| Ulcerative Colitis (UC) is a chronic and nonspecific colorectal disease, which is characterised by chronic inflammation and ulceration of rectcolonic mucous membrane. The clinic symptoms of UC is abdominal pain, diarrhea, bloody purulent stool pus and blood stool and tenesmus and so on. The etiology and pathogenesis of UC is not very clear. UC usually last a very long period and easyly to relapse. In addition, the incidence of colon cancer have a certain relationship with UC. In recent years, with the increasing of living level、the chaging of dietory and living habits,the incidence of UC has significantly rising. Sulfasalazine and mesalazine slow release tablets are primarily healing medicine in western medicine. Although the drug can control the disease partly, but the clinical side effects occurs high.The traditional Chinese Medicine thinks UC belong to the category of "diarrhea". Traditional Chinese Medicine thinks UC has the spleen deficiency, hot and humid, blood stasis, etc for etiology and pathogenesis. The traditional Chinese Medicine shows its superiority in improving quality of life, lowering recurrence rate and lower spend than western medicine. Lianshao Enema is a proved recipe of guang’an men hospital, china academy of Chinese medical sciences. The rentention enema of traditional chinese medicine is commonly method among all the treaments, which it can increase drug concentration in colorectal lesions, reduce the drug’s side effects. So this treatment is used widely by doctors more and more.So we apply Lianshao Enema(LSE) to treat local colorectal symptoms in clinic, as we use traditional medicine by evidence-based to adjust the whole symptoms.It can achieve good clinic curative effect. We think the local performance is summarized as "red, swollen and painful", which can be called for early ulcers. This study will objectively evaluate the clinic efficacy of Lianshao Enema and discusse the pharmacological effects of the drug and the immune mechanism for providing the basis of its clinical application. The whole paper includs three parts:theoretical research, clinical research, experimental study.一.Theoretical researchThere is a summerization about the denomination, etiology, pathology and treatment principle of the Ulcerative colitise(UC) from the view of Traditional chinese medicine (TCM), Which focused on retention enema used traditional Chinese medicine and a variety of treatment options.The report also inllustrate epidemiological study, etiology and pathology and therapy of UC by modern medicine, which made emphasis on CK and AM in the immune factors二.Clinical researchObjective:To obverse the clinic efficacy and security of Lianshao Enema on the treatment of UC. Method:40 patients were randomly divided into treatment group and control group. The two groups were given Mesalazine, 1 g/time,3 times/d, for 2 weeks. the treatment group was given Chinese medicine retention with LSE. Clinical curative effect and adverse reactions were observed in both groups. Results:Total effective rate of treatment group was 94.7%, control group was 75%, The difference was statistically significant (P<0.05); And the treatment group in improving the diarrhea, the symptom such as purulent blood, abdominal pain, tenesmus, the anals hot better than the control group. Through endoscopic grading, the treatment group in improving the mucosal hyperemia, ulcers, erosion is better than that in control group, there are significant differences (P<0.05). Conclusion:In the treatment of UC, Chinese medicine Lianshao enema shows the advantages of reliable curative effect, easy application, and low cost, which is worth of clinical application.三.Experimental study1. Objective:to explore the pharmacological effects and toxicity results of Lianshao Enema on rat.Method:To investigate the mechanism of treatment lianshao Enema on UC, the Ear swelling experiment Body torsion experiment and the treatment experiment on the model rat of UC induced by TNBS were made. At the same time, the security of Lianshao Enema was evaluated by the Toxicology tests and the Rectal stimulation test. Results:.The pharmacodynamic results show:The Lianshao Enema can suppress the pain by Acetic acid, especially the high dose group of LSE (P<0.05).The high dose and low dose groups of LSE can inhibite the ear swelling of mouse by dimethylbenzen (P<0.05). The groups of LSE can suppress the diarrea caused by senna, especially the high dose group of LSE (P<0.001). The Toxicology tests and the Rectal stimulation test show: LSE was safe and reliable in clinic,which was applied by clinical recommended doses for long course. Conclusion:The LSE, which is safe and liable, has the function of relieving imflammation analgesic effects and detumescence effect.2. Objective:To explore the immune regulation mechanism of Lianshao Enema. Method:All the rats were made the model rat of UC induced by TNBS. It was randomly divided into six groups, namely the normal control group, the pathologic control group, the Mesalazine group, the high dose group of LSE, medium dose group of LSE, low dose group of LSE. After 18 days, the rats were killed to get their colonic mucosa. The genes expression of TLR-4 and NF-κ b p65 were detected in colonic mucosa of UC model rats by the RT-PCR method.Results:Relative gene expression of TLR-4/NF-kb p65 in pathologic group were significantly higher than in normal group (P<0.05). In LSE group the relative gene expression of TLR-4/NF-kb and mesalazine group were lower than model group(P<0.05). Conclusion:Lianshao Enema could inhibit the expression of TLR-4/NB-kb p65 mRNA and cut down the activation of proinflammatory factor and prevent the injury of endothelial cell, to cure UC. |
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