溃疡性结肠炎血清学指标、中医分型及疾病严重程度的相关性分析

Analysis in correlations among serological indexes, differentiated syndrome of traditional Chinese medicine and severity of illness in ulcerative colitis

  • 摘要:
      目的  分析溃疡性结肠炎(UC)患者血清学指标血红素加氧酶-1(HO-1)、外周血红细胞沉降率(ESR)和C反应蛋白(CRP)、疾病严重程度及中医证型间的相关性。
      方法  将被诊断为UC的患者纳入实验组,将同期体检中心的26例健康体检人员纳入对照组,采集2组的血清样本。根据改良Mayo评分分级及肠镜检查结果评分分级标准,将UC患者分为轻、中、重度;根据中医辨证并结合临床实际,将其分为大肠湿热证、脾肾两虚证2种证型。空腹抽取肘静脉血,采用酶联免疫吸附法(ELISA)检测HO-1水平。记录UC患者就诊时外周ESR和CRP水平。比较2组血清中HO-1的表达情况;观察UC患者血清中HO-1、CRP、ESR指标,病情严重程度分级及中医证型的相关性。
      结果  实验组血清中HO-1表达水平高于对照组,差异有统计学意义(P < 0.01)。改良Mayo评分分级及肠镜结果评分分级为中、重度的患者HO-1、CRP和ESR水平高于轻度患者,重度患者高于中度患者,差异有统计学意义(P < 0.05)。大肠湿热证患者HO-1、CRP和ESR水平均高于脾肾两虚证,差异有统计学意义(P < 0.05)。大肠湿热证患者的肠镜及改良Mayo分级严重程度高于脾肾两虚证患者,差异有统计学意义(P < 0.05)。
      结论  HO-1、CRP和ESR水平与UC病情的严重程度相关。血液指标、肠镜检查结果评分以及改良Mayo评分不仅可作为衡量患者病情严重程度的参考标准,也可作为本病虚实和指导中医证型分型的依据。但HO-1在轻度UC中不敏感,因此在对UC初筛中的指导意义不大。

     

    Abstract:
      Objective  To analyze the correlations among serological indexesheme oxygenase-1(HO-1), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP), differentiated syndrome of traditional Chinese medicine and severity of illness in ulcerative colitis (UC).
      Methods  A total of 26 patients diagnosed as UC were divided into experimental group, and 26 healthy subjects from the Physical Examination Center during the same period were included in control group. The plasma samples of the two groups were collected. Based on grading criteria of the modified Mayo Scale score and colonoscopy results score, the UC patients were classified into mild, moderate, and severe cases. According syndrome differentiation and clinical practice, they were differentiated as syndrome of dampness-heat in large intestine and deficiency of spleen and kidney syndrome. Elbow venous blood was extracted in a fasted state, and HO-1 level was tested with enzyme-linked immunosorbent assay (ELISA). CRP and ESR were recorded on admission. The expression of HO-1 in the serum of UC subjects and healthy subjects were compared. The relationships among the severity classification, the syndrome of TCM and blood indexes such as HO-1, CRP, and ESR were explored.
      Results  The expression levels of HO-1 in the serum of UC subjects were higher than that of the healthy subjects(P < 0.01). Compared with the mild patients by grading of colonoscopic and modified Mayo scale scores, the levels of HO-1, CRP, and ESR in the plasma of the moderate and severe patients were significantly higher, and severe cases had higher indexes than the moderate ones (P < 0.05). HO-1, CRP and ESR levels in the plasma of syndrome of dampness-heat in large intestine were significantly higher than those of patients with deficiency of spleen and kidney syndrome (P < 0.05).
      Conclusion  The levels of HO-1, CRP and ESR in plasma are correlated with the severity of UC. The plasma indexes, modified Mayo Scale score and colonoscopic scores can not only be utilized as reference standard to measure the severity of UC, but also as foundation of judge the deficiency and excess of the disease and TCM syndrome differentiation of UC. However, HO-1 plasma level is not sensitive in mild UC subjects, so it may not be helpful in screening the UC patients in the initial stage.

     

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