| ObjectiveStudy on the literature about Functional dyspepsia to understand the study progress of Chinese medicine and Modern medicine about Functional dyspepsia.Make one clinical research to evaluate the efficacy and safety of ShuGanJianPiHuoXue(SGJPHX)decoction treating Functional dyspepsia.Make a animal experimental study to investigate its effect on the regulation of brain-gut peptide in FD rats to find out its mechanism.MethodsLiterature research method:Searched for and analyzed the literature about Functional dyspepsia from CNKI and Pubmed to make a summary.From January 2016 to December 2016,in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicineclinic clinics,collected in line with the inclusion of liver depression and spleen deficiency functional dyspepsia patients,a total of 70 cases.According to random number table method were randomly divided into treatment group and control group of 35 cases,each group was 35 patients.The treatment group patients were given the SGJPHX and the control group patients were given Domperidone for treatment lasted 4 weeks.The improvement of Chinese medicine syndrome integral,quality of life,mental and psychological state of the patients were compared to evaluate its efficacy,and the liver and kidney function were detected to evaluate its safety.Animal experimental research method:70 SPF female rats were randomly divided into normal group(10)and modeling group(60)according to the bodyweight of rats.The modeling group rats were adopted by chronic restraint stress+excess fatigue+improper diet for 21days to form the model.After modeling,the modeling group rats were randomly divided into model group,SGJPHX high dose group,medium dose group,low dosegroup,ChaiShaoLiuJunZi(CSLJZ)decoction group and domperidone group.After group division,the SGJPHX high dose group,medium dose group and low dose group rats were given SGJPHX decoction,theCSLJZ group rats were given CSLJZ decoction,the domperidone group rats were given domperidone,and the model group and normal group were given pure water for 14days.The dose is calculated according to the surface area of human rat.During the experiment,observed the hair and stool of the rats,record the food intake and body weight of the rats.Afterwards,made small intestine propulsion experiment to evaluate its effect on promoting gastrointestinal motility.The content of Ghrelin,MTL,CCK,VIP、GAS,CGRP in plasm and iNOS,5-HT,SP in stomach tissue were detected by ELISA method,the protein expression of leptin receptor and cholecystokinin receptor in hypothalamus were detected by immunohistochemistry method,the gene expression of iNOS,5-HT,SP,leptin receptor and cholecystokinin receptor in hypothalamus were detected by RT-PCR method.ResultsClinical study results:1.There was no significant difference in gender,age and course of disease between the treatment group and the controlgroup(P>0.05).2.In the aspect of traditional chinese medicine symptoms,compared with before treatment,some symptoms of patients in the treatment group such as upper abdominal pain,upper abdominal burning sensation,early satiety,postprandial fullness and discomfort,anorexia,lassitude and asthenia,loose sloppy stool,belching and acid regurgitation,irritability or depression,weresignificantly improved(P<0.05),the symptom of nausea and vomit had improved trends,but the difference was not statistically significant(P>0.05).The symptoms of patients in the treatment group such as upper abdominal pain,upper abdominal burning sensation,early satiety,postprandial fullness and discomfort,anorexia,lassitude and asthenia,loose sloppy stool,belching and acid regurgitation,nausea and vomit,were improved obviously(P<0.05).The symptom of irritability or depression had improved trends,but the difference was not statistically significant(P>0.05).Compared with the control group,the symptoms improvement such as upper abdominal pain,upper abdominal burning sensation,postprandial fullness and discomfort,anorexia,irritability or depression were significantly better than the control group(P<0.05).3.After the treatment,there were 12 cases of the treatment group and 6 cases of the control group were cured,14 cases of the treatment group and 8 cases of the control group weresignificantly improved,4 cases of the treatment group and 10 cases of the control group were in effect,but 4 cases of the treatment group and 9 cases of the concrol group were fail.The total effective rate of the treatment group and control group were 88.24%and 72.73%respectively.The efficacy of treatment group was better than the control group,the difference was statistically significant(P<10.05).4.In the aspect of life improvement,the dimension scoresof patients in the treatment group suchas role-physical,bodily pain,general health,vitality,mental health were significantly increased(P<0.05).There was an increasing trend in physiological function,role emotional,social function dimension scores,but the difference was not statistically significan(P>0.05).The dimension scoresof patients in the control group suchas role-physical were significantly increased(P<0.05),There was an increasing trend in dimension scores such as physiological function,bodily pain,general health,role emotional and mental health,but the difference was not statistically significan(P>0.05).Indicating that SGJPHX decoction can be more comprehensive improvement of patient quality of life.5.In the aspect ofpsychosocial factors,after treatment,the score of HAMA and HAMD of patients in the treatment group was decreased significantly(P<0.05).While in the control group,after 4 weeks treatment,the score of HAMA and HAMD showed a trend of decreasing,but with no significant difference(P>0 05).The results showed that SGJPHXdecoctioncould improve the psychosocial factors of the liver depression and spleen deficiency type of functional dyspepsia patients.6.After the treatment,the recurrence rate of treatment group was 26.47%,which was lower than that of the control group(48.48%).There was significant difference between the two groups(P<0.05).7.In the course of the treatment,there were no abnormalities and adverse reactions,the results suggests that SGJPHX decoction is safe.Experimental