經油提取青黛灌腸療法緩解潰瘍性結腸炎患者經全大腸切除後之難治性直腸炎：病例報告與系統藥理學分析

Refractory Proctitis in a Patient with Ulcerative Colitis and Total Colectomy Alleviated by Novel Enema Therapy with Oil-Extracted Indigo naturalis and mesalazine: Case Report and Systems Pharmacology Analysis

背景：儘管已有多種現有療法可用於治療中重度潰瘍性結腸炎（Ulcerativecolitis, UC），但仍可能效果不彰。中藥青黛（Indigo naturalis, IN），對潰瘍性結腸炎顯示出潛在的益處。本研究旨在展示使用青黛萃取物灌腸療法，闡明其於潰瘍性結腸炎患者全結腸切除術後難治性直腸炎的治療過程，並透過系統藥理學方法將青黛與西藥之可能機轉進行比較。材料與方法：一名67歲潰瘍性結腸炎男性患者於全結腸切除術後出現反覆直腸炎，因西藥治療效果不佳，從2021年4月至2022年7月接受油萃取青黛灌腸療法。患者對青黛灌腸療法反應頗佳，治療12個月後，達到臨床與內鏡雙重緩解，且未發現與青黛灌腸治療直接相關的不良事件，然則在停用清黛灌洗後，患者曾發現一次直腸出血。青黛似乎可作為潰瘍性結腸炎之中西醫整合治療方式之一，以機轉而言，西藥主要影響免疫相關通路，而青黛作為抗氧化劑，與炎症及脂質重塑通路相關。結論：此個案研究表明，油萃取青黛灌腸療法對潰瘍性患者的直腸炎可能有效，但需進行嚴謹的隨機對照試驗以進一步確認此治療方法的有效性。

Background: Despite the availability of various novel therapeutics for treating moderate-to-severe ulcerative colitis (UC), many patients may not respond to these treatments. Indigo naturalis (IN) is a Chinese herbal medicine that has shown potential benefits for UC. This study aims to present the treatment course of IN enema for UC with refractory proctitis after total colectomy and to compare IN therapy with Western medicine (WM) using a systems pharmacology approach. Material and methods: We examined the clinical and endoscopic effectiveness of oil-extracted IN administered as enema therapy to a 67-year-old man with treatment-refractory UC from April 2021 to July 2022. The patient showed a clinical response to the IN-enema therapy. After 12 months, the patient achieved combined clinical and endoscopic remission. No adverse events directly related to IN-enema treatment were identified. One rectal bleeding episode was reported after discontinuing the IN-enema therapy. IN appeared to complement WM in treating UC, with WM affecting immunity-related pathways and IN,