| Clinical Research The type characteristics of TCM clinical research on reflux esophagitisObjective:To investigate the distribution in TCM syndrome type of reflux esophagitis, and provide the basis for the treatment in TCM.Methods:The clinical data were collected from October 2010 to December 2015 and recorded on Haitai System 2.0 and 3.0 with nano standard of reflux esophagitis patients. The data were recorded in Microsoft Excel and analysed by SPSS 17.0 software.Results:1 Gender and age distribution137 cases were included in this study which ratio of male to female is close to 1:1(male:50.36%).The oldest case is 85 years old and the youngest case is 35 years old. The average age is 58.64±13.80 years old. The incidences of reflux esophagitis in the elderly is 47.45%,37.23% in middle age,15.33% in youth and none in children.2 Duration distributionThe shortest course in this study is 2 months and the longest is 30 years. The average duration is 54.45±92.39 months. Among them, there are 20 people (14.60%) less than 3 months,42 people (30.66%) between 3 months and 1 year,1 to 5 years 38 people (27.74%) and 5 to 10 years were 20 people(14.60%), and only 17 people (12.40%) more than 10 years.3 The distribution of TCM SyndromesThe ratio of liver-stomach disharmony syndrome is 32.85%, followed by stagnation of liver-stomach heat syndrome (15.33%), spleen deficiency-dampness heat syndrome(13.14%), intermingled heat and cold syndrome (10.95%), spleen-stomach deficient cold syndrome (9.49%), intermin-gled phlegm and qi syndrome (8.03%), static blood blocking collaterals syndrome (6.57%) and stomach yin deficiency syndrome (3.65%).4 Epidemiological data analysis on patients with liver-stomach disharmony syndromeOf the 45 liver-stomach disharmony syndrome patients with RE, there were 17 males and 28 females. The male to female ratio is 1:1.65. Among them, there were 4 young people,20 men and 8 women,5 men and 15 women,17 men and 8 women,8 men and 9 women.The course of disease is relatively long, the most is 3 months to 1 year(35.56%), followed by 1 to 5 years (22.22%), less than 3 months (17.78%),5 to 10 years (11.11%) and more than 10 years (13.33%).Conclusions:1 The liver-stomach disharmony syndrome is the most.2 In this study, the liver-stomach disharmony syndrome cases is the majority of elderly patients and the course of disease is relatively long.Experimental Study Study on the mechanism of Tongjiang granule to treat reflux esophagitisObjective:To observe the effect of Tongjiang Granule on the treatment of reflux esophagitis in rats with liver-stomach disharmony syndrome.Methods:105 SD rats were six to eight-weeks old.10 rats were chosen randomly to serve as sham operation group. The rest (95 rats) were modeled by esophagoduodeno stomy and raised for two weeks. And then stimulated the survived 70 rats post operatively by super position tail clip for a week. The daily amount of food intake, drinking, and hair color mood changes were observed and recorded during the 21 days after esophagoduodeno stomy operation. There were 73 rats survived at last. Three rats were randomly selected to evaluate the model by HE staining of esophus. The rest seventy rats were randomly divided into seven group:control group, model group, high-dose, middle-dose, low-dose group, omeprazole group, mosapride group, Tongjiang granule mixed with omeprazole group. Every rats was administered with Tongjiang granule or omeprazole or mosapride or water according to each of the 10 ml·kg-1 body weight of rats for 21 days. The body weight, food intake, the amount of drinking water were tested and recorded at 7th,14th,21th days in the duration of drug administration. When the therapy is completed, the experiments of gastric juice analysis were underlined including the determination of volume, gastric acidity and pepsin activity of gastric juice. Then the blood taken from abdominal aorta was tested by ELISA and the esophaged tissue were photographed by the medical pathological image analyzer to determine the area of esophageal mucosal erosion. The pathological changes of esophageal tissues were observed by HE Staining and the changes of cell gap and desmosome number in esophageal tissues were teste by TEM observation. The expressions of IKKβ, NF-κB/p65 and Cox-2 were detected by immunohistochemistry and Western Blot and NF-icB/p65 mRNA, Cox-2 mRNA were measured by RT-PCR.Results:1 General situation of ratsAfter administration of Tongjiang granule for 2 weeks, body weights of the rats in low dose group were increased significantly, compared to a control group which received no drug. food intake in Tongjiang granule mixed with omeprazole group was elavated; after administration of Tongjiang granule for 3 weeks, compared to a control group which received no drug, body weight, food intake, water intake and grasping force were all increased.2 The results of gastric juice analysis(1) pH valule of gastric juiceCompared with sham group, the pH value in model group was decreased; compared with model group, the pH value was increased in Tongjiang granule mixed with omeprazole group and moeprazol group; compared with omeprazole group, the pH value was decreased in high-dose group, low-dose group and mosapride group.