目的 研究地衣芽孢桿菌膠囊聯(lián)合美沙拉秦緩釋顆粒治療輕中度活動(dòng)期潰瘍性結(jié)腸炎的臨床療效。方法 選取2015年1月-2018年1月中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院消化內(nèi)科收治的明確診斷為輕度和中度的初治潰瘍性結(jié)腸炎住院患者100例為研究對(duì)象，采用數(shù)字隨機(jī)表法將所有患者分為對(duì)照組和治療組，每組各50例。對(duì)照組口服美沙拉秦緩釋顆粒，1.0 g/次，4次/d。治療組在對(duì)照組治療基礎(chǔ)上口服地衣芽孢桿菌活菌膠囊，0.5 g/次，3次/d。兩組患者均連續(xù)服藥12周。觀察兩組的臨床療效、光鏡下組織學(xué)損傷情況、內(nèi)鏡愈合率和黏膜愈合率，比較兩組的改良Mayo評(píng)分、Mayo內(nèi)鏡亞組評(píng)分、Geboes評(píng)分、腸道菌群數(shù)量。結(jié)果 治療后，對(duì)照組、治療組的總有效率分別為80.00%、94.00%，兩組總有效率比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組改良Mayo評(píng)分、Mayo內(nèi)鏡亞組評(píng)分均顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組Mayo評(píng)分明顯低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，對(duì)照組、治療組腸光鏡下上皮杯狀細(xì)胞和腺體增加，固有層見少量淋巴細(xì)胞、嗜酸性粒細(xì)胞浸潤(rùn)。治療后，兩組患者Geboes評(píng)分均顯著下降，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05），且治療組的Geboes評(píng)分顯著低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，對(duì)照組內(nèi)鏡愈合率為26%，治療組內(nèi)鏡愈合率為30%，兩組內(nèi)鏡愈合率比較差異無統(tǒng)計(jì)學(xué)意義。治療后，對(duì)照組黏膜愈合率為8%，治療組黏膜愈合率為8%，兩組內(nèi)鏡愈合率比較差異無統(tǒng)計(jì)學(xué)意義。治療后，兩組雙歧桿菌、乳酸桿菌的菌群數(shù)量明顯升高，糞腸球菌的菌群數(shù)量明顯降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05），并且治療后治療組雙歧桿菌、乳酸桿菌的菌群數(shù)量顯著高于對(duì)照組，大腸桿菌、糞腸球菌的菌群數(shù)量顯著低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 地衣芽孢桿菌膠囊聯(lián)合美沙拉秦緩釋顆粒治療輕中度活動(dòng)期潰瘍性結(jié)腸炎具有較好的臨床療效，能夠改善內(nèi)鏡和組織學(xué)損傷，改善臨床癥狀，調(diào)節(jié)腸道菌群結(jié)構(gòu)，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To study the clinical effect of Bacillus Licheniformis Capsules combined with Mesalazine SR Granules in treatment of mild and moderate active ulcerative colitis. Methods Patients (100 cases) with mild and moderate active ulcerative colitis in Department of Gastroenterology of Shengjing Hospital of China Medical University from January 2015 to January 2018 were enrolled in this study, and were randomly divided into control group and treatment group, and each group had 50 cases. Patients in the control group were iv administered with Mesalazine SR Granules, 1.0 g/time, four times daily. Patients in the treatment group were iv administered with Bacillus Licheniformis Capsules on the basis of the control group, 0.5 g/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacies, endoscopic healing rates, and mucosal healing rates were evaluated, histological damage under light microscope were observed, and improved Mayo score, endoscopic subgroup score, Geboes score, and intestinal flora in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 80.00% and 94.00%, respectively, and there was difference between two groups (P<0.05). After treatment, improved Mayo scores and endoscopic subgroup scores in the treatment group were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the Mayo scores in the treatment group were significantly lower than those in the control group in the same period, with significant difference between two groups (P<0.05). After treatment, the goblet cells and glands in the control group and treatment group were increased under the light microscope, and lymphocytes and eosinophils in the lamina propria were infiltrated. After treatment, Geboes scores in the treatment group were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the Geboes scores in the treatment group were significantly lower than those in the control group in the same period, with significant difference between two groups (P<0.05). After treatment, the endoscopic healing rates in control group and treatment group were 26% and 30%, respectively, and there was no difference between two groups. After treatment, the mucosal healing rates in control group and treatment group were 8% and 8%, respectively, and there was no difference between two groups. After treatment, the amounts of Bacillus licheniformis and Lactobacillus fermentum in two groups were significantly increased, but amounts of Enterococcus faecalis were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the amounts of B. licheniformis and L. fermentum in the treatment group was significantly higher than those in the control group, but the amounts of Escherichia coli and E. faecalis was significantly lower than that in the control group, with significant difference between two groups (P<0.05). Conclusion Bacillus Licheniformis Capsules combined with Mesalazine SR Granules has clinical curative effect in treatment of mild and moderate active ulcerative colitis, can improve endoscopic and histological injuries, improve clinical symptoms, and regulate the structure of intestinal flora, which has a certain clinical application value.

遼寧省自然科學(xué)基金資助項(xiàng)目（20170540529）；沈陽(yáng)市科學(xué)技術(shù)項(xiàng)目（F15-199-1-39）