ω-3多不饱和脂肪酸和美沙拉嗪联合治疗对溃疡性结肠炎患者血清辅助性T细胞1及辅助性T细胞2细胞因子水平的影响
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摘要
目的探讨ω-3多不饱和脂肪酸(ω-3PUFA)和美沙拉嗪联合治疗对溃疡性结肠炎患者血清辅助性T细胞1(Th1)及辅助性T细胞2(Th2)细胞因子的影响。方法选择驻马店市中心医院2016年1月至2017年12月收治的78例溃疡性结肠炎患者为研究对象,按照治疗方法将患者分为观察组和对照组,每组39例。对照组患者给予美沙拉嗪治疗,观察组患者给予美沙拉嗪和ω-3PUFA联合治疗。分别于治疗前及治疗后采用酶联免疫吸附试验检测2组患者血清白细胞介素(IL)-2、IL-4、IL-10及γ-干扰素(IFN-γ)水平,采用改良Mayo评分评估结肠黏膜炎症反应程度,并评定临床疗效,观察不良反应发生情况。结果治疗前2组患者血清IL-2、IL-4、IL-10及IFN-γ水平比较差异均无统计学意义(P> 0. 05); 2组患者治疗后血清IL-2水平与治疗前比较差异均无统计学意义(P> 0. 05); 2组患者治疗后血清IL-4水平显著低于治疗前,IL-10和IFN-γ水平显著高于治疗前(P <0. 05);治疗后,观察组患者血清IL-4水平显著低于对照组,IL-10和IFN-γ水平显著高于对照组(P <0. 05);治疗后2组患者血清IL-2水平比较差异无统计学意义(P> 0. 05)。治疗前2组患者改良Mayo评分比较差异无统计学意义(P> 0. 05); 2组患者治疗后改良Mayo评分显著低于治疗前(P <0. 05);治疗后观察组患者改良Mayo评分显著低于对照组(P <0. 05)。观察组和对照组患者总有效率分别为94. 9%(37/39)、79. 5%(31/39),观察组患者总有效率高于对照组(χ~2=7. 515,P <0. 05)。观察组和对照组患者不良反应发生率分别为10. 3%(4/39)、20. 5%(8/39),观察组患者不良反应发生率低于对照组(χ~2=6. 498,P <0. 05)。结论ω-3PUFA和美沙拉嗪联合治疗能有效改善溃疡性结肠炎患者血清中Th1和Th2细胞因子水平,减轻结肠黏膜的炎症反应,提高治疗效果,降低不良反应发生率。
Objective To investigate the effect of ω-3 polyunsaturated fatty acid( ω-3 PUFA) combined with mesalazine on the levels of serum helper T cell 1( Th1) and helper T cell 2( Th2) cytokines in patients with ulcerative colitis.Methods A total of 78 patients with ulcerative colitis in Zhumadian Central Hospital from January 2016 to December 2017 were selected as the subjects. The patients were divided into observation group and control group according to the treatment method,39 cases in each group. The patients in the control group were treated with mesalazine,while the patients in the observation group were treated with mesalazine and ω-3 PUFA. The levels of serum interleukin( IL)-2,IL-4,IL-10 and interferon-γ( IFN-γ) were detected by enzyme linked immunosorbent assay; and the degree of colonic mucosal inflammation was evaluated by modified Mayo score before and after treatment. The clinical effect was evaluated and the adverse reaction was observed. Results There was no significant difference in the levels of serum IL-2,IL-4,IL-10 and IFN-γ between the two groups before treatment( P > 0. 05). There was no significant difference in the level of serum IL-2 between the two groups before and after treatment( P > 0. 05). Compared with before treatment,the level of serum IL-4 decreased significantly,and the levels of serum IL-10 and IFN-γ increased significantly after treatment in the two groups( P < 0. 05). The level of serum IL-4 in the observation group was significantly lower than that in the control group,and the levels of serum IL-10 and IFN-γ in the observation group were significantly higher than those in the control group after treatment( P < 0. 05). There was no significant difference in the level of serum IL-2 between the two groups after treatment( P > 0. 05). There was no significant difference in the modified Mayo score between the two groups before treatment( P > 0. 05). The modified Mayo score after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The modified Mayo score in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). The total effective rate in the observation group and the control group was 94. 9%( 37/39) and 79. 5%( 31/39),respectively. The total effective rate in the observation group was higher than that in the control group( χ~2= 7. 515,P < 0. 05). The incidence of adverse reactions in the observation group and the control group was 10. 3%( 4/39) and 20. 5%( 8/39),respectively. The incidence of adverse reactions in the observation group was lower than that in the control group( χ~2= 6. 498,P < 0. 05). Conclusion ω-3 PUFA combined with mesalazine can effectively improve the levels of Th1 and Th2 cytokines,alleviate the inflammatory reaction of colonic mucosa,improve the therapeutic effect and reduce the incidence of adverse reactions in patients with ulcerative colitis.
