香砂六君子汤治疗脾胃气虚型慢性浅表性胃炎的临床及实验研究
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摘要
目的：
一、通过文献研究系统了解对CSG的中西医研究进展。
二、探讨香砂六君子汤对该病的治疗效应,明确其治疗优势。
三、动物实验作为临床研究的延伸,进一步探讨香砂六君子汤治疗脾胃气虚型CSG的作用机制。
方法：
一、文献研究部分：查阅资料,分析资料,系统对CSG的中西医研究进展进行了整理及综述。
二、临床研究部分：以临床最常见的脾胃虚气虚型CSG患者为研究对象,设立香砂六君子汤治疗组、西药常规治疗对照组,对两组患者进行前瞻性对照研究。对中医证候、临床有效率、胃镜、Hp感染、炎症病理以及生存质量等几个项目并进行观察对比。
三、动物实验部分：以SD大鼠为研究对象,设立空白对照组、模型组、香砂六君子汤高剂量组、香砂六君子汤中剂量组、香砂六君子汤低剂量组及替普瑞酮组,分别施以不同的处理因素,继而观察各组大鼠一般状态、HE染色观察胃组织病理、胃排空实验观察大鼠胃肠运动功能、免疫组化观察胃及大脑SP、INOS、5-HT表达、荧光PCR观察INOS mRNA以及5-HT mRNA等指标的表达。
结果：
一、临床研究部分：
(一)治疗14天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、嗳气反酸、食少纳呆、疲乏无力6个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘疼痛、烧心2个症候有显著改善(p<0.05orp<0.01)。治疗组与对照组组间对比：胃脘胀满症候改善较好(p<0.05)。
(二)治疗28天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力8个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、疲乏无力3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：食后胃脘不适症候改善较好(p<0.05)。
(三)治疗56天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力、舌质、舌苔10个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、烧心力3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：胃脘胀满、食后胃脘不适症候改善较好(p<0.05)。
(四)治疗84天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力、舌苔9个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、烧心3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：胃脘胀满、食后胃脘不适症候改善较好(p<0.05)。
(五)治疗后两组患者疗效比较
1.中医症候疗效：治疗56及84天后治疗组总有效率与对照组相比,有统计学差异(p<0.05)。
2.治疗后胃镜疗效：治疗组与对照组粘膜恢复情况比较,有统计学差异(p<0.05)。Hp感染情况(快速尿素酶试验)治疗组自身前后对比,无统计学差异(p>0.05)。对照组自身前后对比,有统计学差异(p<0.05)。2组治疗后对比,有统计学差异(p<0.05),其中Hp阴性患者中行三联根除Hp疗法患者有14人。
3.治疗56天后复查病理,治疗组与对照组炎症程度情况比较,对照组炎症程度的改善要优于治疗组,有统计学差异(p<0.05)。治疗组自身前后比较,无统计学差异(p>0.05)。对照组自身前后比较有明显改善,具有统计学差异(p<0.05)。；而炎症活动度比较,治疗后2组无统计学差异(p>0.05)。治疗组与对照组自身前后比较无统计学差异(p>0.05)。
4.两组CSG患者SF-36生存质量疗效：治疗组与对照组各维度积分对比无显著差异(P>0.05)；治疗组自身前后对比各维度均有显著改善,有统计学差异(P<0.05orP<0.01)。对照组自身前后对比在生理功能、躯体疼痛、精神健康、健康变化自评、躯体健康、精神健康总评上有显著改善,有统计学差异(P>0.05)。
5.疗效的回归分析：治疗后有效率与组别、中医症候积分、SF-36量表积分、Hp感染、病理炎症程度以及活动度的相关性分析表明疗效与治疗组别和中医症候改善有相关性(P<0.05or P<0.01),与SF-36量表积分、Hp感染、病理炎症程度以及活动度无相关性。
6.两组患者安全性观察：两组患者治疗期间均未发现明显的药物不良反应。
二、动物实验部分：
