目的 臨床觀察白花蛇舌草干預濕熱瘀滯型腸內多發(fā)息肉患者內鏡治療術后復發(fā)情況。方法 采用前瞻性的隨機空白對照試驗設計，選取2019年9月1日—2020年12月31日上海中醫(yī)藥大學附屬普陀醫(yī)院消化科收治的門診及住院結直腸多發(fā)息肉患者132例作為研究對象。采用隨機方法分為對照組和試驗組，每組66例。對照組行內鏡治療術給予常規(guī)治療后無藥物干預，試驗組在對照基礎上給予白花蛇舌草湯劑（每日取白花蛇舌草15 g、大棗3枚，煎取400 mL湯劑，分2次飯后溫服）治療，連續(xù)干預1年。觀察并比較兩組術前與術后1年腸道內息肉的復發(fā)率、息肉數目、息肉最大直徑、中醫(yī)證候評分及肝腎功能及血常規(guī)的差異。結果 干預1年后，試驗組復發(fā)9例（14.75%），對照組復發(fā)21例（33.33%），兩組息肉復發(fā)率比較，差異有統(tǒng)計學意義（P＜0.05）。試驗組腺瘤、伴重度異型增生、體質量指數（BMI）≥24 kg·m^-2患者治療后息肉復發(fā)率均較對照組同類型降低，差異顯著（P＜0.05）；術后1年試驗組息肉最大直徑及息肉數目均較對照組顯著減小，差異顯著（P＜0.05）；術后1年試驗組中醫(yī)證候各項評分均顯著低于對照組（P＜0.05）；術后1年，兩組中醫(yī)證候療效比較，差異具有統(tǒng)計學意義（P＜0.05），且術前、術后1年兩組患者肝腎功能、凝血功能等安全性指標無顯著差異。結論 應用白花蛇舌草干預結直腸息肉術后患者，1年后明顯降低腸內息肉的復發(fā)率，尤以腺瘤性息肉、重度異型增生、BMI超重患者更顯著，不僅改善臨床癥狀，還能有效預防結直腸息肉的復發(fā)，改善患者的預后。

Objective To observe the recurrence of intestinal polyps patients with Hedyotis diffusa intervention after endoscopic treatment. Methods A prospective randomized blank controlled trial design was used. A total of 132 outpatients and inpatients with colorectal polyps were selected from the Department of Gastroenterology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 1, 2019 to December 31, 2020. They were randomly divided into control group and experimental group, with 66 cases in each group. Patients in control group were received endoscopic therapy without drug intervention after routine treatment. On the basis of the control group, patients in experimental group were treated with Hedyotis diffusa Decoction (15 g Hedyotis diffusa, three jujubes, 400 mL decocted every day, and taken warm after meals twice) for one year. The recurrence rate of intestinal polyps, the number of polyps, the maximum diameter of polyps, the score of traditional Chinese medicine syndrome, liver and kidney function and blood routine were observed and compared between two groups before and one year after operation. Results One year after intervention, nine cases (14.75%) recurred in the experimental group and 21 cases (33.33%) recurred in the control group. There was significant difference in the recurrence rate of polyps between two groups (P < 0.05). The recurrence rate of polyps in patients with adenoma, severe dysplasia and body mass index (BMI) ≥ 24 kg·m^-2 in experimental group was significantly lower than that in control group (P < 0.05). One year after operation, the maximum diameter and number of polyps in experimental group were significantly smaller than those in control group (P < 0.05). One year after operation, the scores of TCM syndromes in experimental group were significantly lower than those in control group (P < 0.05). One year after operation, there was significant difference between two groups in the efficacy of traditional Chinese medicine syndromes (P < 0.05), and there was no significant difference between two groups in liver and kidney function, coagulation function and other safety indicators (P > 0.05). Conclusion The intervention of Hedyotis diffusa on postoperative patients with colorectal polyps can significantly reduce the recurrence rate of intestinal polyps after one year, especially in patients with adenomatous polyps, severe dysplasia and overweight BMI. It can not only improve clinical symptoms, but also effectively prevent the recurrence of colorectal polyps and improve the prognosis of patients.

R975

2018年引進人才基金項目（2017316A）