Objective To investigate the effect of ω-3 polyunsaturated fatty acid( ω-3 PUFA) combined with mesalazine on the levels of serum helper T cell 1( Th1) and helper T cell 2( Th2) cytokines in patients with ulcerative colitis.Methods A total of 78 patients with ulcerative colitis in Zhumadian Central Hospital from January 2016 to December 2017 were selected as the subjects. The patients were divided into observation group and control group according to the treatment method,39 cases in each group. The patients in the control group were treated with mesalazine,while the patients in the observation group were treated with mesalazine and ω-3 PUFA. The levels of serum interleukin( IL)-2,IL-4,IL-10 and interferon-γ( IFN-γ) were detected by enzyme linked immunosorbent assay; and the degree of colonic mucosal inflammation was evaluated by modified Mayo score before and after treatment. The clinical effect was evaluated and the adverse reaction was observed. Results There was no significant difference in the levels of serum IL-2,IL-4,IL-10 and IFN-γ between the two groups before treatment( P > 0. 05). There was no significant difference in the level of serum IL-2 between the two groups before and after treatment( P > 0. 05). Compared with before treatment,the level of serum IL-4 decreased significantly,and the levels of serum IL-10 and IFN-γ increased significantly after treatment in the two groups( P < 0. 05). The level of serum IL-4 in the observation group was significantly lower than that in the control group,and the levels of serum IL-10 and IFN-γ in the observation group were significantly higher than those in the control group after treatment( P < 0. 05). There was no significant difference in the level of serum IL-2 between the two groups after treatment( P > 0. 05). There was no significant difference in the modified Mayo score between the two groups before treatment( P > 0. 05). The modified Mayo score after treatment was significantly lower than that before treatment in the two groups( P < 0. 05). The modified Mayo score in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). The total effective rate in the observation group and the control group was 94. 9%( 37/39) and 79. 5%( 31/39),respectively. The total effective rate in the observation group was higher than that in the control group( χ~2= 7. 515,P < 0. 05). The incidence of adverse reactions in the observation group and the control group was 10. 3%( 4/39) and 20. 5%( 8/39),respectively. The incidence of adverse reactions in the observation group was lower than that in the control group( χ~2= 6. 498,P < 0. 05). Conclusion ω-3 PUFA combined with mesalazine can effectively improve the levels of Th1 and Th2 cytokines,alleviate the inflammatory reaction of colonic mucosa,improve the therapeutic effect and reduce the incidence of adverse reactions in patients with ulcerative colitis.
引文
[1]雷晓燕,崔梅花.溃疡性结肠炎的治疗进展[J].山东医药,2014,54(6):99-102.
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[3]王艳萍,姬林松,倪猛,等.不同严重程度溃疡性结肠炎患者血清TNF-α、IL-6及IL-8的表达及意义[J].中国老年学杂志,2015,28(14):3940-3941.
[4]中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见[J].中华消化杂志,2018,38(5):292-311.
[5]程华,李雪梅,杨爱萍,等.美沙拉嗪治疗溃疡性结肠炎的临床疗效及对ESR、PLT、D-二聚体影响的多中心研究[J].中国生化药物杂志,2014,31(9):134-136,139.
[6]李雯,訾铁营,吴娟,等.致康胶囊对溃疡性结肠炎患者血清TNF-α、IL-6及CRP的影响[J].世界中医药,2017,12(6):1317-1319,1323.
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[9]郑小娟,郑海燕,罗灵和,等.枯草杆菌二联活菌肠溶胶囊联合美沙拉嗪肠溶片对溃疡性结肠炎患者的临床研究[J].中国临床药理学杂志,2016,19(3):212-214.
[10]牟海军,陈幸幸,周光群,等.美沙拉嗪肠溶片治疗激素抵抗型重症溃疡性结肠炎的临床研究[J].中国临床药理学杂志,2016,32(21):1950-1952,1963.
[11]石计朋,宋亚辉,栗延伟,等.ω-3多不饱和脂肪酸对脂多糖诱导的脑损伤新生大鼠的神经保护作用[J].新乡医学院学报,2018,35(5):368-372.
[12]滕向龙,郭景泉,邹武军.ω-3多不饱和脂肪酸对结直肠癌根治术患者的炎症、营养、免疫功能及预后的影响机制研究[J].中国现代医生,2016,54(29):13-16.
[13]石计朋,孙亚洲,栗延伟,等.ω-3多不饱和脂肪酸和ω-6多不饱和脂肪酸对脂多糖致脑损伤新生大鼠Toll样受体4/核因子-κB信号通路及炎性因子的影响[J].中华实用儿科临床杂志,2018,33(12):918-922.
