| ObjectiveTo evaluate the clinical effects of Jinghua Weikang Capsule (JWC) and other Chinese patent medicines on Helicobacter pylori (H.pylori) infected gastritis. To confirm the anti-H.pylori activities of JWC and its main ingredient Chenopodium Ambrosioides.L (CAL), and explore the impact of both JWC and CAL on gastric mucosal inflammation, epithelial cellular morphology and proinflammatory cytokines in vivo experiments.Methods1. Systematic review:Random and semi-random clinical trials of Chinese patent medicines combined with triple & quadruple on H.pylori infected gastritis were searched and collected from CNKI, Wanfang data, VIP database, Pubmed and Cochrane Library. The quality of including trials was evaluated by Cochrane Collaboration’s tool for assessing risk of bias. Meta-analysis was performed by Review Manager 5.3 software package.2. Animal experiments:77 KM mice were randomly divided into blank control, model control, triple therapy, JWC, CAL, JWC + triple therapy and CAL + triple groups. The H.pylori infected model was established via intragastric administration of fresh H.pylori SS1 suspension. Drug doses were equivalent to clinical administrations and applied as:(1)blank control group free of any gavage; (2)model group with sterile water 4w; (3)CAL group with CAL daily 4w; (4)JWC group with JWC daily 4w; (5)triple therapy group with a suspension of lansoprazole, metronidazole and clarithromycin 1w + sterile water 3w; (6)CAL + triple therapy group with CAL & triple therapy 1w + CAL 3w; (7)JWC + triple therapy group with JWC & triple therapy 1w + JWC 3w. All the animals were sacrificed after treatment. Rapid urease test (RUT) and histological staining were performed to identify the eradication rate. Hematoxylin-eosin (HE) staining was applied to observe the degrees of H.pylori colonization and gastric mucosal inflammation. Use scanning electron microscope to check the epithelial cellular morphology. NF-κB p65, IL-1β, IL-8 and TNF-α mRNA levels were tested by means of real-time PCR. The content of NF-κB p65 in cytoplasm and nucleus was detected by immunohi stochemi stry.Results1. Systematic review:16 trials were included,9 of Chinese patent medicines combined with triple therapy,7 of one with quadruple therapy; 7 of JWC,9 of other drugs. (1)Therapeutic evaluation:The total H.pylori eradication rate of Chinese patent medicines combined with triple/ combined with triple therapies was superior to positive control (OR 1.55,95%CI [1.22 1.96],Z=3.62,P=0.0003). The subgroups analysis: ①According to treatments of control group, the Chinese patent medicines containing therapies was superior to triple therapy (OR 2.44,95%CI [1.68 3.55],Z=4.66,P<0.00001) and equal to bismuth quadruple therapy (OR 1.11,95%CI [0.82 1.52],Z=0.68,P=0.50). ②ccording to classification of treatment groups, JWC containing scheme was superior to triple therapy (OR 3.98,95%CI [1.91 8.29],Z=3.69,P=0.0002) and equal to bismuth quadruple therapy (OR 1.02,95%CI [0.68 1.54],Z=0.10,P=0.92). Other patent drugs containing therapy achieved higher eradication rate than control (OR 2.84,95%CI [0.92 8.79],Z=2.95,P=0.003). (2)Safety:In total the safety between treatment and control groups was identical (OR 0.73,95%CI [0.42 1.26],Z=1.13,P=0.26), and subgroup analysis demonstrated side effects ratio of Chinese patent drugs containing scheme was lower than bismuth quadruple therapy, in accord with triple therapy.2. Animal experiments:(1)H.pylori eradication rates were CAL 50%, JWC 40%, triple therapy 70%, CAL + triple 100%, JWC + triple 80% (x2=10.657,P=0.025), respectively. (2) Under the light microscope observation, model group possessed massive H.pylori colonization and partial inflammatory cell infiltration while without active inflammation and glands atrophy; in other groups H.pylori colonization and inflammatory were slight. (3)Under electron microscope, gastric epithelial cells of blank group tightly arranged along with complete structure as cobblestone, unanimaous cellular volume and clear gastric pits; in model group the cells’arrangement was in disorder with various morphology, rough and partially damaged surfaces; the cellular morphology of other treatment groups was improved with varying degrees, and the improvement in JWC + triple group was optimal. (4)The mRNA values of NF-κB p65, IL-1β, IL-8 and TNF-α in JWC or CAL containing groups increased, which were statistically different from blank and model groups (P<0.001). (5) NF-κB p65 protein levels in cytoplasm were statistical accordance among groups (P=0.168), while both significantly different in cell nucleus and nucleus/cytoplasm. The NF-κB p65 protein nucleus/cytoplasm values of JWC + triple group were statistically different with model group (P=0.041) while the same as blank group (P=0.464).Conclusions1. The Chinese patent medicines, mainly JWC combined with triple therapy achieves higher H.pylori eradication rate which is equal to bismuth quadruple therapy with lower side effects rate. This combination probably can be the complementary or alternative scheme of bismuth quadruple therapy.2. JWC and its major ingredient CAL have a certain bactericidal effect in vivo, and it is synergistic with antibiotics.3. JWC and its major ingredient CAL improve the morphology of gastric mucosal epithelial cells.4. It is the possible mechanism of the anti-inflammatory effect of JWC and CAL, that both of them reduce the NF-κB p65 expressing level.
|
PDF Full Text Request