Clinical Observation And Anti-inflammatory Mechanism Of Changtong Ointment In The Treatment Of Chemotherapy-induced Intestinal Mucositis(Spleen Stomach Deficiency Cold Type)

Objective:To observe the clinical efficacy of Changtong ointment in the treatment of chemotherapy-induced intestinal mucositis(spleen stomach deficiency cold type)and explore its anti-inflammatory mechanism,so as to provide a theoretical basis for the clinical application of Changtong ointment in the treatment of chemotherapy-induced intestinal mucositis.Methods:Clinical observation:72 patients with tumor chemotherapy in the Affiliated Hospital of North Sichuan Medical College from February 2021 to November 2021 were selected,which met the acceptance and exclusion criteria of CIM(Chemotherapy-induced Intestinal Mucositis)and spleen stomach deficiency cold syndrome.They were randomly divided into treatment group and control group,with 36 cases in each group.Both groups were given basic treatment,the control group was treated with MF multi-source therapeutic instrument,and the treatment group was treated with Changtong ointment on the basis of the control group,twice a day,30 minutes each time.After 7 days of treatment,the digestive system symptoms such as nausea,diarrhea,vomiting and the score of traditional Chinese medicine syndrome were observed and compared between the two groups.Mechanism study:Thirty 210-240g male SPF SD rats were randomly divided into control group,model group and Changtong ointment group,with 10 rats in each group.The rats in model group and Changtong ointment group were injected intraperitoneally with 5-FU for 5 days to build CIM model,and the control group was injected with equal volume of normal saline.On the first day of administration,the control group and the model group were treated with MF multi-source therapeutic instrument,and the Changtong ointment group was treated with external application of Changtong ointment twice a day for 30 minutes each time for 8 days.The weight and food intake of rats were recorded every day to evaluate the degree of diarrhea.On the 9th day,the rats were killed,the serum and intestinal tissue were collected,and the content of serumTNF-α、IL-1β、IL-6 was detected by ELISA;The expression of TNF-α、IL-1β、IL-6、TLR1-2 and TLR5-6 genes in different groups of rats was determined by QRT PCR.Results:Clinical observation:After treatment,the symptoms of nausea,vomiting and diarrhea in the two groups were improved,Comparing the gastrointestinal symptoms of the two groups,the curative effect of the treatment group was better than that of the control group(P<0.05),and there were no adverse reactions in all patients during the treatment.The score of TCM Syndrome Scale in the two groups after treatment was lower than that before treatment(P<0.05),andthe score of the treatment group was significantly lower than that of the control group(P<0.05).The total effective rate was 88.89%in the treatment group and 52.78%in the control group(P<0.05).Mechanism research:Changes in body weight,food intake and degree of diarrhea:in terms of daily food intake,the daily food intake of model group rats is lower than that of normal group,and the daily food intake of Changtong ointment group is higher than that of model group.In terms of weight change,the weight of rats in the model group was lower than that in the normal group,and the weight of rats in the Changtong ointment group was higher than that in the model group(P<0.05).The diarrhea score of the model group was higher than that of the normal group,and that of the Changtong ointment group was lower than that of the model group(P<0.05).Changes of serum inflammatory factors:compared with the normal control group,the content of TNF-α、IL-1β、IL-6 of the model group increased(P<0.05);Compared with the model group,the levelsof TNF-α、IL-1β、IL-6 in Changtong ointment group decreased(P<0.05).Changes of TNF-α、IL-1β、IL-6、TLR1-2 and TLR5-6 gene expression in tissue:compared with the normal control group,The expression of IL-6、IL-1β、TNF-α、TLR1-2 and TLR5-6 in the model group increased significantly(P<0.05);Compared with the model group,The expression of IL-6、IL-1β、TNF-αand TLR2 in Changtong ointment group decreased significantly(P<0.05),there was no significant change in the expression of TLR1,TLR5 and TLR6(P>0.05).Conclusion:Changtong ointment is effective in the treatment of chemotherapeutic intestinal mucositis(spleen stomach deficiency cold type)without obvious side effects,which is worthy of further clinical promotion.Changtong ointment can significantly improve intestinal mucositis induced by 5-FU in rats,and its mechanism may be through the inhibition of TLR2/NF-κB pathway,down regulating inflammatory factor TNF-α、IL-6andIL-1βAnd exert anti-inflammatory effect.