[14]徐再玲,施骅,刘俊伟,等.ω-3多不饱和脂肪酸辅助治疗溃疡性结肠炎的疗效及其机制研究[J].中华全科医学,2018,16(4):561-563,596.
[15]荆琼珊,李可.免疫因素在溃疡性结肠炎发病机制中的作用[J].医药前沿,2016,6(1):8-10.
[16]马柏强,杨越涛,王理富,等.ω-3多不饱和脂肪酸对术后早期炎性肠梗阻的疗效及其作用机制研究[J].中国临床药理学杂志,2015,26(9):715-717.
[17]高俊,王静东,王琦三,等.含ω-3多不饱和脂肪酸的肠外营养对胃癌病人免疫功能影响的Meta分析[J].肠外与肠内营养,2015,22(2):107-111.
[18]陈则华,胡慧芸,陈鹰,等.ω-3多不饱和脂肪酸调节血脂及抗动脉粥样硬化作用机制研究进展[J].医药导报,2018,37(11):1334-1338.
[2]潘燕,欧阳钦.八味锡类散灌肠对溃疡性结肠炎的治疗作用及其机制研究[J].中国中西医结合杂志,2014,34(1):27-30.
[3]王艳萍,姬林松,倪猛,等.不同严重程度溃疡性结肠炎患者血清TNF-α、IL-6及IL-8的表达及意义[J].中国老年学杂志,2015,28(14):3940-3941.
[4]中华医学会消化病学分会炎症性肠病学组.炎症性肠病诊断与治疗的共识意见[J].中华消化杂志,2018,38(5):292-311.
[5]程华,李雪梅,杨爱萍,等.美沙拉嗪治疗溃疡性结肠炎的临床疗效及对ESR、PLT、D-二聚体影响的多中心研究[J].中国生化药物杂志,2014,31(9):134-136,139.
[6]李雯,訾铁营,吴娟,等.致康胶囊对溃疡性结肠炎患者血清TNF-α、IL-6及CRP的影响[J].世界中医药,2017,12(6):1317-1319,1323.
[7]刘秀艳,高文艳.难治性溃疡性结肠炎研究进展[J].现代中西医结合杂志,2017,26(29):3302-3306.
[8]孙达龙,陈凤媛,潘勤聪.溃疡性结肠炎的药物治疗现状及进展[J].中华全科医师杂志,2014,13(11):916-919.
[9]郑小娟,郑海燕,罗灵和,等.枯草杆菌二联活菌肠溶胶囊联合美沙拉嗪肠溶片对溃疡性结肠炎患者的临床研究[J].中国临床药理学杂志,2016,19(3):212-214.
[10]牟海军,陈幸幸,周光群,等.美沙拉嗪肠溶片治疗激素抵抗型重症溃疡性结肠炎的临床研究[J].中国临床药理学杂志,2016,32(21):1950-1952,1963.
[11]石计朋,宋亚辉,栗延伟,等.ω-3多不饱和脂肪酸对脂多糖诱导的脑损伤新生大鼠的神经保护作用[J].新乡医学院学报,2018,35(5):368-372.
[12]滕向龙,郭景泉,邹武军.ω-3多不饱和脂肪酸对结直肠癌根治术患者的炎症、营养、免疫功能及预后的影响机制研究[J].中国现代医生,2016,54(29):13-16.
[13]石计朋,孙亚洲,栗延伟,等.ω-3多不饱和脂肪酸和ω-6多不饱和脂肪酸对脂多糖致脑损伤新生大鼠Toll样受体4/核因子-κB信号通路及炎性因子的影响[J].中华实用儿科临床杂志,2018,33(12):918-922.
[14]徐再玲,施骅,刘俊伟,等.ω-3多不饱和脂肪酸辅助治疗溃疡性结肠炎的疗效及其机制研究[J].中华全科医学,2018,16(4):561-563,596.
[15]荆琼珊,李可.免疫因素在溃疡性结肠炎发病机制中的作用[J].医药前沿,2016,6(1):8-10.
[16]马柏强,杨越涛,王理富,等.ω-3多不饱和脂肪酸对术后早期炎性肠梗阻的疗效及其作用机制研究[J].中国临床药理学杂志,2015,26(9):715-717.
[17]高俊,王静东,王琦三,等.含ω-3多不饱和脂肪酸的肠外营养对胃癌病人免疫功能影响的Meta分析[J].肠外与肠内营养,2015,22(2):107-111.
[18]陈则华,胡慧芸,陈鹰,等.ω-3多不饱和脂肪酸调节血脂及抗动脉粥样硬化作用机制研究进展[J].医药导报,2018,37(11):1334-1338.