| Background and ObjictiveUlcerative colitis (chronic nonspecific ulcerative colitis) is adisease of digestive tract characterised by chronic inflammation andulceration of colonic mucous membrane. Etiopathogenisis andpathogenesis of the disease is not very clear. Because of its difficultyto cure ,long course of disease and easily to be cancer of colon,it hasbeen known as difficuly disease in the world.At present,there are noeffective western medicine in treating UC. Even these medicines canquickly control the symptoms,the clinical remission rate is high. Andthe disease is easily recurring after drug withdrawal. And side reactionis multi with long-term medication. These medicines are not ideal tointractable cases. Chinese medicine has remarkable preponderance intreating this disease and is obviously superior to western medicine intotal curative effect.The topic is beginning with the mechanism of immunologic injury,controling the reaction of inflammatory and improving the microcosmiccirculation . We deeply investigate the mechanism of chinese Medicinemethods in treating from the aspects of regulating cellular immunefunction, restraining the reaction of inflammatory injury, promoting therepair of colonic mucous membrane. We deeply analyze the mechanism ofrepressing recur after henosis in order to offer the objective evidenceof reasonably selecting the treating method and medicine. Thus, we canpropose the multiple rings treating theory of UC and the way ofmicrocosmic syndrome differentiation.MethodsThe study was strictly designed under the guidance of GUIDELINE FORNEW DRUGS CLINICAL TRIALS (1997 Edition 3) Guidelines for Treament ofChronic Unspecific Ulcerative Colitis with Chinese Materia Medica. Incombination with actual clinical situation, adopting random positivecontrol method, on the basis of diagnosis criterion established onInflammatory Bowel Disease Seminar at chengdu in 2000, 87 case of chronicrecurrent type in UC active phase was selected from out-patient clinic(OPD) and ward of Dongzhimen Hospital, 301 Hospital, 306 Hospital,treated group received tutor's proved recipe (trogopterus xanthipesmilne-edwards excrement 10g , typha angustifolia pollen10g, root and redpaeonia root of herbaceous peony 10g apiece,Chinese angelica 6g,driedbetel palm10g, the rhizome of Chinese goldthread 10g, the bark of a corktree 10g , saussurea lappa Clarke root 10g ,forsythia10g, bge root 20g),control group received sulfasalazine (SASP), (4-6g/d). Both treatment course was 3 months, and attend 6 months, main observed index: 1.Therapeutic effect, including clinical general effect, change of TCMsyndrome, therapeutic effect of mucous membrane under endoscope,therapeutic effect of mucous membrane under microscope, the change ofclinical activity index, CAI, endoscopic index. 2. Immue index of bothgroups before and after treatment, CD4+/CD8+/CD3+of peripheral blood,serum Tumornecrosis factor-alpha (TNF-α), plasma TetramethylpyrazineB2(TXB2), 6-keto-prostaglandin F1α(6-Keto-PGF1α). TNF-α,TXB2, 6-Keto-PGF1αwere also detected in 20 normal persons as normal control.ResultsObservation of therapeutic effect1. Clinical general therapeutic effect of treated group is betterthan control group (P<0.001); the total remission percentage of two group(68.18% vs 41.86%), total effective percentage of two group(95.45% vs74.42%), the statistic significant is difference, treated group isobviously better than control group.2.After treatment, the relapse rate in six months of treated groupis obviously lower than that of control group(P<0.001).3. Syndrome scores of treated group was dropped apparently, theforward improvement of treated group is better than control group(P<0.001).4. Clinical activity index (CAI) and endoscopic index of treatedgroup significantly dropped after treatment (P<0.05), the forwardimprovement of control group was better than control group (P<0.001).5. There was no obvious ill-effect on treated group, but three casesof control group had ill-effect, one case stopped receiving treatmentbecause of it.6. After six months of treatment, the pathologic grade and endoscopegrade of the treated group significantly lower than control group(P<0.001).7. After six months of treatment, the