| ObjectiveUlcerative colitis(chronic nonspecific ulcerative colitis) is a disease of digestive tract characterised by chronic inflammation and ulceration of colonic mucous membrane.Clinical manifestation:mucus,pus and blood stool;diarrhea; abdominal pain;tenesmus and so on.It has anfractousive pathogenesy,which they affect each other and even emerge vicious cycle.It causes UC easily to relapse and last a very long period.At present,aminosalicylic acid,cortex steroid hormone and immunomodulator is the effective western medicine.In active stage of ulcerative colitis,these medicine can quickly control the symptoms.The clinical remission rate is high.But the disease is easily recur after drug withdrawal.And side reaction is multi with long-term medication,which causes very low compliance.Professor Wang Xinyue,my tutor who studies UC based on the theory of Traditional Chinese Medicine and Modern Medicine,expound it accurately. Kuijiefufafang is my tutor's proved recipe based on treating with p norishing Qi, promoting blood circulation,removing toxic materials.The topic evaluate its therapeutic and resisting relapse effect.It meanwhile investigates the mechanism of resisting relapse effect from the view of restraining the reaction of inflammatory injury,promoting the repair of colonic mucous membrane combining.We deeply analyze the mechanism of repressing recur after henosis in order to offer the objective evidence of reasonably selecting the treating method and medicine.MethodsThe CR study was strictly designed under correlated standard.In combination with actual clinical situation,adopting random positive control method,on the basis of diagnosis criterion established on Inflammatory Bowel Disease Seminar at Jinnan in 2007,60 cases of chronic recurrent type in UC active phase and chronic type was selected from out-patient clinic(OPD) and ward of Dongzhimen Hospital, Dongfang Hospital,China-Japan friendship Hospital,treated group received tutor's proved recipe(parching excrementum pteropi 10g,raw pollen typhae 10g, angelicae 10g,red and white peony root 10g apiece,charred semen arecae 10g, roasted radix aucklandiae 10g,coptidis rhizoma 10g,amoorcorn tree bark 10g, raw astragali 30g,forsythia suspensa 20g,parching atractylodes macrocephala 10g),control group received sulfasalazine(SASP),(4-6g/d).Both treatment course was 3 months,and attended by 6 months partly,mainly observed index:1. Therapeutic effect,including clinical general effect,change of TCM syndrome,the change of clinical activity index(CAI),endoscopic index(EI) and relapse rate.2. serum Antineutrophil cytoplasmic antibody(ANCA) 3.colon mucous membrane Smad7 and IκBα.ResultsEvaluation of therapeutic effect and resisting relapse effect①Clinical general therapeutic effect of treated group is better than control group;Including the total remission percentage of two groups,total effective percentage of two group,the statistic significant is difference,treated group is obviously better than control group.②After treatment,the relapse rate in six months of treated group is obviously lower than that of control group.③Syndrome scores of treated group was dropped apparently,the forward improvement of treated group is better than control group.④CAI and EI of treated group significantly dropped after treatment,the forward improvement of control group was better than control group(P<0.01).⑤There was no obvious ill-effect on treated group,which is obviously lower than control group.Researching on mechanism of resisting relapseClinical index:①Serum ANCA concentration of patients in UC active phase were remarkably higher than normal value.ANCA is significant in differential diagnosis of UC;P-ANCA has something to do with the reactiveness of UC,especially patients with positive P-ANCA which can be an index monitoring the active UC;The casual relation among ANCA→vasculitis of intestinal mucosa→UC was not sure;The rate of ANCA becoming negative of.the herbal group is obviously higher than the western medicine group,so was when treating the recurrent UC which showed the preponderance in improving the patients'immunologic derangement.②Colon mucous Smad7 concentration of patients in UC active phase were remarkably higher than normal value.Colon mucous Smad7 concentration in relapse phase of UC patients were significantly higher than that of not relapse patients.After treatment and after six months of attending,colon mucous Smad7 concentration of treated group were significantly lower than that of control group.③Colon mucous IκBαconcentration of patients in UC active phase were remarkably lower than normal value.Colon mucous IκBαconcentration in relapse phase of UC patients were significantly lower than that of not relapse patients.After treatment and after six months of attending,colon mucous IκBαconcentration of treated group were significantly higher than that of control group.ConclusionWe have got satisfied therapeutic effect in treating UC by using the methods of norishing Qi,promoting blood circulation,removing toxic materials guided by determination of treatment based on differentiation of syndromes.And the therapeutic effect was obviously better than SASP.Especially in the TCM syndrome,CAI,EI,and resisting relapse,showed its superiority.Compared with western medicine,it had no obvious ill-effect.The following is the contra-relapse mechanism of Chinese medicine:1.Restraining the multi expression of Smad7, preventing the aggregation of inflamed cell;2.Raising the expression of ANCA, down regulating the condition of local immunity;3.Raising the expression of Colon mucous IκBαsince nonage so as to enhance mucosa epithelial cell proliferation,lessen apoptosis,promoting the repair of injuried mucous membrane in later stage. |
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