| Objectives:1.Through Meta analysis,we systematically evaluated the effectiveness of the published randomized controlled trial of Shenlingbaizhu Powder on diarrhea irritable bowel syndrome,and observed its safety,so as to provide evidence-based basis for clinical research and practice.2.Through the observation and analysis of the interaction between intestinal flora and epithelial cells,the possible mechanism of Shenlingbaizhu Powder in the treatment of diarrheal irritable bowel syndrome was preliminarily discussed,to provide new ideas and methods for traditional Chinese medicine research of diarrheal irritable bowel syndrome and to improve the level of prevention and treatment of diarrheal irritable bowel syndrome.Methods:1.Meta analysis:All the literatures about Shenlingbaizhu Powder in the treatment of diarrheal irritable bowel syndrome were searched in CNKI,Wanfang data general database of academic papers,VIP Chinese sci-tech periodical full-text database and PubMed.After screening according to the inclusion and exclusion criteria set by the study,the final included literature was evaluated according to the Cochrane system evaluation manual,and the statistical software Revman 5.3 was used for data statistics and Meta analysis.The total effective rate of clinical treatment was taken as the outcome index,and the adverse reactions were observed.2.Animal experiment:70 SPF Wistar rats were randomly divided into blank control group,model group,low,middle and high dose Shenlingbaizhu Powder groups,glutamine group and Peifeikang group,with 10 rats in each group.Except the blank control group,the rats in other groups were fed with raw rhubarb decoction containing crude drug lg/ml at the dose of 20ml/kg for 8 days,and the frequency was once a day to establish IBS-D model.The diarrhea,activity and body weight of rats in each group were closely observed and recorded every day.After successful modeling,except for the blank control group and the model group,each group was given intragastric administration of corresponding drugs,and the cecal contents and intestinal tissues were collected two weeks later.The intestinal histopathology of experimental animals was observed,the numbers of Enterococcus,Enterobacter,Lactobacillus and Bifidobacterium in the cecal contents of rats were detected,the mRNA and protein levels of tight junction proteins(ZO-1,Occludin,Claudin)in intestinal tissue were measured,and the expression levels of mucin 2(MUC2),intestinal alkaline phosphatase(IAP),nuclear factor kappa B(NF-?B)and p38 mitogen activated protein kinase(p38MAPK)were measured.Finally,the data are processed and analyzed.Results:1.Meta analysis:A total of 372 articles were searched from 4 databases.After screening,14 randomized controlled studies were included,all of which were domestic journal papers.A total of 1147 medical records were included,including the experimental group(n=582)and the control group(n=565).A total of 14 patients were lost in 3 studies.Revman 5.3 software was used to evaluate the literature quality and analyze the data of 1133 cases.According to the different experimental measures,the 14 studies were divided into two groups.The results showed that the total effective rate of clinical treatment in Shenlingbaizhu powder group and Shenlingbaizhu powder combined with western medicine group was better than that in western medicine group,which was statistically significant.The results show that Shenling Baizhu Powder can significantly improve the total clinical effective rate of diarrhea irritable bowel syndrome,and there are no serious adverse reactions related to traditional Chinese medicine.2.Animal experiment:2.1 In terms of intestinal flora,compared with the blank control group,the number of enterococci and enterobacteria in the cecal contents of the model group increased significantly(P<0.01)while the number of Lactobacillus and Bifidobacterium decreased,and the symptoms of intestinal flora imbalance appeared.Compared with the model group,the number of Enterococcus and Enterobacter in the middle and high dose groups of Peifeikang and Shenlingbaizhu Powder decreased significantly(P<0.05),and the number of Lactobacillus and Bifidobacterium returned to the normal level.Shenlingbaizhu Powder low dose group had partial improvement,but the difference was not statistically significant.2.2 In terms of intestinal histopathology,the length of intestinal villi in the normal group was uniform,the arrangement was compact,and the number of goblet cells was normal.The villi shortened and goblet cells decreased in the model group.Glutamine,Peifeikang and Shenlingbaizhu powder can improve the villus injury of intestinal tissue in model rats.2.3 In terms of mRNA and protein levels of tight junction protein molecules(ZO-1,Occludin and Claudin)in intestinal tissue,glutamine granule,Peifeikang capsule and Shenlingbaizhu Powder could significantly up-regulate the mRNA expression of ZO-1 and Occludin,and the mRNA expression of Claudin also increased.The middle and low dose groups of Shenlingbaizhu Powder could also improve the mRNA expression of ZO-1,Occludin and Claudin.Compared with the model group,glutamine granule,Peifeikang capsule and Shenlingbaizhu powder in high and middle dose groups could significantly up-regulate the protein expression of ZO-1 and Occludin,and the protein expression of Claudin also had an upward trend.The low dose group of Shenlingbaizhu Powder could also improve the protein expression of ZO-1,Occludin and Claudin to a certain extent.2.4 In terms of the mRNA expression level of MUC2 and IAP,the middle and high dose groups of Peifeikang and Shenlingbaizhu Powder could significantly improve the mRNA expression of MUC2 in the model group,and the mRNA expression of MUC2 in the glutamine group was also significantly up-regulated.There was no significant effect on the mRNA expression of IAP in all the tested drug groups.2.5 in terms of the expression level of intestinal inflammatory signal molecules(NF-?B,p38MAPK),each drug group had no significant effect on the mRNA expression of NF-?B and p38MAPK in the colonic tissue of model rats.Conclusions:1.Meta analysis indicates that Shenlingbaizhu Powder alone or in combination with conventional western medicine is effective and safe in the treatment of diarrheal irritable bowel syndrome.Therefore,Shenlingbaizhu Powder is worth further popularizing and applying in clinic.2.The results of animal experimental study showed that Shenling Baizhu Powder,Peifeikang and Glutamine could regulate the intestinal flora diversity of diarrhea irritable bowel syndrome,improve intestinal histopathology,regulate the expression level of tight junction protein molecules and colon barrier regulation related genes,and the middle and high dose groups were better than the low dose group.It is suggested that Shenling Baizhu Powder in the treatment of diarrhea irritable bowel syndrome has a certain dose dependence.Combined with the previous research,the interaction between intestinal flora and epithelial cells may be one of the mechanisms of Shenling Baizhu Powder in the treatment of diarrheal irritable bowel syndrome. |
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