| Tongue coating is an important clinical apparent feature of diseases.In TCM clinical practice,different colors and thicknesses of tongue coating also correspond to different etiologies.Current studies have shown that the changes of oral microorganism are the basis of different tongue coating types。Especially,the oral and intestinal tract are the most important microecosystem of human body,and also an important part of human digestive tract,so they are interrelated in structure,function and pathological changes.Geographic tongue is the characteristic tongue image,which is not affected by light and subjective consciousness.At present,studies have confirmed that Geographic tongue often appears in allergic diseases,viral infections,psoriasis,Sjogren’s syndrome and other immune-related diseases.Traditional Chinese medicine believes that it is caused by deficiency of qi or Yin about stomach or deficiency of qi and blood.But,so far,the main pathogenesis is unclear,although there are some theories that have been put forward which oral flora,heredity,vitamin deficiency and so on.Intestinal flora is an important part of the human immune system.Especially,the interaction with of intestinal flora and oral flora.So,we come up with a hypothesis that:Geographic tongue is related to Intestinal flora and the intestinal flora can affect the human immune function in patients through the regulation of intestinal flora.So the study purpose is that objectively and quantitatively reflect the characteristics of the intestinal microbiology in Geographic tongue patients of the precancerous diseases and cancers of the stomach and esophagus.And more,we will explore the immunoregulation pathological mechanism.In order to use tongue to assess the pathogenetic condition and its related immune statusPart Ⅰ Intestinal flora diversity in Geographic tongue patients of the precancerous diseases and cancers of the stomach and esophagusObjective:To compare and analyze the differences and characteristics of the structure and diversity of intestinal flora in patients of the precancerous diseases and cancers of the stomach and esophagus with Geographic tongue and normal coating,and to find the characteristic intestinal flora in Geographic tongue patients.Methods:We classified the patients into the Graphic Tongue(GT)and Normal tongue-coating(NTC),and evaluated 50 patients with the precancerous diseases of gastric and esophagus(GT:25 cases;NTC:25 cases),and 20 patients with gastric and esophagus cancer(GT:10 cases;NTC 10 cases).Collect the patient’s tongue picture、baseline information、intestinal microbiome and calculate the lesion area of tongue surface on the GT,which is divided into mild,moderate,and severe lesions.Through 16SrRNA high-throughput sequencing,the composition characteristics and differences of oral and intestinal microbiota are evaluated.Results:In the comparative analysis study of intestinal microbiome,it was found that Compared with thin-coated patients,①There were significant differences in the diversity、composition and structure of intestinal flora under different tongue patterns(P<0.05).②Among the characteristic intestinal bacteria genus of patients with pre-cancerous disease,the characteristic genus about g_Anaerostipes、g_Eubacterium_ruminantium_group were gradually increased with the aggravation of the area of the tongue lesions degree,.T he relative contents of the g_Ruminococcaceae_UCG-014、g_Lachnospira、g_Mitsuokella enriched by Normal tongue-coating patients will gradually increase with the aggravation of stripping degree.③The relative content of characteristic intestinal flora streptococcus can decrease with the reduction of the area of the tongue lesions,and the tongue-coating tends to be normal coating and the expression level gradually decreases.④the Prevotella and Bacteroidaceae/Enterobacteriaceae(B/E)ratio in the two diseases will decrease in Geographic tongue patients of the precancerous diseases and cancers of the stomach and esophagus(P<0.05),streptococcus is the opposite(P<0.05)。Conclusion:Geographic tongue patients of the precancerous diseases and cancers of the stomach and esophagus have their characteristic intestinal flora,which will show a certain regular change with the extent of the lesion area,and its appearance may indicate that the patient has more severe inflammation and low immune function.Part Ⅱ The study on the regulation and mechanism of intestinal microflora of Geographic tongue patients on the immune function of miceObjective:To investigate the Immune function and immune regulation mechanism of Geographic tongue patients of the precancerous diseases of the stomach by FMT(Fecal Microbiota Transplants)in germ-free mouse mice.Methods:We use the 8 weeks of C57BL/6J mice,First,we created the germ-free mouse mice though the antibiotics were combined with gavage.Second,we collected the defecate of Geographic tongue and improved after treatment、Normal tongue-coating patients of the precancerous diseases of the stomach and healthy volunteers.After being treated,it becomes bacterial liquid.Third,we use FMT,planted the intestinal microflora in germ-free mouse mice.Finally,we studied the effects of different kinds of human bacterial liquid on the organs,cytokines and immune molecules of mice.So as to explore the immune function and mechanism of intestinal flora of Geographic tongue patientsResults:①The macrophage pheagocytosis lower than that of the other groups,and the difference was statistically significant(P<0.05),suggesting that the intestinal flora of unmoss-removed patients may weakened immune function.②The INF-α index was significantly lower than that of the other groups,and the difference was statistically significant(P<0.05),suggesting that that the intestinal flora of unmoss-removed patients might weaken the antiviral function of the receptor mice.③TNF-α and IL-12p40 were higher than those in other groups(P<0.05),suggesting that the intestinal flora of unmoss-removed patients may aggravate the inflammatory response of recipient mice.④In addition,the expression of SIgA in the GT intestinal flora transplantation group was also lower than that in the other groups(P<0.05),indicating that the intestinal mucosal immunization related functions were weak.⑤CD11c+and CD80+double positive expression did not show any difference in the ability of the cell uptake,processing and antigen presentation in the mice of the intestinal flora transplantation group of Geographic tongue patients.⑥The study on the mechanism suggests that the intestinal flora of Geographic tongue patients can affect the immune system by regulating the NF-κB pathway,but does not activate the TLR-2 receptor related NF-κB pathway.But the increase of TNF-α and IL-12p40 may activate NF-κB and cause more severe inflammatory response.Conclusion:The intestinal flora of Geographic tongue patients can weaken the antiviral and mucosal immune function of the host,aggravate the inflammatory immune response to reduce the immune function of the host. |
