| The first part:theoretical studyMeta analysis of Shengyang Yiwei Decoction compared with western medicine in the treatment of UCObjective:To evaluate the effectiveness of Shengyang Yiwei Decoction in the treatment of ulcerative colitis by meta analysis.Methods:PubMed,Embase,Cochrane Library,CNKI,VIP,CBM and Wanfang database were retrieved by computer to collect the randomized controlled trial on the treatment of ulcerative colon with Shengyang Yiwei soup.After the inclusion and exclusion criteria were selected,data extraction and evaluation were included in the study,the statistical software of Statal4.0 was used.Meta analysis was carried out.Results:a total of 6 effective randomized controlled trials were included,and there were obvious bias in random grouping,distribution concealment and blindness,all of which were not low quality literature.The total effective rate of Shengyang Yiwei Decoction in the treatment of UC was 1.157 times that of Western Medicine(RRF=1.157,95%CI:1.079-1.240,P<0.001),and the total effective rate of Shengyang Yiwei Decoction in treating UC was 1.641 times of Western Medicine(RR= 1.64195%CI:1.346-2.002,P<0.001).At the same time,the short-term and long-term cure rate of UC was significantly higher than that of Western Medicine(RR=1.453,95%CI:1.189-1.775,P<0.001;long term RR=3.050,95%CI:1.891-4.919,P<0.001).Conclusion:compared with western medicine,Shengyang Yiwei decoction has better clinical effect in the treatment of UC.The risk of bias is high in this study,which needs further validation of high-quality randomized controlled trials.The second part:Experimental ResearchEffect of Shengyang Yiwei Decoction on ulcerative colitis rats with spleen deficiencyObjective:To observe the effect of Dongyuan Shengyang Yiwei Decoction on the symptoms of spleen asthenia ulcerative colitis in rats.By analyzing the index of TNF-alpha,IL13 and MPO in the serum and colon tissues of the spleen asthenia ulcerative colitis rats,the lipid peroxidation index of MDA,SOD and so on,AQP3 and AQP in the colon tissue were analyzed by the analysis of the Shengyang Yiwei decoction.The effects of aquaporin 8 and IKK-beta/NF-kappa B pathway on ulcerative colitis of spleen deficiency type were studied.Methods:48 SD rats were allocated randomly,including blank group,model group,mesalazine(MSLQ)group,Shengyang Yiwei Decoction low dose(SYYWT-L)group,Shengyang Yiwei Decoction(SYYWT-M)group and Shengyang Yiwei Decoction(SYYWT-H)group.For the rats outside the blank group,the combination of senna leaf/2,4,6-and three nitrobenzene sulfonic acid was used to prepare the spleen deficiency type ulcerative colitis syndrome syndrome combination model.Group MSLQ and group SYYWT-L,SYYWT-M and SYYWT-H were treated with mesalazine and Shengyang Yiwei Decoction respectively at low,medium and high dosage of traditional Chinese medicine decoction.The blank and model group were the same.The experimental period was 2 weeks,and the four time points of ID,7d and 14d were recorded before the treatment cycle,and the data of fecal water content,body mass and 24h intake of the spleen deficiency syndrome of rats were recorded and compared.After 2 weeks of treatment,the rats were taken blood from the heart,The content of TNF-alpha and IL13 in serum was detected by ELISA,and the colonic tissue of rats was observed and the morphological and pathological changes were observed under the naked eye and under the microscope.The content of MPO,MDA and SOD in the colon tissues of each group was detected by ELISA method,and the protein immunoblot test was used to detect AQP3 and AQ in the colon tissue.The expression of P8,IKK-beta and NF-kappa B-p65 protein was detected by real-time fluorescence quantitative PCR.The expression levels of AQP3,AQP8,IKK-beta and NF-kappa B-p65 mRNA were detected.Results:the spleen deficiency type ulcerative colitis model could be successfully prepared by the/2,4,6-and three nitrobenzene sulfonic acid compound method.Compared with the blank group,the spleen asthenia syndrome was found in rats,such as weakness,Naty,diarrhoea and emaciation.Compared with the blank group,the model group had the following changes:the colonic eye and the pathological score under the microscope.The content of TNF-alpha in the serum increased significantly,the content of IL13 decreased significantly(P<0.05),the content of MPO and MDA in the colon tissue increased significantly(P<0.05)?and the content of SOD decreased significantly(P<0.05).At the protein level,the expression of AQP3 and AQP8 protein in the colonic