(一)脾胃气虚型CSG造模后大鼠的一般表现：造模各组大鼠体重1-6d体重与空白组比较,增长速度无显著差异；7d开始体重逐渐下降,11d起体重明显下降。
(二)大鼠体重：造模后各造模组与空白组比较体重有显著差异(P<0.01)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组组大鼠体重均明显增加,有显著性差异(P<0.05)。而香砂六君子汤各剂量组之间对比未见明显差异,与模型组比较,替普瑞酮组在给药后体重未见明显增加。
(三)大鼠进食量：造模后各造模组与空白组比较有显著差异(P<0.01)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组大鼠进食量均明显增加,有显著性差异(P<0.01),而香砂六君子汤各剂量组之间对比未见明显差异,但是仍低于空白组大鼠的进食量(P<0.01)。
(四)大鼠的饮水量：造模后各造模组饮水量少于与空白组,有显著差异(P<0.01or P<0.05)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组大鼠饮水量均明显增加,有显著性差异(P<0.01or P<0.05),而香砂六君子汤各剂量组之间以高剂量组改善最为显著,但香砂各剂量组仍低于空白组大鼠的饮水量(P<0.01)。
(五)大鼠的胃排空功能：与空白组大鼠比较,除香砂高剂量组以外,余各组胃排空功能均较弱(P<0.01or P<0.05)。与模型组大鼠相比,香砂各剂量组大鼠胃排空量均更强,有显性差异(P<0.01or P<0.05)。
(六)普通光镜观察病理：与空白组比较,其他各组胃粘膜下层见有淋巴细胞浸润,局部血管少许充血等慢性炎症改变,炎症细胞浸润主要在黏膜浅层,腺体保持完整。与模型组比较,香砂各剂量组炎症有一定减轻,而替普瑞酮组炎症减轻最明显。
(七)大鼠胃及大脑SP表达：与空白组大鼠比较,除香砂中、高剂量组以外,余各组胃SP的表达均较强(P<0.01or P<0.05)。与模型组大鼠相比,香砂各剂量组大鼠胃SP的表达均较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃SP的表达也较弱(P<0.01)。而与空白组大鼠比较,除香砂高剂量组以外,余各组大脑SP的表达均较强(P<0.01or P<0.05),与模型组大鼠相比,香砂各剂量组大鼠大脑SP的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃SP的表达无明显差异性。
(八)大鼠胃及大脑INOS表达：可以发现,与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组胃INOS2的表达均较强(P<0.0lor P<0.05)。与模型组大鼠相比,香砂高剂量组大鼠胃INOS2的表达较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃INOS的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂中、高剂量组以外,余各组大脑INOS2的表达均较强(P<0.05),。与模型组大鼠相比,香砂各剂量组大鼠大脑INOS的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃INOS的表达无明显差异性。
(九)大鼠胃及大脑5-HT表达：与空白组大鼠比较,除模型组以外,余各组胃5-HT的表达均较无显著差异(P>0.05)。与模型组大鼠相比,香砂中、高剂量组大鼠胃5-HT的表达较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃5-HT的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组大脑5-HT的表达均较强(P<0.05),。与模型组大鼠相比,香砂各剂量组大鼠大脑5-HT的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃5-HT的表达无明显差异性(P>0.05)。
(十)胃、脑组织5-HTR1A mRNA表达：空白组大鼠比较,除香砂中、高剂量组以外,余各组胃5-HTR1A mRNA的表达均较多(P>0.05)。与模型组大鼠相比,香砂中、高剂量组大鼠胃5-HTR1A mRNA的表达无明显差异(P>0.05)。与模型组大鼠相比,替普瑞酮组胃5-HTR1A mRNA的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组大脑5-HTRlAmRNA的表达均较多(P<0.05or P<0.01)。模型组大鼠相比,香砂高剂量组大鼠大脑5-HTR1A mRNA的表达较少(P<0.01)。与模型组大鼠相比,替普瑞酮组胃5-HTR1A mRNA的表达无明显差异性(P>0.05)。
