广西医学

目的探讨大黄牡丹汤辅助英夫利西单抗治疗克罗恩病（CD）的临床效果及对CD简化内镜评分（SES⁃CD）的影响。方法将82例CD患者随机分为对照组（n=41）和观察组（n=41），分别给予单独英夫利西单抗治疗、大黄牡丹汤辅助英夫利西单抗口服治疗。比较治疗前后两组患者的中医证候（腹部刺痛、下利赤白、舌质暗红、肛门灼热）积分、CD活动指数（CDAI）、SES⁃CD、磁共振肠道成像指标［容积转运常数（Ktrans）、速率常数（Kep）及血管外细胞外容积分数（Ve）］、肠道超声分段活动评分（IBUS⁃SAS）、炎症因子［红细胞沉降率（ESR）及血清C反应蛋白（CRP）水平、肿瘤坏死因子α（TNF⁃α）水平］，以及治疗后两组患者的临床疗效。观察治疗期间两组患者不良反应发生情况。结果治疗后，观察组的总有效率高于对照组，腹部刺痛、下利赤白、舌质暗红、肛门灼热积分，CDAI、SES⁃CD、IBUS⁃SAS，Ktrans、Kep、Ve，ESR、血清CRP、TNF⁃α水平低于对照组（P<0.05）。治疗期间，两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论大黄牡丹汤辅助英夫利西单抗可明显减轻CD患者的临床症状、肠道及全身炎症反应，修复黏膜损伤，改善血管通透性，其效果优于单用英夫利西单抗治疗。

Objective To investigate the clinical effect of infliximab assisted by Dahuang Mudan Decoction for the treatment of Crohn's disease (CD) and the effect on the Simplified Endoscopic Score for Crohn's Disease (SES‑CD). Methods A total of 82 CD patients were randomly assigned to control group (n=41) or observation group (n=41), infliximab therapy alone, and oral administration of infliximab assisted by Dahuang Mudan Decoction were given to both groups, respectively. The Traditional Chinese Medicine syndrome scores (including abdominal stabbing pain, bloody purulent diarrhea, dark reddish tongue, and anal burning sensation), Crohn's Disease activity index (CDAI), SES‑CD, intestinal magnetic resonance enterography parameters with respect to volume transfer constant (Ktrans), rate constant (Kep), and extravascular extracellular volume fraction (Ve), Intestinal Bowel Ultrasound Segmental Activity Score (IBUS‑SAS), and inflammatory factors in terms of erythrocyte sedimentation rate (ESR), serum C‑reactive protein (CRP) level, and tumor necrosis factor α (TNF‑α) level were compared between the two groups before and after treatment. Clinical efficacy was also compared between the two groups after treatment. The occurrence of adverse reactions during treatment were observed in both groups. Results After treatment, the total effective rate in the observation group was higher than that in the control group. The scores for abdominal stabbing pain, bloody purulent diarrhea, dark reddish tongue, and anal burning sensation, as well as CDAI, SES‑CD, IBUS‑SAS, Ktrans, Kep, Ve, ESR, serum CRP and TNF‑α levels were lower in the observation group than in the control group (P<0.05). No statistically significant difference was observed in the total incidence rate of adverse reactions between the two groups during treatment (P>0.05). Conclusion Infliximab assisted by Dahuang Mudan Decoction can significantly relieve clinical symptoms, intestinal and systemic inflammation, repair mucosal damage, and ameliorate vascular permeability in CD patients, with superior effect compared to infliximab therapy alone.