Mechanism Study Of Jianpi Huazhuo Decoction In The Treatment Of Non-alcoholic Steatohepatitis Based On The Gut-liver Axis

Objective: Based on the gut-liver axis,clinical effect of jianpi huazhuang decoction on non-alcoholic steatohepatitis was investigated,and the mechanism was discussed.Methods: Clinical observation: Sixty patients up to standard were divided into the experimental group and the control group.The experimental group was given a decoction of turbid drinking water to aggravate their spleen,while the control group was given shuilinjia.The course of treatment lasted for 12 weeks.The changes of TCM syndrome indexes,single symptom points,body weight,body mass index,biochemical indexes(ALT,AST,TG,TC,GLU),serum endotoxin,liver color doppler ultrasound and safety indexes before and after treatment were analyzed.Experimental study: A rat model of nonalcoholic steatohepatitis was established through feeding a high fat diet.Rat were divided into 5groups: blank group,model group,low dose group,medium dose group and high dose group.The liver wet weight,ALT,AST,TG,TC,GLU,LPS and d-lac of rats in each group were detected after 8 weeks of intervention.The expressions of TLR4 and NFκB proteins in liver tissues were detected using Western blot.The expression of Occludin proteins in ileum tissues was detected using immunohistochemistry.The relative quantitative determination of E.coli and lactobacillus in feces was determined using RT-PCR.Result:Clinical observation: 1.The comprehensive efficacy of the experimental group was superior to the control group(P < 0.05).2.Comparison of TCM syndrome points:compared with the prior treatment data,both groups showed improvement(P < 0.05);compared with the treated group,the experimental group was superior to the control group(P < 0.05).3.Comparison of single symptom scores: the single symptom scores of all the experimental group showed different degrees of improvement(P < 0.05).The main symptom,right flank fullness,and the secondary symptom,loose stool quality,were better than that of the control group(P < 0.05).In the control group,not only body obesity,other symptom scores were also improved to different extend(P < 0.05).4.Weight and body mass index: compared with the prior treatment data,both groups showed different degrees of decline(P < 0.05).Comparing the treated groups,difference between the two groups was statistically significant(P < 0.05),the experimental group was superior to the control group.5.Biochemical indicators: compared with prior treatment data,both groups showed improvement in ALT,AST,TG and TC(P < 0.05).After treatment,the experimental group was superior to the control group in TG,TC and GLU(P < 0.05),while there was no significant difference in ALT and AST(P > 0.05).6.Serum endotoxin: compared with the prior treatment data,serum endotoxin levels in the experimental group were statistically significant(P < 0.05),while those in the control group were not statistically significant(P > 0.05).After treatment,the experimental group was superior to the control group(P <0.05).7.Liver color doppler ultrasound: compared with the prior treatment data,both groups showed improvement(P < 0.05).Comparing the treated groups,the experimental group was superior to the control group(P < 0.05).8.Safety index: no abnormalities were found in both groups.Experimental study:1.In terms of liver wet weight,liver index,ALT,AST,TG,TC and GLU,rats in the model group were more abnormal than those in the blank group(P < 0.05),while those in the medium and high dose groups of invigorating jianpi huazhuo decoction were better than those in the model group(P < 0.05).In terms of liver histopathology,the model group was significantly abnormal compared with the blank group.The medium dose and high dose groups of jianpi huazhuo decoction were improved compared with the model group.2.In terms of serum LPS,TLR4 and NFκB protein expression,rats in the model group were more abnormal than those in the blank group(P <0.05),and those in the medium and high dose groups were improved better than those in the model group(P < 0.05).3.In terms of D-LAC,Occludin protein,E.coli and lactobacillus,the model group was more abnormal than the blank group(P < 0.05).The medium and high dose groups of jianpi huazhuo decoction were better than the model group(P < 0.05).In terms of pathological manifestations of intestinal mucosa,the model group was significantly abnormal compared with the blank group,and the medium and high dose groups of jianpi huazhuang decoction showed different degrees of improvement compared with the model group.Conclusion: 1.Jianpi huazhuo decoction has a definite clinical effect,improving the patients’ symptoms,signs,biochemical indicators,serum endotoxin and liver color doppler ultrasound,with inapparent side effects.2.The mechanism of Jianpi huazhuo decoction may play a role in the treatment of nonalcoholic steatohepatitis by regulating intestinal flora,repairing intestinal mucosal barrier,reducing intestinal mucosal permeability,inhibiting LPS/TLR4/NF B signaling pathway,blocking the vicious cycle of intestinal liver injury,and playing a role by regulating the gut-liver axis system.