(十一)胃、脑组织INOS mRNA表达：与空白组大鼠比较,只有模型组胃INOS mRNA的表达较强(P<0.05)。与模型组大鼠相比,香砂高剂量组大鼠胃INOS mRNA的表达较少(P<0.01)。与模型组大鼠相比,替普瑞酮组胃INOS mRNA的表达无明显差异(P>0.05)；而与空白组大鼠比较,同样只有模型组胃INOS mRNA的表达较强(p<0.05)。与模型组大鼠相比,香砂高剂量组大鼠大脑INOS mRNA的表达较少(P<0.05)。与模型组大鼠相比,替普瑞酮组胃INOS mRNA的表达无明显差异性(P>0.05)。
结论：
一、临床研究部分：
(一)香砂六君子汤改善中医症候方面呈现如下几个优势：1.起效较快。2.症候改善全面。3.对消化不良症状侯改善效果较好。如胃脘胀满、食后胃脘不适症候的疗效较对照组更优。4.对消化道外症状改善效果较好。5.远期疗效较好。
(二)香砂六君子汤Hp的治疗效果不佳。
(三)常规西药对照组在对患者炎症程度的改善上要优于中药香砂六君子汤组。
(四)对生存质量的疗效呈以下几个特点：1.香砂六君子汤治疗脾胃气虚型CSG对患者生活质量的提高较为全面。2.香砂六君子汤和常规西药对照组在改善临床症状后均能有效提高患者生活质量。
(五)疗效与治疗药物和中医症候改善具有相关性,与SF-36量表积分、Hp感染、病理炎症程度以及活动度无线性关联。
二、动物实验部分：
(一)香砂六君子汤能在短期内改善脾胃气虚型CSG大鼠的体重减轻情况,但是在短期内难以达到正常水平。
(二)高剂量的香砂六君子汤对脾胃气虚型的CSG大鼠胃排空功能改善作用较强,可达到正常水平。
(三)对于胃粘膜炎症的改善,香砂六君子汤并无较为突出的优势。
(四)脾胃气虚型CSG模型可出现病变部位SP含量的增高；香砂六君子汤中、高剂量能减少胃、脑SP的表达,并且基本达到正常水平。在此方面,替普瑞酮与香砂高、中剂量组,尤其是高剂量组的疗效存在一定差距。
(五)香砂高、中剂量可以减少中枢神经及外周神经INOS的表达；外周胃神经系统的INOS表达强弱可能与中枢神经系统INOS mRNA表达强弱有关联；可能是香砂六君子汤改善实验大鼠胃排空功能的机理。
(六)香砂高、中剂量可以有效下调中枢神经及外周神经5-HT的表达；胃5-HT表达强弱可能与中枢神经系统5-HT1A mRNA表达强弱有关联；通过对消化道及中枢神经的5-HT及5-HT1A有效下调,可能是香砂六君子汤改善实验大鼠胃消化不良状态的机理。
Objective
1.1To reviewe iterature to understand the chronic superficial gastritis(CSG) research progress of Chinese and Western Medicine.
1.2To investigated the treatment effect, of Xiangsha Liujunzi Decoction of CSG and clear the therapeutic advantage. Alpha
1.3Animal experiments as an extension of the clinical research, to further explore the mechanism of action of Xiangsha Six Gentlemen Decoction tr-eatment of spleen qi deficiency type CSG.
1.4Literature parts:reviewed and analyzed literature to understand the chronic superficial gastritis(CSG) research progress of Chinese and Western Medicine.
Method
1.1Clinical study parts:patients with CSG owing to Spleen-Stomach Qi Deficiency were assigned to2groups:the therapy group were treat with Xiangsha Liujunzi decoction and control group were treat with Conventional western medicine. To observe the traditional Chinese medicine syndrome, clinical efficiency, gastroscopy, Hp infection, the inflammatory pathology and quality of life and compared.
