Effect Of Ursodeoxycholic Acid On Ulcerative Colitis And Serumal IL-23,IL-17 And Intestinal Flora Levels

Objective: By comparing the combined application of UDCA and mesalazine with that of mesalazine alone in the treatment of mild to moderate active UC patients,the efficacy was observed and the mechanism of action was discussed,so as to provide evidence-based medical basis for the diagnosis and treatment of UC with UDCA.Methods: A total of 40 patients with mild and moderate UC admitted to the department of gastroenterology of the 900 th hospital of the joint logistics support force of the Chinese people’s liberation army from August 2017 to December 2018 were randomly assigned to the control group（group A）with 20 cases and the experimental group（group B）with 20 cases.During the same period,20 healthy control cases were randomly selected from the healthy subjects and set as the healthy group（group C）.Another 20 patients with mild bile reflux gastritis were selected as routine application group of ursodeoxycholic acid（group D）.Group A was given mesalazine enteric-coated tablets orally,with A dose of 1g/time and 4 times/day.In group B,on the basis of mesalazine enteric-coated tablets treatment,oral ursodeoxycholic acid soft capsule was given,200mg/time,2 times/day.No treatment was given in group C;Group D was given oral ursodeoxycholic acid soft capsule,200mg/time,2 times/day,swallowed before going to bed.At baseline,1 week after treatment,and 4 weeks after treatment,the Mayo clinic score and IBDQ scores（including intestinal symptoms,systemic symptoms,emotional ability,and social ability）of group A and group B were collected according to the patients’ gastrointestinal symptoms.Fresh fecal samples were collected from the four groups of patients,and 16 s rRNA bacterial assay was used to detect fecal flora.At the same time,the elbow venous blood of group A,group B and group C in the morning when fasting was extracted,the serum was routinely separated,and the levels of il-23 and il-17 in serum were detected by enzyme-linked immunosorbent assay,for comparison and statistical analysis between groups.Results: After 4 weeks of treatment,the Mayo score in group B and group A was significantly lower than that of before treatment（P<0.05）.The Mayo score of group B was not significantly lower than that of group A（P>0.05）,but the decrease of Mayo score in group B was significantly higher than that in group A（P<0.05）.The total score of IBDQ in group B and group A increased significantly after 4 weeks of treatment（P < 0.05）.The improvement of total score of IBDQ,social ability and systemic symptoms in group B was better than that in group A.The difference was statistically significant（P < 0.05）.Although the emotional ability and intestinal symptoms in group B and group A were higher than those in baseline period,there was no significant difference between the two groups（P > 0.05）.After treatment,the IL-23 value of group B and group A decreased significantly（P < 0.05）,but there was no significant difference between the two groups（P > 0.05）;after treatment,the IL-17 value of group B and group A decreased significantly（P < 0.05）,and the IL-17 value of group B was significantly lower than that of group A,the change rate was also statistically significant（P < 0.05）;After 4 weeks of treatment,Proteus decreased significantly compared with Group A（P < 0.05）,Thickwalled bacteria increased significantly（P < 0.05）,Actinomycetes and Clostridium decreased in Group B and Group A,but there was no significant difference between Group B and Group A（P > 0.05）;Bacteroides and Clostridium in Group B decreased significantly compared with Group A after 4 weeks of treatment（P > 0.05）.< After treatment,Rosella,Escherichia-Shigella and Prevotella₉ decreased and F.prausnitzii increased in group B and group A,but there was no significant difference between group B and group A（P > 0.05）.Conclusion: The clinical efficacy of ursodeoxycholic acid combined with mesalazine in the treatment of UC patients is obvious,and better than that of mesalazine alone.The mechanism may be related to the reduction of serum cytokine IL-17,the recovery of short-chain fatty acid-related bacteria and the inhibition of the proportion of some pro-inflammatory bacteria.