| BackgroundUlcerative colitis is a type of inflammatory bowel disease.34%to 45%of patients with moderate to severe UC need glucocorticoid therapy.30%of patients with severe UC have poor response to steroid therapy and develop steroid-resistance or steroid-dependence as steroid-refractory ulcerative colitis.The clinical treatment of steroid-refractory UC is more difficult,and the rate of colon resection is high.It has become one of the difficult diseases of digestive system diseases.At present,immunosuppressant and biologic agent conversion treatment are often used for patients with steroid-refractory UC in clinical treatment,but there are also problems such as large toxic and side effects,high recurrence rate,and poor patient compliance.Due to repeated episodes of illness,prolonged healing,long-term risk of cancer and prone to complicated toxic megacolon,some patients must be treated with surgical resection of the colon.Traditional Chinese medicine has obvious advantages in treating this disease.It can be treated with syndrome differentiation to regulate the function of organs,assist the gradual reduction of steroid to disable,maintain remission and reduce recurrence,thereby reducing the rate of colon resection and improving the prognosis.Objective1.Compare the difference in clinical manifestations between steroid-refractory group and steroid-effective group,and study the clinical features of patients with steroid-refractory ulcerative colitis.2.Observe the therapeutic effects of Qingrequshijianpihuayu prescription combined with western medicine on steroid-refractory ulcerative colitis.Methods1.From April 2015 to January 2018,in china-japan friendship hospital outpatient and ward of digestive internal medicine,diagnosed and treated of 66 patients with moderate and severe ulcerative colitis were enrolled,according to the patient responds to steroid therapy,they were divided into steroid-refractory group and steroid-effective group.Compare the differences between the two groups of patients through the statistical analysis of the patient's basic data,classification staging,clinical symptoms,colonoscopy,pathological examination,laboratory examinations,follow-up and other relevant data.2.Observe curative effect of 22 cases of steroid-refractory ulcerative colitis patients taking Qingrequshij ianpihuayu prescription combined with western medicine,including:syndrome score,the main symptom scores,the mucosa lesion score,disease activity score,etc.Results1.The study included 66 patients with ulcerative colitis,30 cases steroid-refractory group and 36 cases steroid-effective group.The male to female ratio of steroid-refractory group was 1.31:1(17/13),aged within 18-69,their mean age was 42.08±11.99,The male to female ratio of steroid-effective group was 0.89:1(17/19),aged within 20-69,their mean age was 41.19-13.84,no statistical difference between the two groups of patients with gender and age(P=0.470,0.796).2.Forty-six patients(62.12%)had a course of less than 5 years in 66 patients,11(16.67%)in 5-10 years,and 14 patients(21.21%)more than 10 years of age.The average duration of steroid-refractory group was 7.54±1.59 years,and steroid-effective group was 4.65±0.92 years,no significantly statistical difference(P = 0.176).3.Steroid-refractory group had a significantly higher degree of abdominal pain,tenesmus than steroid-effective group(P = 0.000,0.007).Steroid-refractory group was mainly for the chronic relapse type(96.67%vs 83.33%),clinical classification was all full colonic(100%vs 52.73%),severe ulcerative colitis(100%vs 66.67%).4.The levels of hemoglobin(HGB)and albumin(ALB)in patients with steroid-refractory ulcerative colitis were significantly reduced,and the platelet count(PLT)was significantly increased.The C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)all increased to varying degrees,but there was no statistical difference between the two groups.There were 19 cases(63.33%)of moderate anemia in the steroid refractory group,9 cases(25.00%)of the steroid effective group,17 eases(56,67%)of the hypoproteinemia in the refractory group,and 8 cases(22.22%)of the effective group.The number of patients with moderate anaemia and hypoproteinemia in the steroid refractory group was significantly higher than that in the effective group(P=0.002,0.026).5.The patients were evaluated by the symptoms scale,3 cases had marked effect,17 cases were effective,2 cases had no effect,the total effective rate was 90.91%.After Qingrequshijianpihuayu prescription combined western medicine in the treatment of steroid-refractory ulcerative colitis patients,the main symptom scores such as abdominal pain,diarrhea,and mucopurulent and bloody stools were significantly decreased in patients(P<0.05).6.After 6 months of treatment of Qingrequshijianpihuayu prescription combined western medicine,colonoscopy results showed that mucosal lesion scores of patients with steroid-refractory ulcerative colitis were significantly lower than those before treatment.The Mayo disease activity score showed that the disease activity was significantly less than before the treatment,the clinical remission rate was 23.08%,and the effective rate was 84.62%.7.Follow-up found that 2 cases achieved steroids reduction,7 cases achieved steroids discontinued,1 case achieved immunosuppressant(azathioprine)discontinued,steroids withdrawal success rate was 45.45%,after 5-9 months of Chinese medicine treatment,steroids can be withdrawn and the median withdrawal time is 7 months.Conclusion1.The steroid-refractory ulcerative colitis patients had extensive colon lesions.Compared with the steroid-effective group,the patients had significant symptoms of abdominal pain and tenesmus.2.Platelet counts in patients with steroid-refractory ulcerative colitis were significantly higher,and more than half had moderate anemia and hypoproteinemia.3.Qingrequshijianpihuayu prescription combined western medicine therapy can improve clinical symptoms,repair intestinal mucosa,reduce the disease activity in patients with steroid-refractory ulcerative colitis,can achieve about half of steroid-refractory ulcerative colitis patients with withdrawal or reduction of steroids. |
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