1.2Animal experiments:Establishing CSG model rats with spleen-Stomach Qi deficiency type as the objective, then establish the blank control group, the model group,the Xiangsha Liujunzi decoction high-dose group, the Xiangsha Liujunzi decoction dose group, the Xiangsha Liujunzi decoction low dose group and Conventional western medicine group were treated with different processing factors, and then to observe the general status of rats in each group, HE staining of gastric tissue pathology, gastrointestinal motor function in rats. To observe the exopression of SP, INOS and5-HT in the brain and stomach by immunohisto-chemistry. To observe the exopression of INOS RNA, and5-HT RNA. By fluorescent PCR.
Result
1.1The clinical research:
1.1.1The TCM syndrome score comparison of14days after treatment:the treatment group before and after comparison:epigastric fullness, epigastric discomfort, epigastric pain, belching and acid reflux, poor appetite and indigestion, fatigue after eating were significantly improved (p<0.05or p <0.01);the control group before and after comparison:epigastric pain, heartburn symptoms significantly improved (p<0.05or p<0.01). Epigastric fullness symptoms was improve better in the treatment group (p<0.05).
1.1.2The TCM syndrome score comparison of28days after treatment:lthe treatment group before and after comparison:epigastric fullness after eating, epigastric discomfort, epigastric pain, heartburn, belching and acid reflux, poor appetite and indigestion, loose stool, fatigue, weakness8symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, fatigue, weakness three symptoms have significantly improved (p<0.05or p<0.01). After eating epigastric discomfort symptoms was improve better in the treatment group (p <0.05).
1.1.3The TCM syndrome score comparison of56days after treatment:the treatment group before and after comparison:epigastric fullness, epigastric discomfort after eating, epigastric pain, heartburn, belching and acid reflux, food poor appetite, loose stool, fatigue, weakness, tongue quality,10symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, burning effort three symptoms significantly improved (p<0.05or p<0.01). The epigastric fullness, epigastric discomfort symptoms after eating were improve better in the treatment group(p<0.05).
1.1.4The TCM syndrome score comparison of84days after treatment:the treatment group before and after comparison:epigastric fullness after eating, epigastric discomfort, epigastric pain, heartburn, belching and acid reflux, food less poor appetite, loose stool, fatigue, weakness, tongue10symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, heartburn three symptoms significantly improved (p<0.05or p<0.01). The epigastric fullness, epigastric discomfort symptoms after eating were improve better in the treatment group (p<0.05).
1.1.5The efficacy comparison in two groups after treatment:
1.1.5.1TCM symptoms of the therapeutic effect:the total efficiency to56and84days after the treatment group compared with the control group has better therapeutic effect (p<0.05).
1.1.5.2The gastroscopic effect:treatment group and control group has a significant difference in mucosal recovery (p<0.05). Hp infection:treatment group before and after contrast has no significant difference (p>0.05). The control group itself before and after contrast has a significant difference (p<0.05). contrast between two groups After treatment, there has a significant difference (p<0.05).
1.1.5.3The pathological inflammation therapeutic effect:compared with the treatment group in the degree of inflammation, the control group is better, there has statistically significant (p<0.05). Treatment group before and after comparison has no significant difference (p>0.05). The control group before and after comparison has a significant difference (p<0.05), And the degree of inflammatory activity after treatment has no significant difference (p>0.05). there has no significant difference in before and after comparison in both group (p>0.05).
1.1.6The quality of life effect:integral comparison of the treatment group and control group in each dimension has no significant difference (P>0.05); treatment group itself before and after treatment comparison of each dimension improved significantly (P<0.05or P<0.01). The control group itself before and after treatment comparison has significantdifference in6dimension.1.1.7Efficacy of the regression analysis:It shows that there has relationship between efficacy and the different treatment, as well as Chinese medicine symptoms (P<0.05or P<0.01), there has no relationship between efficacy and the SF-36scale points, Hp infection, the degree of pathological inflammation, and activity analysis.
