| Aim: To evaluate the clinical efficacy of moxibustion treatment on the patients of ulcerative colitis(UC)and the regulating effect of moxibustion on LPS,SIg A in serum and LPS/TLR4 signaling pathway in colonic mucosa of UC rats,and to explain the mechanism of moxibustion on UC treatment.Methods: Part I: This is a randomized,controlled,and single-blind design,128 UC patients were randomly divided into the moxibustion group(64 cases)and the fake moxibustion group(64 cases).The patients in the moxibustion group were treated with herbal moxibustion,and the patients in the fake herbal moxibustion were treated with fake herbal moxibustion,and both groups were treated for 12 weeks,three times a week.CRF data were collected from both groups before and after treatment.To observe the clinical efficacy of moxibustion on UC,the clinical efficacy,clinical symptom and physical signs scale,modified Mayo activity index,Baron endoscopic score,inflammatory bowel disease questionnaire(IBDQ),abdominal pain score(VAS),and hospital anxiety and depression scale(HADS)were compared between the two groups.Part II: Male SD rats were randomly divided into the normal group(HC),the model group(UC),the moxibustion group(UC+HM)and western medicine group(UC+W).UC models rat induced by Dextran sulfate sodium(DSS)were established in another three groups except the HC group.There was no intervention in the HC group and the UC group;Rats in the UC+HM group were treated with bilateral Tianshu(ST25)and Shangjuxu(ST37),and were treated with herbal moxibustion.2 columns were used on every point each time,and treating for a total of 7 days,once a day.The UC+W group was intragastrically administered with mesalazine enteric-coated tablets twice a day for a total of 7 days.HE staining was used to observe the pathological changes of the colon.The effects of moxibustion on the contents of LPS and SIg A in the serum of rats were measured by ELISA.The protein and m RNA expression of LPS/TLR4 pathway-related in the intestine of rats were measured by immunohistochemistry and RT-PCR.Results: Part ?: 1.Main efficacy indicators Total clinical effectiveness:After treatment,the total effective rate of the moxibustion group was 89.1%,and the total effective rate of the fake moxibustion group was 61.1%.The total clinical efficiency of the moxibustion group was significantly higher than that of the fake moxibustion group,and the difference was statistically significant(P<0.01).2.Secondary efficacy indicators(1)Clinical symptom scores of TCM: Compared with before treatment,the scores of traditional Chinese medicine symptoms such as abdominal pain,diarrhea,mucus pus and bloody stool,and cold limbs were significantly lower in the two groups of UC patients(P<0.01).Compared with the two groups,the reduction of clinical symptom scores in the moxibustion group was significantly better than that in the fake moxibustion group(P<0.01).(2)Improved Mayo activity index: Compared with before treatment,the modified Mayo scores of the two groups of UC patients were significantly lower after treatment(P<0.01).Compared with the two groups,the reduction of the modified Mayo score in the moxibustion group was significantly better than that in the fake moxibustion group(P<0.01).(3)Baron endoscopy score: Compared with before treatment,the Baron endoscopic scores of the two groups of UC patients were significantly lower after treatment(P<0.01).Compared with the two groups,the reduction of Baron endoscopic score in the moxibustion group was better than that in the fake moxibustion group(P<0.05).(4)IBDQ score: Compared with before treatment,the IBDQ scores of the two groups of UC patients were significantly lower after treatment(P<0.01).Compared with the two groups,the improvement of IBDQ score in the moxibustion group was better than that in the fake moxibustion group(P<0.05).(5)VAS score of abdominal pain: Compared with before treatment,the VAS scores of abdominal pain in the two groups of UC patients were significantly lower after treatment(P<0.01).Compared with the two groups,the decrease of VAS score the two groups of UC patients have no difference(P>0.05)(6)HADS score: Compared with before treatment,the HADS-A scores of the two groups of UC patients decreased after treatment(the moxibustion group: P<0.01,the fake moxibustion group: P<0.05),compared with the two groups,the reduction of HADS-A score in the moxibustion group was significantly better than that in the moxibustion group(P<0.01).Compared with before treatment,the HADS-D scores of the two groups of patients with UC decreased after treatment(the moxibustion group:P<0.01,the fake moxibustion group: P<0.05).Compared with the two groups,the reduction of HADS-D score in the moxibustion group was significantly better than that in the moxibustion group(P<0.01)Part ?: 1.Under the optical microscope,the colonic mucosa of rats is clear and intact,there is no pathological changes in the normal group(HC).Colonic mucosal epithelial defects,structural disorder,obvious congestion,edema,ulceration and inflammatory cell infiltration in the mucosa and submucosa are observed in the Model group(UC)rats.The healing mucosa of the rats,colonic mucosa can be observed in the moxibustion group(UC+HM)and the western medicine group(UC+W),and there is no obvious congestion but with a small amount of inflammatory cell infiltration in rats of the two groups.Compared with the HC group,the histopathological scores of the UC group,the UC+HM group and the UC+W group were significantly increased(P<0.01).Compared with the UC group,the histopathological scores of the UC+HM group and the UC+W group were significantly lower(P<0.01).2.Compared with HC group,the levels of LPS and SIg A in peripheral blood of UC group were significantly increased(P<0.01).Compared with UC group,the levels of LPS and SIg A in peripheral blood of UC+HM group and UC+W group were significantly decreased(P<0.01).3.Compared with the HC group,the expression of SIg A in colonic mucosa of UC group was decreased(P<0.01),the expression of TNF-?,IL-6,LBP,CD14,TLR4, MyD88 and TRIF were increased(P<0.01).Compared with the UC group,the expression of SIg A in colonic mucosa of the UC+HM and the UC+W rats was increased(P<0.01),while the expression of TNF-?,IL-6,LBP,CD14,TLR4,TRIF(P<0.01)and My D88(P<0.05)in colonic mucosa of the UC+HM group were decreased,the expression of TNF-?,IL-6,CD14,TLR4,My D88,TRIF(P<0.01)and LBP(P<0.05)decreased in the UC+W group.4.Compared with the HC group,the expression of IL-10 m RNA in colonic mucosa of UC group was decreased(P<0.01).The expression of IL-6,IL-12,IL-17,IL-23,TNF-?,TNFR1 and TNFR2 m RNA were increased(P<0.01).Compared with the UC group,the expression of IL-10 m RNA in colonic mucosa of the UC+HM and the UC+W rats were increased,while the expression of IL-6,IL-12,IL-17,IL-23,TNF-?,TNFR1(P<0.05)and TNFR2(P<0.01)m RNA in colonic mucosa of the UC+HM group were decreased,and the expression of IL-17,IL-23,TNF-?(P<0.05),IL-6,TNFR1 and TNFR2(P<0.01)m RNA in colonic mucosa of UC+W group were decreased.Conclusions: 1.Herbal medicine combined with western medicine have good curative effect on UC,which can improve clinical symptoms such as abdominal pain,diarrhea and mucus pus and blood in patients with UC,reduce anxiety and depression,and improve the quality of life of patients with UC.2.Herbal moxibustion can regulate the expression of LPS and SIg A in peripheral blood of UC rats and the protein and m RNA expression of LPS/TLR4pathway-related molecules in colonic mucosa,alleviate intestinal inflammation,this effect may be related to the regulation of LPS/TLR4 signaling pathway in UC rats treated by moxibustion. |
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