| Object :From the perspective of inflammatory mediators and cytokines,to explore the mechanism of abdominal postoperative intestinal adhesion occurred and Qingchang Mixture in protecting and treating abdominal postoperative intestinal adhesion, through observing the curative effect of Qingchang Mixture and the control effect on intestinal adhesion in the rat model of NLRP3,caspase-1,IL- 1?,MMP- 9 and TIMP- 1,to explore the pathogenesis of occurred in and the mechanism of prevention and treatment of abdominal postoperative intestinal adhesion.Method:(1) clinical research: 60 patients included in the standard will be divided into treatment group and control group, 30 cases each. The control group given conventional western medicine non-surgical therapy includes routine fasting,rehydration, acid suppression,resistance to infection,and symptomatic treatment,when it is necessary to give the treatment such as gastrointestinal decompression,parenteral nutrition; In western medicine treatment group,on the basis of conventional non-surgical therapy, Qingchang Mixture retention enema. Observed two groups of patients with postoperative bowel sounds for the first time in time,first exhaust time,for the first time defecation time, infection, rupture of incision, lung infection in the cases of postoperative complications. After 1 years follow-up,statistical intestinal adhesion cases happened.(2) experimental study: selected Wistar rats,were randomly divided into 5 groups,normal control group,model control group,Qingchang Mixture low dose group, the middle dose Qingchang Mixture group, Qingchang Mixture high dose group,18/group, in addition to the normal control group, the rest of the four groups made intestinal adhesions model. 24 h after lavage, respectively in 2 days, 7 days, 14 days executed part of rats, observe the rat abdominal cavity adhesion degree. By using Elisa and immunohistochemical method to detect the distribution and expression of NLRP3,caspase-1, IL- 1 ?, MMP- 9, TIMP- 1.Results: the clinical research proves, the treatment group was earlier than the control group in bowel sounds time for the first time,exhaust time,for the first defecation time(P<0.05),two groups of incision infection,split,the incidence of pulmonary infection is no statistical significance(P> 0.05), after 1 years follow-up,the incidence of intestinal adhesion of treatment group was obviously lower than control group(P<0.05). Experiments on animals suggest NLRP3 in model control group, caspase 1, IL-1? factor is higher than the normal control group, Qingchang Mixture including NLRP3 dose group, caspase-1, IL-1?factor levels significantly lower than that of model control group, and NLRP3 and caspase-1, adhesion degree has significant correlation, has no obvious correlation with IL-1?, and 7 days postoperatively, model control group significantly increased intestinal tissue expression of MMP-9 P<0.05), significantly increased expression of TIMP- 1(P < 0.05), but the 14 days after surgery, MMP-9 reduce much than TIMP-1, compared with model control group, qingchang mixture group significantly lower levels of MMP- 9, elevated TIMP- 1 level.Conclusion: the occurrence of abdominal postoperative intestinal adhesion and NLRP3,caspase-1, IL-1? excessive expression,MMP-9 / TIMP-1 ratio, lead to excessive extracellular matrix degradation, degradation/synthetic imbalance; Intestinal adhesions may activate the NLRP3 inflammasome, but there may be other inflammasome(NLRP1,etc.) are involved in the formation process of intestinal adhesion; Qingchang Mixture can prevent the occurrence of abdominal postoperative intestinal adhesion, its mechanism may be through: one is to reduce NLRP3, caspase-1,IL-1?levels, reduce inflammation response; Second inhibition of intestinal tissue MMP-9 expression and activation of TIMP-1, maintain the balance of the extracellular matrix. |
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