results:1.Model evaluationAccording to the changes of hair,stool,food intake and body weight before and after modeling,it was found that the model of liver depression and spleen deficiency type FD was successful.2.Compared with the normal group,the gastrointestinal motility of the model group was significantly decreased,and the small intestine propulsion rate was significantly decreased too(P<0.01).After administration for 14 days,compared with the model group,the small intestine propulsion rate of SGJPHX decoction high dose group,medium dose group,domperidone group and CSLJZdecoction group were very significantly increased(P<0.01),and the rat of SGJPHX decoction low dose group was significantly increased(P<0.05).It indicated that SGJPHX decoction could increase the gastrointestinal peristalsis of model rats and showed a dose-effect relationship.3.Compared with the normal group,the level ofGhrelin,MTL,GAS in plasm of the model group rats were significantly reduced(P<0.05),but the content of CCK,VIP and CGRP were significantly increased(P<0.05).Compared with the model group,the content of Ghrelin and MTL in plasm of the SGJPHX decoction each dose group,domperidone group and CSLJZ decoction group were significantly increased(P<0.05).The content of GAS in plasm ofSGJPHX decoction high dose group was significantly increased(P<0.05),there is an increasing trend in the content of GAS in plasm of the other groups,but the difference was not statistically significant(P<0.05).The content of CCK in plasm of the SGJPHX decoction each dose group and domperidone group were very significantly decreased(P<0.01),and the content of CCK in plasm of CSLJZ decoction group was significantly decreased(P<0.05).The content of VIP in plasm of SGJPHX decoction high dose group,medium dose group,domperidone group and CSLJZ decoction group were significantly reduced(P<0.05),there is an reducing trend in the content of VIP in plasm of SGJPHX decoction low dose group,but the difference was not statistically significant(P>0.05).The content of CGRP in plasm of each group rats were significantly reduced(P<0.05).The results show that SGJPHX decoction could regulating brain gut peptide such as Ghrelin,MTL,GAS,CCK VIP and CGRP,and the traditional Chinese medicine activating blood could enhance the effect of SGJPHXdecoction on inhibiting CCK secretion.4.Compared with the normal group,theexpression of iNOS protein and SP protein in stomach tissue were significantly increased(P<0.05),and the expression of 5-HT protein was significantly decreased(P<0.05).Compared with the model group,theexpression of iNOS protein in stomach tissue of SGJPHXdecoction each dose group,domperidone group and CSLJZ decoction group were significantly decreased(P<0.05).Theexpression of SP protein in stomach tissue of SGJPHX decoction high dose group and domperidone group were were very significantly decreased(P<0.01),and that of SGJPHX decoction medium dose group and domperidone group were significantly decreased(P<0.05).theexpression of 5-HT protein in stomach tissue of SGJPHX decoction medium dose group and low dose group were very significantlyincreased(P<0.01),and that of SGJPHX decoction high dose group was significantlyincreased(P<0.05),there was an increaseing trend in theexpression of 5-HT protein in stomach tissue of domperidone group and CSLJZ decoction group,but the difference was not statistically significant(P>0.05).It suggested that the expression of iNOS,SP and 5-HT protein was regulated by SGJPHX decoction,and it had a dose-effect relationship,the traditional Chinese medicine activating blood could enhance the effect of SGJPHXdecoction on inhibiting theexpression of SP protein in stomach tissue.5.Compared with the normal group,theexpression of iNOSgene,5-HTgene and SPgene in the hypothalamus were very significantly decreased(P<0.01).Compared with the model group,theexpression of iNOSgene in the hypothalamus of SGJPHX decoction high dose group and domperidone group were were very significantly increased(P<0.01),and other group s were significantly increased(P<0.05).Theexpression of 5-HTgene in the hypothalamus of SGJPHX decoction high dose group,SGJPHX decoction medium dose group and CSLJZdecoction group were very significantly increased(P<0.01),the SGJPHX decoction low dose group and domperidone group were significantly increased(P<0.05).Theexpression of SP gene in the hypothalamus of SGJPHX decoction each dose group,domperidone group and CSLJZ decoction group were very significantly increased(P<0.01).6.Compared with the normal group,theexpression of OB-R1 protein and OB-R1 gene in the hypothalamus were very significantly increased(P<0.01),the CCKAR protein and CCKAR gene were very significantly increased too(P<0.01).Compared with the model group,theexpression of OB-R1 gene in the hypothalamus of SGJPHX decoction high dose group,SGJPHX decoction medium dose group,domperidone group and CSLJZ decoction group were very significantly decreased(P<0.01),the SGJPHX decoction low dose group was significantly decreased(P<0.05).Theexpression of CCKAR gene and OB-R1 protein in the hypothalamus of SGJPHX decoction high dose group and domperidone group were very significantly decreased(P<0.01),other group’s were significantly decreased(P<0.05).Theexpression of CCKAR protein in the hypothalamus of SGJPHX decoction each dose group and CSLJZ decoction group were significantly decreased(P<0.05),the domperidone group was very significantly decreased(P<0.01).ConclusionThe clinical research results shows that SGJPHX decoction has unique curative effects for treating functional dyspepsia patients suffered from liver depression and spleen deficiency on improving the clinical symptoms,quality of life,psychosocial factors,it is safe and better than domperi-done.The experiment results shows that SGJPHX decoction exerts its effects for treating functional dyspepsia probably by promoting gastro-intestinal movement,regulating brain gut peptide,decreasing the visceral hypersensitivity,which may be one of its mechanisms in treating functional dyspepsia.The activating blood traditional Chinese medicine can inhibit the role of CCK,SP. |
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