Clinical Observation And Mechanism Study Of Pingkui Enema In The Treatment Of Ulcerative Colitis

ObjectivesTo observe the clinical efficacy and safety of Pingkui Enema combined with mesalazine in the treatment of mild to moderate ulcerative colitis mainly in the left half of the colon(damp-heat type of large intestine),and further explore its mechanism.Methods:1.Clinical research:Selected 20 patients with mild to moderate active ulcerative colitis who met the inclusion criteria.On the basis of original oral mesalazine,have en enema vsith Pingkui Enema before bedtime.The whole treatment process is 3 weeks.The TCM symptom score,safety index were observed before and after treatment.Serum diamine oxidase,D-lactic acid and deoxycholic acid and ursodeoxycholic acid were measured by enzyme-linked immunosorbent assay before and after treatment.2.Experimental study:8 of a total of 60 SD rats were randomly selected as the normal group.We replicated the ulcerative colitis model with the remaining 52 rats by trinitrobenzenesulfonic acid + ethanol enema;2 were dissected at random at the 3rd days,so as to observe if the model was successfully established.The remanining 50 rats were randomly divided into 5groups:modem group,sulfasalazine(SASP)grou(0.32g/kg),Pingkui Enema high(1 7.28g/kg),medium(8.64g/kg),low(4.32g/kg)dose group,with 10 rats in each group.The drug administration group was given corresponding drugs for enema treatment,while the normal group and the model group were given equal volume normal saline enema for 10 consecutive days.The change of disease activity index(DAI)in rats was observed.After the materials were collected,the pathological changes of colon mucosa were observed with naked eyes,HE staining was performed for histopathological evaluation.ELISA was used to detect serum D-lactic acidosis,double amine oxidase levels,and deoxycholic acid,ursodeoxycholic acid levels.Results:1.Clinical research:Evaluation of efficacy:The total effective rate was 80%after 3 weeks of treatment.TCM syndrome evaluation:Compared with before treatment,the total score of TCM symptoms after treatment decreased significantly(P<0.01,the difference was statistically significant).In terms of individual symptoms,the symptoms of pus blood stool,diarrhea,abdominal pain,tenesmus,and anal burning were significantly improved after treatment(P<0.05,with statistically significant difference),while the symptoms of poor appetite were not significantly improved(P>0.05,with no statistically significant difference).Safety assessment:Before and after treatment,there were no significant differences in liver function indexes ALT,AST,renal function indexes BUN and Scr,and no adverse events occurred during the treatment.2.Experimental study:The body weight of the rats in each drug group was significantly higher than that in the model group(P<0.05).The DAI,colonic mucosal damage degree score and histopathological score in each drug group were significantly lower than the model group(P<0.05).Compared with the model group,the D-LA,DAO,and DCA decreased,and the UDCA increased in each drug group,and there were statistically significant differences between the SASP group,the high-dose group of Pingkui Enema group and the model group.Conclusion:1.Compared to the treatment with mesalazine alone,combined use of Pingkui Enema can significantly improve the clinical symptoms,and the safety is high,which is worthy of promotion.2.Pingkui Enema may play a role in promoting colonic mucosal repair,reducing D-LA,DAO and DCA levels,increasing UDCA levels in ulcerative colitis rats.This provides a theoretical basis for the clinical use of Pingkui Enema.