目的 研究地衣芽孢杆菌胶囊联合美沙拉秦缓释颗粒治疗轻中度活动期溃疡性结肠炎的临床疗效。方法 选取2015年1月-2018年1月中国医科大学附属盛京医院消化内科收治的明确诊断为轻度和中度的初治溃疡性结肠炎住院患者100例为研究对象，采用数字随机表法将所有患者分为对照组和治疗组，每组各50例。对照组口服美沙拉秦缓释颗粒，1.0 g/次，4次/d。治疗组在对照组治疗基础上口服地衣芽孢杆菌活菌胶囊，0.5 g/次，3次/d。两组患者均连续服药12周。观察两组的临床疗效、光镜下组织学损伤情况、内镜愈合率和黏膜愈合率，比较两组的改良Mayo评分、Mayo内镜亚组评分、Geboes评分、肠道菌群数量。结果 治疗后，对照组、治疗组的总有效率分别为80.00%、94.00%，两组总有效率比较差异有统计学意义（P<0.05）。治疗后，两组改良Mayo评分、Mayo内镜亚组评分均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗组Mayo评分明显低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，对照组、治疗组肠光镜下上皮杯状细胞和腺体增加，固有层见少量淋巴细胞、嗜酸性粒细胞浸润。治疗后，两组患者Geboes评分均显著下降，同组治疗前后比较差异具有统计学意义（P<0.05），且治疗组的Geboes评分显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，对照组内镜愈合率为26%，治疗组内镜愈合率为30%，两组内镜愈合率比较差异无统计学意义。治疗后，对照组黏膜愈合率为8%，治疗组黏膜愈合率为8%，两组内镜愈合率比较差异无统计学意义。治疗后，两组双歧杆菌、乳酸杆菌的菌群数量明显升高，粪肠球菌的菌群数量明显降低，同组治疗前后比较差异具有统计学意义（P<0.05），并且治疗后治疗组双歧杆菌、乳酸杆菌的菌群数量显著高于对照组，大肠杆菌、粪肠球菌的菌群数量显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 地衣芽孢杆菌胶囊联合美沙拉秦缓释颗粒治疗轻中度活动期溃疡性结肠炎具有较好的临床疗效，能够改善内镜和组织学损伤，改善临床症状，调节肠道菌群结构，具有一定的临床推广应用价值。

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.

辽宁省自然科学基金资助项目（20170540529）；沈阳市科学技术项目（F15-199-1-39）