摘要
目的观察并分析复方白头翁汤联合西药治疗溃疡性结肠炎(UC)合并的难治性阿米巴肠炎的临床疗效以及肠道微生态的变化,为UC合并的难治性阿米巴肠炎的临床治疗提供参考。方法收集临床诊断的溃疡性结肠炎合并的难治性阿米巴肠炎患者12例,予复方白头翁汤联合西药治疗,分别于治疗前、治疗结束后行大便阿米巴检测、症状评分;并留取患者治疗前、治疗结束后4周、8周大便行高通量测序及代谢组学检测。结果1.阿米巴滋养体及包囊清除情况:治疗结束后,12位入组的患者,11位患者大便常规未见阿米巴滋养体及包囊,总有效率为91.7%;1位患者大便常规镜检可见包囊,延长治疗10 d后,该患者大便常规未见阿米巴滋养体及包囊,此时总有效率为100%。2.中医证候积分变化:(1)总积分比较:治疗后患者积分较治疗前明显下降,差异有统计学意义(P<0.05)。(2)单项症状积分比较:主要症状及次要症状积分均较治疗前明显下降,差异有统计学意义(P<0.05)。3.治疗前后患者肠道菌群的变化及代谢组学分析:(1)治疗前及治疗结束后4周、8周患者肠道菌群的丰度及多样性均发生了变化,差异具有统计学意义(P<0.05)。(2)物种组成及差异性分析:①在门水平上,治疗前,患者的肠道菌群主要由厚壁菌门、放线菌门、变形菌门和拟杆菌门组成,治疗后,厚壁菌门、变形杆菌门和拟杆菌门占据了主导地位,放线菌门的比例有所下降。②在属水平上,与治疗前相比,患者大便的拟杆菌属(Bacteroides)、粪杆菌属(Faecalibacterium)、链球菌属(Streptococcus)等显著增高,而大肠埃希菌-志贺氏菌属(Escherichia-Shigella)、嗜血杆菌属(Haemophilus)、梭状芽孢菌属(Clostridioides)等显著降低。(3)代谢组学及差异性分析:治疗后患者肠道菌群在新陈代谢通路、甘油磷脂代谢通路、次生代谢产物的生物合成方面均具有明显差异。具有明显差异性的物质包括吲哚-3-乳酸、左旋肉碱、磷酸胆碱等,差异具有统计学意义(P<0.05)。结论运用复方白头翁汤联合西药治疗UC合并的难治性阿米巴肠炎,能够有效杀灭阿米巴滋养体及包囊,可有效缓解患者的症状,提高临床疗效,改善患者中医证候评分,其机制可能与改善肠道菌群结构及其代谢通路从而起到辅助抗炎的作用有关,可为临床治疗UC合并的难治性阿米巴肠炎提供参考。
Objective Observe and analyse the clinical efficacy of compound Baitouweng decoction combined with Western medicine in the treatment of refractory amoebic enteritis complicated by ulcerative colitis,as well as changes in intestinal microbiota,providing reference for the clinical diagnosis and treatment of refractory amoebic enteritis complicated by ulcerative colitis.Methods Collect patients who meet the diagnostic criteria for ulcerative colitis complicated with refractory amoebic enteritis They were treated with compound Baitouweng decoction combined with Western medicine.Stool samples were collected before treatment,4 weeks after treatment,and 8 weeks after treatment.The final samples were subjected to high-throughput sequencing and metabolomics testing,and correlation analysis was conducted based on the patient's symptom score.Results 1.Clearance of amoebic trophoblasts and cysts:After 8 weeks of treatment,among the 12 enrolled patients,11 patients did not show amoebic trophoblasts and cysts in their stool routine,and 1 patient showed amoebic cysts in his stool routine microscopy.The total effective rate was 91.7%.After extending the treatment for 10 days,no entamoeba histolytica trophozoites or cysts were found in the patient's stool routine examination.At this time,the total effective rate reached 100%.2.Changes in symptom scores:(1)Comparison of total scores:The scores of UC patients with refractory amoebic enteritis decreased significantly compared to before treatment,and the difference was statistically significant(P<0.05).(2)Comparison of scores for individual symptoms:The scores for both primary and secondary symptoms decreased significantly compared to before treatment,and the difference was statistically significant(P<0.05);3.Changes in gut microbiota and metabolomics analysis before and after treatment:(1)After treatment,the abundance and diversity of gut microbiota in patients showed significant changes in both alpha and beta diversity,with statistical significance(P<0.05).(2)Species composition and differential analysis:①At the phylum level,before treatment,the patient's gut microbiota was mainly composed of Firmicutes,Actinobacteria,Proteobacteria,and Bacteroidetes,which accounted for over 90%of the total.After treatment,Firmicutes,Proteobacteria,and Bacteroidetes dominated,while the proportion of Actinobacteria decreased At the genus level,compared with before treatment,the number of protective bacteria such as Bacteroides,Faecalibacterium,and Streptococcus in the patient's stool significantly increased,while invasive bacteria such as Escherichia coli Shigella,Haemophilus,and Clostridium were significantly reduced.(3)Metabolomics and differential analysis:Metabolomics analysis of fecal samples from patients after treatment showed significant differences in metabolic pathways,glycerophospholipid metabolism pathways,and biosynthesis of secondary metabolites.Among them,substances with significant differences include indole-3-lactic acid,L-carnitine,phosphatidylcholine,etc.,and the differences are statistically significant(P<0.05).Conclusion The use of compound Baitouweng decoction combined with Western medicine can effectively treat and kill intestinal Amoebic Trophoblasts and Cysts in the treatment of UC complicated refractory amoebic enteritis.It can effectively alleviate patients'symptoms,improve clinical efficacy,and improve patients'TCM syndrome scores.The mechanism may be related to improving the structure and metabolomics of intestinal microbiota,thereby improving the intestinal microbiota environment and metabolic pathways,and playing an auxiliary anti-inflammatory role.It can provide reference for the clinical treatment of UC complicated refractory amoebic enteritis.
作者
陈立
孔佑甲
申海霞
崔换天
温伟波
李娅琳
CHEN Li;KONG Youjia;SHEN Haixia;CUI Huantian;WEN Weibo;LI Yalin(Jinning Phosphate Mine Hospital,Kunming650600,China;Yunnan First People's Hospital,Kunming650032,China;The First Clinical Medicine College,Yunnan University ofChinese Medicine,Kunming 650500,China)
出处
《云南中医药大学学报》
2025年第2期23-31,共9页
Journal of Yunnan University of Chinese Medicine
基金
云南省临床医学中心开放课题(2022LCZXKF-XH11)。
关键词
溃疡性结肠炎
难治性阿米巴肠炎
复方白头翁汤
中西医结合治疗
肠道微生态
ulcerative colitis
refractory amoebic enteritis
compound Baitouweng decoction
integrated traditional Chinese and western medicine treatment
intestinal microbiota
