摘要
[目的]从治疗前后中医症状、Claudin-2、5表达水平及黏膜超微结构变化,探讨健脾清热活血方干预溃疡性结肠炎(UC)的作用机制。[方法]选取临床符合纳入标准的50例UC患者,随机分为治疗组和对照组,每组各25例,分别给予健脾清热活血方和美沙拉嗪治疗,疗程为12周。应用结肠镜复查及组织病理学技术比较治疗前后结肠黏膜组织学Geboes评分;应用免疫组化检测结肠黏膜Claudin-2和Claudin-5表达;应用透射电镜检测结肠黏膜超微结构改变;记录治疗前及治疗后4、8、12周中医证状积分,主客观指标合参评估健脾清热活血方的临床效用。[结果]从总体疗效分析,治疗组(80.0%)和对照组(76.0%)对比差异无统计学意义。从主要效应指标分析,治疗后,2组患者肠镜评分、肠黏膜组织学评分较治疗前显著降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。从次要效应指标分析,治疗前2组患者中医症状积分比较差异无统计学意义;治疗后12周综合症状积分较治疗前明显降低(P<0.05);治疗后4周及8周症状积分虽有下降,与治疗前比较差异无统计学意义(P>0.05)。治疗后Claudin-2表达比治疗前显著下调;Claudin-5表达比治疗前显著上调(P<0.05)。电镜下治疗前上皮细胞微绒毛稀疏、变短,细胞间连接松散间隙增宽;治疗后上皮细胞微绒毛排列整齐结构基本完整,细胞间相互连接紧密。[结论]健脾清热活血方可能通过下调Claudin-2、上调Claudin-5表达,修复肠黏膜机械屏障,诱导肠黏膜炎症缓解,从而发挥治疗效用。
[Objective]To explore the mechanism of Jianpi Qingre Huoxue formula in the treatment of UC from the changes of TCM symptoms,Claudin-2,5 expression level and mucosal ultrastructure before and after treatment.[Methods]Fifty patients with UC were randomly divided into treatment group and control group according to 1:1.They were treated with Jianpi Qingre Huoxue formula and mesalazine sustained-release granules for 12 weeks.Before and after treatment,they were compared with each other by colonoscopy reexamination and histopathology.The expression of Claudin-2 and Claudin-5 was detected by immunohistochemistry.The ultrastructural changes of colonic mucosa were detected by transmission electron microscope,the syndrome scores of TCM before treatment,4 weeks,8 weeks and 12 weeks after treatment were recorded in detail,and the clinical effect of Jianpi Qingre Huoxue formula was evaluated by subjective and objective indexes.[Results]There was no significant difference between the treatment group(80.0%)and the control group(76.0%).From the analysis of main effect indexes,after treatment,the enteroscopy score and intestinal mucosa histology score of the two groups were significantly lower than before treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).From the secondary effect index analysis,before the treatment,there was no statistical difference between the two groups in TCM symptom score,which was comparable;after the treatment,12 weeks’ comprehensive symptom score was significantly lower than before the treatment(P<0.05);but after the treatment,4 weeks and 8 weeks’ symptom score decreased,which was not statistically significant compared with before the treatment(P>0.05).After treatment,the expression of Claudin-2 was significantly down regulated before treatment,and after treatment,the expression of Claudin-5 was significantly up regulated before treatment(P<0.05).Under the electron microscope,the microvilli of epithelial cells were sparse and short before treatment,and the loose gap between cells was widened;after treatment,the microvilli of epithelial cells were arranged in order and the structure was basically complete,and the cells were closely connected.[Conclusion]Jianpi Qingre Huoxue formula may play a therapeutic role by down regulating the expression of Claudin-2 and up regulating the expression of Claudin-5,repairing the mechanical barrier of intestinal mucosa and inducing the alleviation of inflammation of intestinal mucosa.
作者
绳荣湍
陈良荣
方健松
张涛
邱燕婷
SHENG Rong-tuan;CHEN Liang-rong;FANG Jian-song;ZHANG Tao;QIU Yan-ting(Department of Gastroenterology,Ruikang Affiliated Hospital of Guangxi University of TCM,Nanning 530000,China;Department of Gastroenterology,Hospital of TCM of Guiping,Guiping 537200,China)
出处
《中国中西医结合消化杂志》
CAS
2020年第9期688-692,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Digestion
基金
国家自然科学基金(No:81260536)
广西自然科学基金(No:2018GXNSFAA281042)
广西一流学科建设项目重点课题(No:2018XK082,No:2019XK164)。
