The Clinical Efficacy Of The Qingchang Huashi Decoction To Treat Ulcerative Colitis And Experimental Study On Its Influence On Nf-κB、Caspase-3and Intestinal Mucosal Barrier

Objective:To evaluate the clinical efficacy of QingChangHuaShi Prescription in treatment of active ulcerative colitis;to observe the effect of QingChangHuaShi Prescription on the protein expressions of NF-κB, claudin-1, Caspase-3and ZO-1in colonic epithelial cells in the mouse model of ulcerative colitis via animal studies, and to explore the possible mechanism of QingChangHuaShi Prescription in treatment of active ulcerative colitis.Methods:In clinical research,90cases of patients diagnosed as mild or moderate active ulcerative colitis by colonoscopy and as colorectal hygropyrexia syndrome by TCM diagnosis were randomly selected by using a randomized controlled method.They were randomly divided into the TCM group of30cases,the Western medicine group of30cases, and the TCM+Western medicine group of30cases. The TCM group received oral administration of QingChangHuaShi Prescription combined with TCM retention enema; the Western medicine group received delayed-release mesalamine granules; the TCM+Western medicine groupreceived oral administration of QingChangHuaShi Prescription, TCM retention enema and delayed-release mesalamine granules. The total course of treatment was three months. The improvement of clinical symptoms, the curative effect of TCM clinical syndromes, colonoscopy scores and safety evaluation were observed. In experimental research, Balb/c mice were randomly divided into the TCM group, Western medicine group, TCM+Western medicine group, ASODN group, model control group and blank control group.The mouse model of ulcerative colitis was induced by using the TNBS method.All mice were executed after treatment for seven days and the colonic specimens were taken.The gross morphological and pathological changes in the colonic mucosa were observed in each group.The expression levels of NF-κB, Claudin-1, caspase-3and ZO-1in the colonic tissue were detected by Western blot.Results:In clinical research, the bloody purulent stool, abdominal distension, minor symptoms, the curative effect of TCM syndromes, comprehensive curative effect, remission rate were all improved in the TCM group, Western medicine group and TCM+Western medicine group;but the differences were notstatistically significant among the groups (P>0.05). The remissions of diarrhea and abdominal pains in the TCM group and TCM+Western medicine group werebetter thanthe Western medicine group (P<0.05); but the differences were notstatistically significant between the TCM group and TCM+Western medicine group (P>0.05).The mucosal healing rate after treatment in the TCM+Western medicine group was better than both the TCM group and the Western medicine group (P<0.05);but the difference was notstatistically significant between the TCM group and the Western medicine group (P>0.05). In experimental research, the colon pathology scores of mice were significantly improved in both the TCM group and the TCM+Western medicine group. The protein expressions of NF-κB and caspase-3in the model control group were significantly higher than the block control group (P<0.05).The protein expressions of NF-κB and caspase-3in the TCM group and the TCM+Western medicine group were significantly lower than the model control group (P<0.05).The protein expressions of claudin-1and ZO-1in the model control group were significantly lower than the block control group (P<0.05).The protein expressions of claudin-1and ZO-1in the TCM group and the TCM+Western medicine group were significantly higher than the model control group (P<0.05).Conclusion:The QingChangHuaShiPrescription was effective for treatment of patients with active UC and endoretention of damp heat.The comprehensive curative effects of TCM alone, TCM+Western medicine and Western medicine alone in treatment of active UC were not significantly different.TCM alone and TCM+Western medicine for treatment of active UC were better than Western medicine alone in improving the abdominal painsand diarrhea symptoms.TCM+Western medicine was better than TCM orWestern medicine alone inthe endoscopic mucosal improvement.And there were no significant adverse reactions in the use of TCM and TCM+Western medicine. The QingChangHuaShiPrescription could inhibit the protein expressions of NF-κB and caspase-3in the colonic tissue of UC model mice, increase theprotein expressions ofclaudin-1and ZO-1, inhibit the NF-κB pathway, reduce theinflammatory reaction, inhibit theapoptosis of intestinal epithelial cells, increase the expression of intestinal mucosal tight junction protein and repair the intestinal mucosal barrier, which might be one of the mechanisms for treatment of active UC.