(2) Total acid contentCompared with sham group, the total acid content was significantly increased in model group; compared with model group, the total acid content was decreased significantly in all treatment group; compared with omeprazole group, the total acid content was significantly increased in high-dose group, low-dose group and Mosapride group.(3) Total acid secretionCompared with sham group, the total acid secretion was significantly increased in model group; compared with model group, the total acid secretion was significantly reduced in addition to mosapride group of other drug groups; compared with omeprazole group, the total acid secretion was significantly increased in high-dose group, low-dose group and Mosapride group.(4) Activity of pepsinCompared with sham operation group, the activity of pepsin was significantly higher in model group; compared with model group, the activity of pepsin was significantly higher in middle-dose group and low-dose group; compared with omeprazole group, the activity of pepsin was significantly higher in low-dose group.3 Morphological manifestation of Gross of esophagusCompared with sham operation group, erosion rate was increased in model group; compared with model group, erosion rate was decreased in all treatment groups; compared with omeprazole group, erosion rate was decreased in Tongjiang granule mixed with omeprazole group.4 Morphological manifestation of histopathology of esophagus(1) HE stainingIn sham group the surface of mucosa of the rat was smooth; in model group the mucosa was infiltrated by lots of inflammatory cells, with an ulcerated surface; basal layer was invaded by a few inflammatory cells in high dose group; the basal layer showed discontinuity in middle-dose group and broken in low-dose group; there was a few neutrophil and eosinophils scatted within the basal layer in mosapride group; the basal layer in omeprazole group was thickened; capillaries in Tongjiang granule mixed with omeprazole group showed congestion and edema.(2) Transmission electron microscopeCompared with sham group, desmosome was decreased and cell gap was brodened in model group; Compared with model group, desmosome was increased and cell gap was diminished in all doses groups; compared with omeprazole group, desmosome was increased and cell gap was diminished in Tongjiang granule mixed with omeprazole group, desmosome was decreased and cell gap was brodened in high-dose group,low-dose group and mosapride group.5 Expression of IKK beta, Nuclear factor kappa B/p65 and Cox-2 in esophageal tissue(1) Immunohistochemical resultsSham operation group rats esophageal mucosal epithelial basal layer of cells were negative; the expression was strongest in model group; in each treatment group the expression of positive cells was weakly positive; the expression is more not obvious in omeprazole group and Tongjiang granule mixed with omeprazole group.(2) Real Time PCR resultsCompared with sham group, the expression of Nuclear factor kappa B/p65 mRNA was higher in model group than that of model group, and the expression of NF-kappa B/p65 mRNA was decreased in each group.Compared with sham group, the expression of Cox-2 mRNA was significantly higher in model group; compared with model group, the expression of Cox-2 mRNA was significantly lower in omeprazole group and Tongjiang granule mixed with omeprazole group.(3) Western Blot results1) IKK beta proteinCompared with sham group, the expression of IKK beta protein was significantly increased in model group; compared with model group, the expression of IKK beta protein was significantly reduced in treatment groups; compared with omeprazole group, the expression of IKK beta protein was increased significantly in mosapride group, significantly lowered in Tongjiang granule mixed with omeprazole group.2) Nuclear factor kappa B/p65 proteinAfter treatment, the expression level of Nuclear factor kappa B/p65 was lower in high-dose group, middle-dose group and low-dose group than that of model group.3) Cox-2 proteinCompared with sham group, the expression of Cox-2 protein was significantly higher in model group; compared with model group, the expression of Cox-2 protein was decreased in high-dose group, and reduced in treatment groups; compared with omeprazole group, the expression of Cox-2 protein was reduced in Tongjiang granule mixed with omeprazole group.6 Levels of inflammatory cytokinesPro inflammatory cytokines (IL-1, IL-6, IL-8):compared with sham group, the level was increased significantly in model group; compared with model group, the level was reduced in treatment group; compared with omeprazole group, the level was significantly increased in low-dose group;Anti inflammatory factor (IL-4, IL-10):compared with sham group, the level was significantly reduced in model group; compared with model group, the level was significantly increased in treatment group.Conclusions:1 The body weight, food intake, water intake and grasping force of rats in model group which had received different doses Tongjiang granule for three weeks were improved significantly.2 The acidity of gastric juice can be reduced and the activity of pepsin can be increased in all doses group.3 The IKK(3 level, expression of kappaB protein and gene, Cox-2 expression were all down-regulated in all Tongjiang granule doses group. The secretion of inflammatory cytokines can be regulated to reduce injury of esophageal mucosa and to protect the mucosa barrier. |
PDF Full Text Request