tissue decreased significantly(P<0.05),while the MPO and AQP8 protein in the colonic tissue decreased(P<0.05).The expression of kappa B p65 protein increased significantly(P<0.05),and at the gene level,the expression level of AQP3 and AQP8mRNA increased significantly(P<0.05),while the expression of IKK beta and NF-kappa B p65mRNA decreased significantly(P<0.05).Compared with the model group,mesalazine and Shengyang Yiwei decoction could significantly improve the water content of the feces,body mass and 24h intake,and reduce the syndrome of spleen deficiency in TCM,diarrhea and emaciation.The results of the experiment showed that all the other groups except the low dose group of Shengyang Yiwei decoction could improve the gross gross eye score of the colon and the pathological score(P<0.05).The content of TNF-alpha in the serum decreased significantly,the content of IL13 increased significantly(P<0.05),and the content of MPO and MDA in the colon tissue decreased significantly(P<0.05).The content of SOD increased significantly(P<0.05),and the expression of AQP3 and AQP8 protein in the colonic tissue increased significantly(P<0.05),and the expression of IKK beta and NF-kappa B p65 protein decreased obviously,and the expression level of AQP3 and AQP8mRNA decreased significantly at the gene level(P<0.05).(P<0.05).Conclusion:Shengyang Yiwei decoction can significantly improve the syndrome of spleen deficiency syndrome,alleviate the symptoms,alleviate the injury of the colon tissue and protect the intestinal mucosa.The experimental results show that the mechanism of the therapeutic effect of the prescription may be that it can regulate the level of inflammatory factors such as MPO,TNF-a,IL13 and so on,and regulate the M.The content of lipid peroxidation,such as DA and SOD,can inhibit the inflammatory state and slow down the inflammatory damage.It can also increase the expression of AQP 3 and AQP8 at the level of protein and gene,regulate the reabsorption of water,reduce the water content of the stool,and promote the alleviation of diarrhea;it can also be derived from the protein and gene levels of IKK beta and NF-kappa B p65.The upstream suppresses the IKK beta/NF-kappa B p65 signaling pathway and reduces the expression of downstream inflammatory factors.The third part clinical study Clinical observation of Shengyang Yiwei decoction combined with mesalazine in the treatment of ulcerative colitis with spleen deficiency typeObjective:To investigate the clinical effect of Shengyang Yiwei Decoction on the patients with spleen deficiency type ulcerative colitis,the improvement of the colon mucosa under the colonoscopy and the regulation of some serum inflammatory factors.Methods:40 cases of Spleen Asthenia Type ulcerative colitis were randomly divided into two groups:20 cases in the control group were treated with mesalazine,one 1g and four times a day;20 cases in the observation group were taken orally with Shengyang Yiwei Decoction on the basis of the control group,one dose daily,2 times,each time 250ml,two groups were treated for 8 weeks.The changes of clinical symptoms,TCM syndromes and enteroscopy were observed in the two groups before and after treatment.The therapeutic effects of the two groups were compared and the serum levels of interleukin 6(IL-6)and tumor necrosis factor-alpha(TNF-alpha)were detected before and after the treatment.Results:1 cases were lost in the observation group.The comprehensive curative effect of Western medicine in the observation group and the total effective efficiency of TCM syndrome(89.47%,94.73%%)and the control group(75%,80%)had no significant difference(P>0.05).The two groups of TCM syndrome scores and the Baron score under the enteroscopy were significantly lower than those before the treatment,and the comparison between the groups was observed.The decrease of the group was more significant(P<0.05);the content of serum IL-6 and TNF-alpha in the serum was significantly lower than that before treatment(P<0.05),and the decrease in the observation group was more significant(P<0.05)than that of the observation group(P<0.05);there was no obvious adverse reaction in the clinical trial.Conclusion Shengyang Yiwei decoction combined with mesalazine is effective in the treatment of spleen asthenia ulcerative colitis.It can reduce the TCM syndrome,relieve the clinical symptoms,improve the mucosal injury,reduce the high level of serum inflammatory factors,inhibit the inflammation and promote the disease. |
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