| Background and ObjectiveUlcerative colitis(UC)is a chronic inflammatory bowel disease with lesions mainly in the mucosa and submucosa of the colorectal and rectum.Chronic inflammatory response and immune response disorders may be the key causes of UC.The purpose of this study was to explore the relationship between the TCM syndrome type of ulcerative colitis and the serum inflammatory factors(TNF-?,IL-1?,IL-4,IL-6,IL-8),the severity of the disease,and the colonoscopic manifestations,so as to provide a reasonable objective basis and direction for TCM syndrome differentiation and treatment.MethodsFrom March 2019 to January 2020,45 patients with ulcerative colitis and 31 healthy control(HC)patients were recruited from the gastroenterology clinic and ward of our hospital.UC patients referred to as UC group and healthy controls are collectively referred to as the HC group,collected by the method of questionnaire survey and check the inspection report of volunteers generally cases,colonoscopy and histological results,with reference to the traditional Chinese medicine syndrome quantitative table and the patient's pulse and tongue carried out in accordance with the classification standard of dialectical classification,gathers the serum samples of all the volunteers using immune enzyme-linked adsorption method to complete the proinflammatory factor(TNF-?,IL-1?,IL-4,IL-6,IL-8)and inflammatory factor(IL-4)suppression level detection,using SPSS25.0 for statistical analysis.Results1.Clinical dataA total of 45 patients and 31 healthy controls were successfully included in this study.In the UC group,25 males and 20 females accounted for 55.5%and 44.5%respectively.The average age of UC group was 41.9±12.0 years old,with 28 patients aged 18-44 years,accounting for 62.2%.There were 17 patients aged 45 or above,accounting for 37.8%.The mean age of HC group was 34.4±9.8 years,including 19 males and 12 females.The difference in mean age between UC group and HC group was statistically significant(P=0.005),and there was no significant gender difference between the two groups(P 0.645).In terms of inducing factors,emotional factors accounted for 31.1%,dietary factors accounted for 55.6%,tiredness accounted for 26.7%,and feeling cold-evil accounted for 4.4%.In terms of duration,the longest duration was 37 years,and the shortest duration was 3 months,with a median length of 3 years.In terms of clinical type,there were 16 cases(35.6%)of primary patients and 29 cases(64.4%)of recurrence patients.In terms of disease degree,there were 24 cases(53.3%)of mild patients,15 cases(33.3%)of moderate patients and 6 cases(13.3%)of severe patients.In terms of scope of lesions,there were 15 cases(37.5%)of type E1,10 cases(25.0%)of type E2,and 15 cases(37.5%)of type E3.2.Colonoscopy and histopathological findingsIn terms of endoscopic mucosal manifestations,97.5%of patients presented with mucus or secretions under electronic endoscopy,92.5%of patients with vascular network disappearance/unclear,82.5%of patients with congestive edema,85.0%of patients with erosion,60.0%of patients with shallow ulcers,55.0%of patients with intestinal mucosal roughness,35.0%of patients with contact bleeding,5.0%of patients with polyps,and 2.5%of patients with colon bag disappearance.Histopathology:histopathological patients with crypt inflammation accounted for 87.2%,crypt abscess accounted for 66.7%,goblet cell reduction accounted for 61.5%,glandular hyperplasia accounted for 38.5%,superficial erosion accounted for 35.9%,lymphocyte aggregation accounted for 30.7%.3.Related results of TCM syndromesDistribution of TCM syndromes of UC patients:The syndrome differentiation type of 45 UC patients was large intestine dampness-heat syndrome in 20(44.5%),spleen-deficiency dampness-obstruction syndrome in 8(17.8%),liver-depression spleen-deficiency syndrome in 6(13.3%),heat toxin syndrome in 6(13.3%),spleen-kidney Yang deficiency syndrome in 3(6.6%),and cold and hot mixed syndrome in 2(4.5%).Analysis of TCM syndrome type,gender,inducing factors,disease course distribution and anxiety and depression score of UC patients:There were more males than females in patients with large intestine dampness-heat syndrome,and more females than males in patients with spleen-deficiency dampness-obstruction syndrome and liver-depression spleen-deficiency syndrome(P<0.05).Patients with syndrome of liver-depression spleen-deficiency were often induced by emotional changes(P=0.000),while patients with syndrome of large intestine dampness-heat syndrome were mostly induced by dietary factors(P=0.000).The most common disease course in patients with 1-5 years was liver-depression spleen-deficiency syndrome(P=0.001).The most common patients with a course of disease of more than 6 years were patients with heat toxin syndrome(P=0.000).Compared with other syndromes,the patients with heat toxin syndrome and liver-depression spleen-deficiency syndrome had higher anxiety degree and were more prone to depression.Endoscopic manifestations of different TCM syndromes:Contact bleeding and ulceration of the mucosa under colonoscopy were more common in patients with heat intoxication syndrome and less common in patients with spleen deficiency and dampness syndrome(P=0.006).The common microscopic manifestations of spleen-deficiency dampness-obstruction syndrome patients were erosion,mucosal hyperemia and edema,vascular network disappearance/unclear,and mucus and secretions adhesion.4.Relationship between inflammatory factors and TCM syndrome types1.Comparison of levels of inflammatory factors between UC patients and healthy control group:Serum levels of TNF-?,IL-1?,IL-6 and IL-8 in patients with ulcerative colitis were significantly higher than those in healthy controls(P<0.01).The level of IL-4 was significantly lower than that of the healthy control group(P=0.000).2.Levels of inflammatory factors of different syndromes:The level of IL-1? and IL-8 in patients with large intestine dampness-heat syndrome was significantly higher than that in patients with liver-depression spleen-deficiency syndrome(P=0.033?P=0.036).The level of IL-6 in patients with heat toxin syndrome was significantly higher than that in patients with spleen-deficiency dampness-obstruction syndrome(P=0.012)and patients with spleen-kidney Yang deficiency syndrome(P=0.039).The level of IL-8 in patients with heat toxin syndrome was significantly higher than that in patients with liver-depression spleen-deficiency syndrome(P=0.005).3.Levels of inflammatory factors in different degrees of illness:The TNF-? level in moderate patients was significantly higher than that in mild patients(P=0.025)and the TNF-??IL-6 and IL-8 level in severe patients was significantly higher than that in mild patients(P=0.021?P=0.009?P=0.045).Conclusions1.In patients with ulcerative colitis,the syndrome of large intestine dampness-heat was the most common,and the disease course of patients with the syndrome of heat toxin was generally longer.2.The anxiety degree of patients with heat toxin syndrome and liver-depression spleen-deficiency syndrome was higher.The Patients with heat toxin syndrome and liver-depression spleen-deficiency syndrome were more likely to have depressive symptoms.3.Endoscopic mucosal lesions were generally severe in UC patients with large intestine dampness-heat syndrome and heat toxin syndrome,and mild in UC patients with spleen-deficiency dampness-obstruction syndrome.4.Serum levels of inflammatory factors in UC patients with large intestine dampness-heat syndrome and heat toxin syndrome were higher than those in patients with other syndromes.The serum inflammatory cytokines can better reflect the severity of the disease. |
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