| Objective:To observe the clinical effect of Hewei Yuyang Decoction in the treatment of ESD-induced ulcer in gastric cancer,observe the effect of Hewei Yuyang Decoction on the expression of EGF,PGE2 and P-catenin in rats with acute gastric ulcer,and to explore the mechanism of Hewei Yuyang Decoction in treating ESD-induced gastric ulcer.Method:1.Clinical trial method:This study is a single-center prospective randomized controlled trial.A total of 65 subjects with early gastric cancer were enrolled in the study.They were randomly divided into observation group with 32 cases and control group with 33 cases.The observation group was treated with Hewei Yuyang Decoction combined with omeprazole,while the control group was treated with omeprazole alone for 8 weeks.At the 4th and 8th weeks,the symptoms,ulcer status and histological maturity of regenerated mucosa of the two groups were evaluated.The effects of gender,age,Helicobacter pylori infection,non-steroidal anti-inflammatory drugs(NSAIDs)taking,lesion location and initial ulcer size on ulcer healing were analyzed by multivariate analysis.At the same time,the efficacy and safety of ESD in the treatment of early gastric cancer were also evaluated.2.Animal experimental methods:According to the characteristics of ESD,rats with acute gastric ulcer were induced by acetic acid injection plus radio frequency cauterization.Sham-operated group,model group,omeprazole positive drug control group were set up.Hewei Yuyang decoction was divided into low-dose group,middle-dose group and high-dose group.Each dose group of Hewei Yuyang decoction was given Chinese herbal decoction for 14 days,the positive drug control group was given omeprazole for 14 days,and the sham-operated group and the model group were given NS for the same dose.Rats were sacrificed on the 15th day of administration.The gastric ulcer index,ulcer inhibition rate,thickness of regenerated mucosa,serum EGF and PGE2 levels were compared.The expression of ?-catenin in gastric mucosa was detected by Western blot.Results:1.Clinical findings:In this study,65 cases of ESD were treated and a total of 60 cases were included in the analysis.The overall resection rate was 95%(57/60),the cure resection rate was 91.7%(55/60),and the incidence of delayed hemorrhage was only 3.3%(2/60).The scores of syndromes in both groups decreased significantly after 4 and 8 weeks of treatment,especially in the observation group(P<0.05).The ulcer area in the observation group decreased more significantly than that in the control group after 4 and 8 weeks of treatment(P<0.05).The total effective rate between the two groups was significant different(P<0.05),With 93.0%in the observation group and 87.1%in the control group 4 weeks after operation.There was no significant difference in the total effective rate between the two groups at 8 weeks after operation(P>0.05).The histological maturity of ulcer regeneration mucosa in the observation group was better than that in the control group at 4 and 8 weeks after operation(P<0.05).Multivariate analysis of factors affecting ulcer healing after ESD,such as sex,age,Helicobacter pylori infection,NSAIDs taking,location of lesions,size of initial ulcer,showed that the initial ulcer area greater than 1200 mm2 required longer healing time.No adverse complications occurred in the observation group,and no adverse events related to the use of the drug were observed.2.Animal experiment results:The area of gastric ulcer in Hewei Yuyang decoction group and omeprazole group decreased,especially in Hewei Yuyang decoction high-dose group and omepraz:ole group,which had significant difference compared with model group(P<0.05).The thickness of regenerated mucosa in Hewei Yuyang decoction group and omeprazole group was better than that in model group(P<0.05),and that in Hewei Yuyang decoction high dose group was better than that in omeprazole group(P<0.05).The serum EGF level in Hewei Yuyang Fang high dose group was higher than that in omeprazole group,and the serum PGE2 level in high and medium dose group was higher than that in omeprazole group(P<0.05).The expression of beta-catenin in gastric tissues of rats in model group and administration group was higher than that in sham-operated group.The expression level of(3-catenin in middle dosage group was not significantly different from that in omeprazole group(P>0.05)?Conclusion:1.ESD is a safe and effective treatment for early gastric cancer.2.Hewei Yuyang Decoction combined with omeprazole can accelerate the healing rate of ulcer after ESD,improve the quality of ulcer healing and relieve clinical symptoms.It is superior to omeprazole single drug treatment,and has good safety.It is worth popularizing and applying.3.Ulcer healing with initial area greater than 1200 mm2 takes longer.The recommended course of treatment is 8 weeks.4.Promoting the secretion of EGF and PGE2 and benign regulation of ?-catenin expression may be the main mechanism of Hewei Yuyang decoction in treating ESD-induced ulcer. |
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