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中药治疗复发性和难治性克罗恩病:一例报告

Traditional Chinese medicine for management of recurrent and refractory Crohn disease: A case report.

作者信息

Lai Hezheng, Wang Kang, Dong Qing, Zhu Xiaoshu, Li Xiaoke, Qi Shuo

机构信息

School of Science and Health, Western Sydney University, Campbelltown, New South Wales.

The Chinese Medicine Center, Collaboration Between Beijing University of Chinese Medicine and Western Sydney University.

出版信息

Medicine (Baltimore). 2019 Apr;98(15):e15148. doi: 10.1097/MD.0000000000015148.

Abstract

INTRODUCTION

Crohn disease (CD) is a chronic relapsing systemic inflammatory disease afflicting the gastrointestinal system with a high morbidity. There has been increasing clinical interest in traditional Chinese medicine (TCM) treatment for CD. This report aims to present patient outcome of therapeutic management using TCM in combination with pharmacologic therapy.

PATIENT CONCERNS

A 53-year-old woman with a more than 23-year history of chronic indigestion, reflux, abdominal pain, and excessive diarrhea, and a more than 21-year history of recurrent refractory CD. The condition had been managed for 21 years with ongoing pharmacologic therapy, and surgical intervention; however, with poor therapeutic effect.

DIAGNOSIS

In this study, the diagnosis of CD was based on integrating patient symptoms and radiologic findings and biopsy results. The patient had no differential diagnosis.

INTERVENTIONS

The patient received acupuncture treatment at an approximate frequency of once per week for a total of 21 sessions until November 5, 2018. The patient also received Chinese herbal medicine (CHM) on an as-needed basis to manage her symptoms.

OUTCOMES

Patient reported symptoms of chronic indigestion, reflux, abdominal pain, and excessive diarrhea were substantially improved by combined TCM and pharmacologic therapy intervention, while the dosage of her medication was reduced.

CONCLUSION

Following acupuncture treatment, improvements of subjective symptoms: chronic indigestion, reflux, abdominal pain, and excessive diarrhea, were observed. CHM provided immediate relief of indigestion, reflux, and abdominal pain. TCM may be a potential therapeutic strategy to manage clinical symptoms of CD, if this is proven useful in future RCT studies.

摘要

引言

克罗恩病(CD)是一种慢性复发性全身性炎症性疾病,侵袭胃肠道,发病率很高。中医(TCM)治疗CD在临床上越来越受到关注。本报告旨在介绍中医联合药物治疗的患者治疗结果。

患者情况

一名53岁女性,有超过23年的慢性消化不良、反流、腹痛和腹泻过多病史,以及超过21年的复发性难治性CD病史。该疾病已通过持续的药物治疗和手术干预处理了21年,但治疗效果不佳。

诊断

在本研究中,CD的诊断基于患者症状、影像学检查结果和活检结果的综合判断。该患者无鉴别诊断。

干预措施

患者接受针灸治疗,频率约为每周一次,共21次,直至2018年11月5日。患者还根据需要服用中药以控制症状。

结果

患者报告称,中医与药物联合治疗干预后,慢性消化不良、反流、腹痛和腹泻过多等症状得到显著改善,同时药物剂量减少。

结论

针灸治疗后,观察到主观症状如慢性消化不良、反流、腹痛和腹泻过多有所改善。中药能立即缓解消化不良、反流和腹痛。如果在未来的随机对照试验研究中得到证实,中医可能是控制CD临床症状的一种潜在治疗策略。

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本文引用的文献

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Enteral nutrition for maintenance of remission in Crohn's disease.肠内营养用于维持克罗恩病的缓解
Cochrane Database Syst Rev. 2018 Aug 11;8(8):CD005984. doi: 10.1002/14651858.CD005984.pub3.
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Low dose naltrexone for induction of remission in Crohn's disease.低剂量纳曲酮诱导克罗恩病缓解
Cochrane Database Syst Rev. 2018 Apr 1;4(4):CD010410. doi: 10.1002/14651858.CD010410.pub3.
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Crohn Disease: Epidemiology, Diagnosis, and Management.克罗恩病:流行病学、诊断与管理
Mayo Clin Proc. 2017 Jul;92(7):1088-1103. doi: 10.1016/j.mayocp.2017.04.010. Epub 2017 Jun 7.
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Crohn's disease.克罗恩病。
Lancet. 2017 Apr 29;389(10080):1741-1755. doi: 10.1016/S0140-6736(16)31711-1. Epub 2016 Dec 1.
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Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease.硫唑嘌呤或6-巯基嘌呤用于诱导克罗恩病缓解
Cochrane Database Syst Rev. 2016 Oct 26;10(10):CD000545. doi: 10.1002/14651858.CD000545.pub5.
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Complementary and Alternative Medicines Used by Patients With Inflammatory Bowel Diseases.炎症性肠病患者使用的补充和替代药物。
Gastroenterology. 2017 Feb;152(2):415-429.e15. doi: 10.1053/j.gastro.2016.10.004. Epub 2016 Oct 12.
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Cancers complicating inflammatory bowel disease.炎症性肠病并发的癌症。
N Engl J Med. 2015 Apr 9;372(15):1441-52. doi: 10.1056/NEJMra1403718.

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