To Investigate The Mechanism Of Treating Acute Pharyngitis With Zizheng Dihuang Decoction Based On TLR4/NF-?B Signaling Pathway

Objective: 1.Through the clinical study of Acute Pharyngitis,the therapeutic effect of Zheng Shi Hou ke Zizheng Dihuang decoction on acute pharyngitis with lung-stomach excess-heat syndrome was clarified.To explore the mechanism of Zizheng Dihuang decoction in treating acute pharyngitis of lung-stomach excess-heat syndrome.2.Based on TLR4/NF-?B signaling pathway,the possible mechanism of Zizheng Dihuang decoction in treating acute pharyngitis was explored through experimental study on animal models of acute pharyngitis.Methods: 1.Clinical trial: A total of 104 cases of acute pharyngitis in the Outpatient Department of the First Affiliated Hospital of Anhui University of Traditional Chinese medicine from otolaryngology 2017.10 to 2020.01 were collected.104 patients were divided into two groups: Chinese Medicine Group and Western Medicine Group according to the order number of patients.The researchers recorded the patient' gender,age,height,weight,bad habit(smoking and drinking)and course of disease.The clinician records and scores the symptoms and signs of the patient before and after treatment.The level of inflammatory cells was measure by blood routine examination and serum levels of IL-1?,IL-6,IL-10 and TNF-? were measured by ELISA.At the end of the treatment,patients were asked to record the onset time of treatment and satisfaction with the medicine.2.Animal experiment: 60 healthy SD rats were randomly divided into black group,model group,the experimental group and the control group.In addition to the black group,the acute pharyngitis models were established in the other groups,and the color,luster,hyperemia,swelling degree of Oral Mucosa,activity,fur and diet of the rats were observed before and after administration.After treatment,the oral Mucosa of rats was taken and stained with HE,and the pathological changes of the oral Mucosa were evaluated.The serum levels of TNF-?,Il-1?,IL-6 and IL-10 were measured by ELISA.The expression levels of TLR4 and p-NF-?B-P65 in rat oral Mucosa were determined by Western Blot.3.SPSS20.0 statistical analysis software was used to analyze the clinical data and experimental data.Result: 1.The results of the clinical trial: After treatment,the symptoms and signs scores and onset time of the two groups were statistically analyzed(p<0.01).It is proved that both treatments are effective for acute pharyngitis.There was no significant difference between Chinese Medicine Group and Western Medicine Group in the overall efficacy and the main symptoms and signs(p>0.05).The improvement of secondary symptoms and signs in the Chinese Medicine Group was more obvious than that in the Western medicine group(p<0.01).The average onset time was shorter than that of Western Medicine Group(p<0.01).The patients were more satisfied with traditional Chinese medicine treatment than Western medicine(p<0.01).Blood routine examination,Chinese Medicine Group and Western Medicine Group before and after treatment of inflammatory cells in the blood(p<0.01),indicating that both drugs can reduce the patient's inflammatory reaction.Serum levels of TNF-?,IL-1?,IL-6,IL-10 were measured by ELISA before and after treatment(P<0.01).Compared between Chinese Medicine Group and Western Medicine Group the serum levels of TNF-?,IL-1?,IL-6,IL-10(P>0.05).Both treatments significantly reduced serum levels of TNF-?,IL-1?,IL-6 and increased IL-10.2.Animal results: Compared with the blank group,model group can increase the serum levels of TNF-??IL-1??IL-6 and reduced serum levels of IL-10(p<0.01).After treatment with Zizheng Dihuang decoction or Amoxicillin can reduced the serum levels of TNF-?,IL-1? and IL-6,increased IL-10 levels(p<0.01).Compared with the black group,rats in the model group had oral Mucosa ulceration,mucosal vessels hyperemia,redness and swelling.Pathology shows massive Inflammation cell.After treatment with Zizheng Dihuang decoction or Amoxicillin,the degree of congestion,swelling and ulceration of the oral Mucosa was also reduced compared with the model group.Pathology shows a small amount of Inflammation cell.Compared with the black group,the expression of TLR4 and p-NF-?B-P65 protein in the oral Mucosa of the model group increased significantly(P<0.01).Compared with model group,TLR4 and p-NF-?B-P65 protein expression in oral mucosa of acute pharyngitis rats were significantly decreased after treatment with Zizheng Dihuang decoction or Amoxicillin(P<0.01).Zizheng Dihuang decoction or Amoxicillin can significantly reduce the expression of TLR4/NF-?B signaling pathway related proteins in Oral Mucosa.Conclusion: 1.Zizheng Dihuang decoction has a good therapeutic effect on acute pharyngitis with lung-stomach excess-heat syndrome.After 5 days of treatment,the main symptoms(sore throat),secondary symptoms(cough,dry throat,thirst,stool),physical signs of the patients with acute pharyngitis in the Chinese Medicine Group.Zizheng Dihuang decoction is more effective than Amoxicillin improving minor symptoms in patients with acute pharyngitis.2.Zizheng Dihuang decoction has good therapeutic effect on acute pharyngitis rat model.Zizheng Dihuang decoction significantly improved the systemic symptoms of acute pharyngitis rats,alleviated the oral mucosa swelling and ulceration in acute pharyngitis rats,and pathology showed that there was a significant decrease in the eosinophil granulocyte between the mucous glands and the Inner Mucosa.3.The mechanism of Zizheng Dihuang decoction in treating acute pharyngitis of lungstomach excess-heat syndrome may be through regulating TLR4 / NF-?B signal pathway.Clinical study: After treatment of acute pharyngitis patients with lung-stomach excess-heat syndrome inflammatory cells in the blood of patients decreased(P<0.01).The serum levels of TNF-?,IL-1?,IL-6 were significantly decreased and increased the level of IL-10(P<0.01).Animal study have shown that can decreased TNF-?,IL-1?,IL-6 level,increased IL-10(P<0.01).Zizheng Dihuang decoction decreased the expression of TLR4 and p-NF-?B-P65 in oral mucosa of model rats(P<0.01).Clinical and animal studies have confirmed that Zheng's Zizheng Dihuang decoction can significantly inhibit the TLR4 /NF-?B signaling pathway related factors which reducing symptoms of acute pharyngitis with lung-stomach excess-heat syndrome.