| Objective: The characteristics of inflammatory immune markers of Crohn’s disease were explored by detecting the relevant immunological indicators of Crohn’s disease anal fistula and non-Crohn’s complex anal fistula.To observe and evaluate the distribution characteristics of TCM syndromes in patients with Crohn’s disease and anal fistula,and to explore the relationship between TCM syndrome type,inflammatory immune index and fistula healing.Research Method:Part I: Screening for Crohn’s disease anal fistula and non-Crohn’s anal fistula from February 2015 to October 2018.After the exclusion,Crohn’s disease anal fistula was set as the experimental observation group,ordinary non-Patients with complex anal fistula were assigned to the control observation group.Both groups were tested for laboratory inflammatory markers(leukocytes,C-reactive protein,erythrocyte sedimentation rate),immune markers(interleukin 2,interleukin 6,interferon,transforming growth factor,vascular endothelial growth factor,tumor necrosis factor and T lymphocytes.Counting,including CD3+,CD4+,CD8+,NK,CD19+ cell count),histological analysis was performed on the wall of the fistula during operation,and two groups of indicators were analyzed.The Crohn’s disease activity index(CDAI)and the perianal Crohn’s disease activity index(PCDAI)were recorded before and after operation in the Crohn’s disease anal fistula group.Part II: The TCM syndromes of Crohn’s disease anal fistula were evaluated at the time of enrollment and follow-up.The distribution characteristics of TCM syndromes of Crohn’s disease anal fistula were analyzed.And the correlation between the TCM syndrome type of Crohn’s disease and anal fistula and the treatment results.Result: 53 patients with anal fistula with Crohn’s disease and 33 patients with anal fistula with non-Crohn’s disease.The CD anal fistula group had higher CRP,ESR,and VEGF values than the CD anal fistula group [(15.46±22.03 vs 1.62±3.10)(p<0.001),(29.87±24.30 vs 11.15±10.68)(p <0.001),(202.00 ± 145.19 vs 128.73 ± 101.47)(p <0.05)].Histological analysis of the iliac wall showed that the IL-17 F level in the CD anal fistula group was higher than that in the non-CD anal fistula group[(378.34±311.55 vs 1150.58±101.08)(p<0.001))].The CD3+,CD4+,NK,and CD19+cell values in the CD anal fistula group were lower than those in the non-CD anal fistula group [(878.87±438.72 vs 1187.28±372.31)(p<0.05),(462.74±217.88 vs696.56±282.81)(p<0.05),(165.85±130.30 vs 297.13±148.50)(p<0.05),(147.54±141.52 vs 244.44±142.68)(p<0.001)].The clinically simplified CDAI score and PCDAI score of the 53 patients with CD anal fistula were lower than those at the enrollment group [(4.58±1.73 vs 5.73±1.94)(p<0.001),(4.53±1.75 vs 9.94±1.55)(p<0.001).Among the 53 patients with CD anal fistula,the TCM syndromes from high to low were damp heat accumulation syndrome(33 cases,62.26%),spleen and stomach deficiency syndrome(17 cases,32.08%),cold dampness syndrome(3 cases,5.66%),TCM syndromes of CD anal fistula were evaluated at follow-up.12 cases(22.6%)were damp-heat accumulation syndrome,20 cases(37.7%)were spleen-stomach deficiency syndrome,and 4 cases(7.5%)were cold and damp spleen.certificate.Among them,26 patients(49.06%)had changes in their syndromes during the follow-up period.Among them,21(63.64%)of the patients with damp-heat syndrome had the highest changes.Conclusion: Inflammatory markers CRP,ESR,VEGF,and PLT have guiding significance for the clinical identification of CD anal fistula and non-CD anal fistula.Patients with anal fistula in Crohn’s disease present with an immune disorder.The syndrome differentiation of Crohn’s disease in patients with anal fistula is mainly due to the syndrome of damp-heat accumulation.The stable period is mainly due to the deficiency of cold syndrome.It may be related to the pathogenesis of Crohn’s disease,which is the spleen-stomach deficiency and cold,and the damp-heat accumulation is related to the standard. |
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