intestinal dampness-heat pattern (53%), and secondly ones were spleen deficiency with dampness accumulation pattern (34%) and liver depression and spleen deficiency pattern (13%, P<0.05). The levels of inflammatory activity indexes (ESR, CRP and FC) were higher in group of large intestinal dampness-heat pattern than those in group of liver depression and spleen deficiency pattern, and was a little higher in group of liver depression and spleen deficiency pattern than those in group of spleen deficiency with dampness accumulation pattern (P<0.05). The levels of inflammatory activity indexes (ESR, CRP and FC) increased significantly in patients at UC active stage compared with those at clinical remission stage (P<0.05). The levels of inflammatory activity indexes (ESR, CRP and FC) were significantly higher in severe active group than those in mile active group and moderate active group, and were higher in moderate active group than those in mile active group (P<0.05). The expressions of inflammatory activity indexes (ESR, CRP and FC) were the highest in patients with extensive UC, the secondly higher in patients with left hemicolon UC and the lowest in patients with rectal UC (P>0.05). The TCM pattern type was mainly spleen deficiency with dampness accumulation pattern, secondly was liver depression and spleen deficiency pattern and thirdly was large intestinal dampness-heat pattern in patients at clinical remission stage. The TCM pattern type was mainly spleen deficiency with dampness accumulation pattern, secondly was large intestinal dampness-heat pattern and thirdly was liver depression and spleen deficiency pattern in patients at mile active stage. The TCM pattern type was mainly large intestinal dampness-heat pattern in patients at moderate active stage and severe active stage (P<0.05). The levels of ESR, CRP and FC were positively correlated to Mayo scores in 325 patients, and the relevancy was the highest between ESR, CRP and FC and Mayo scores in patients with large intestinal dampness-heat pattern (P<0.05). Conclusion The levels of ESR, CRP can objectively reflect the clinical activity and severity of UC, and large intestinal dampness-heat pattern has the highest predictive value. It can assist clinical and curative effect reviews and improve UC diagnosis and treatment levels.

Key words: ulcerative colitis, inflammatory activity indexes, disease stages, TCM pattern-differentiation classification

中图分类号: 

  • R256.3