qualities of the treated groupwere significiantly better than control group (P<0.001).The change of immune index1. CD3+ cellular counting, CD8+ cellular counting and percentage ofperipheral blood in active phase of UC patients were significantly higherthan that of normal reference criterion, ratio of CD4+/CD8+, and CD4+ cellular percentage were significantly lowerer than that normalreference criterion, and have relationship with degree of disease andlesion range. There was no difference of CD4+ cellular counting ofperipheral blood between UC patients and healthy people.CD3+ cellular counting ,CD8+ cellular counting and percentage ofperipheral blood in relapse phase of UC patients were significantlyhigher than that of not relapse patients, ratio of CD4+/CD8+, and CD4 +cellular percentage were significantly lowerer than that not relapsepatients.CD3+ cellular counting ,CD8+ cellular counting and percentage ofperipheral blood in treated group were significantly lower than that ofcontrol group, ratio of CD4+/CD8+, and CD4+cellular percentage weresignificantly higher than that of control group after treatment and aftersix months of treatment, CD3+ cellular counting,CD8+ cellular countingand percentage, ratio of CD4 + /CD8 + , CD4 + cellular percentage ofperipheral blood in treated group after six months of treatment weresimilar compared with them after treatment. And CD3+ cellular counting,CD4+cellular counting ,CD8+ cellular counting and percentage in controlgroup after six months of treatment were significantly differentcompared with them after treatment(P<0.05).2. Serum TNF-αconcentration of patients in UC active phase wereremarkblely higher normal value (P<0.001).Serum TNF-αconcentration in relapse phase of UC patients weresignificantly higher than that of not relapse patients.After treatment, serum TNF-αconcentration of treated group weresignificantly lower than that of control group (P<0.001). After sixmonths of treatment, serum TNF-αconcentration of treated group weresignificantly lower than that of control group (P<0.001);The value oftreated group were similar compared with them after treatment; The valueof control group had significantly diffrence compared with them aftertreatment(P<0.001).3.Plasma TXB2,6-Keto-PGF1αconcentration and ratio ofTXB2/6-Keto-PGF1αof patients in UC active phase were remarkblely highernormal value (P<0.001).Plasma TXB2,6-Keto-PGF1αconcentration and ratio ofTXB2/6-Keto-PGF1αin relapse phase of UC patients were significantlyhigher than that of not relapse patients.After treatment, Plasma TXB2,6-Keto-PGF1αconcentration and ratio ofTXB2/6-Keto-PGF1αof treated group were significantly lower than that ofcontrol group (P<0.001). After six months of treatment, Plasma TXB2,6-Keto-PGF1αconcentration and ratio of TXB2/6-Keto-PGF1αof treatedgroup were significantly lower than that of control group (P<0.001);Thevalues of treated group were similar compared with them after treatment;The value of control group had significantly diffrence compared with themafter treatment (P<0.001).ConclusionsWe have got satisfied therapeutic effect in treating UC by using themethods of determination of treatment based on differentiation ofsyndromes. And the therapeutic effect was obviously better than SASP.Especially in the TCM syndrome, endoscopic index, pathologic index and contra- relapse, showed its superiority in the betterment of livingquality. Compared with western medicine, it had no obvious ill-effect.The following is the contra- relapse mechanism of Chinese medicine: 1.Restraining the excessive generation of T type of lymphocyte subgroup,regulating the accentuated cellular immune function; regulating thedisequilibrium of T type of lymphocyte subgroup, improving cellularimmunity all over the body;2. Restraining the multi expression of TNF-α, preventing the aggregation of inflamed cell;3. Promoting thecirculation of blood so as to promote the repair of injuried mucousmembrane. 4. Improving the qualities of the patients. Therefore, weconsider that chinese medicine has the role of prevent immunologic injury,restraining mucosa injury, promoting repair, so can repress recur afterhenosis . |
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