1.1.8Observation safety in two groups of patient:two groups of patients during treatment were not found significant adverse drug reactions.
2.1The animal experiments:
2.1.1The body weight of rats:after modeling, there has significant difference between model ing-made modules and blank group (P<0.01). Giving drug intervention, compared with the model group rats, the rats in all dose group of Xiangsha Liujunzi decoction were significantly increased, there was significant difference (P<0.05). There has no significant difference among each dose group of Xiangsha Liujunzi decoction, compared with model group, Conventional western medicine group, has no significant increase in body weight after intervention.
2.1.2Food quantity intake in rats:after modeling, there has significantly different between each modeling group and the blank group (P<0.01). Given the drug intervention, compared with the model group rats, Xiangsha Liujunzi decoction each dose group rats eating volume increased significantly, there are significant differences (P<0.01), while there has no significant difference among each dose group of Xiangsha Liujunzi decoction, but eating volume of these groups still lower than the blank group rats (P<0.01).
2.1.3Water quantity intake of rats:there has significantly different between each modeling group and the blank group (P<0.01or P<0.05). Given the drug intervention, each dose group compared with the model group rats Xiangsha Six Junzi Decoction in rats drinking water volume increased significantly, there are significant differences (P<0.01or P<0.05), while Xiangsha liujunzi Decoction dose group between the most significant improvement of the high dose group, but Xiangsha each dose group was still lower than the blank water intake of rats (P<0.01).
2.1.4Gastric emptying of rats:compared with the blank group rats, except Xiangsha high dose group, other groups gastric emptying is weaker (P<0.01or P<0.05). Compared with the model group, gastric emptying are better in Xiangsha each dose group.(P<0.01or P<0.05).
2.1.5Ordinary light microscope pathology:Compared with blank group, other groups of gastric mucosa presents lymphocytic infiltration of chronic inflammatory changes of the local vascular little congestion, inflammatory cell infiltration in the mucosa shallow glands remain intact. Compared with model group, Xiangsha inflammation in each dose group must reduce the inflammation for Purell ketone group to reduce the most obvious.
2.1.6In rat stomach and brain SP expression:blank group, in addition to Xiangsha outside the high dose group, Ⅰ group the stomach of SP expression (P<0.01or, P<0.05). Compared with model group rats, Xiangsha each dose group rat gastric SP expression were weaker (P<0.01). Compared with the model group were also weak (P<0.01), for the expression of SP Puri ketone group stomach. And compared with the control group, rats, other than the addition to Xiangsha high dose group, Ⅰ brain SP expression are stronger (P<0. Olor P<0.05), compared with the model rats, Xiangsha each dose group SP expression of rat brain was no significant difference (P>0.05). Compared with the model rats, no significant difference for the expression of SP Puri ketone group stomach.
2.1.7In rat stomach and brain INOS expression:can be found, compared with the control group rats, in addition to low Xiangsha, other than in the high dose group, the expression of more than groups of stomach INOS2strong (P<0.01or P<0.05). Compared with model group rats, the expression of the Xiangsha high dose groups stomach INOS2weaker (P<0.01). Rats compared with the model group, on behalf of the stomach the INOS the expression of the the Puri ketone group, no significant difference (P>0.05); compared with the control group rats, in addition to the in Xiangsha in the high dose group, I group of brain INOS2expression of strong (P<0.05). Compared with model rats, Xiangsha each dose group rat brain INOS expression was no significant difference (P>0.05). Compared with the model rats, no significant difference for the stomach the INOS the expression of the the Puri ketone group.
2.1.8In rat stomach and brain5-HT expression:blank rats In addition to the model group, the expression of I group of the stomach of5-HT compared with those without a significant difference (P>0.05). Compared with model rats, Xiangsha in weak expression of the rat stomach of the high dose group of5-HT (P<0.01). Compared with the model rats, for the expression of the Puri ketone group gastric5-HT was no significant difference (P>0.05); comparison with the control group rats, in addition to low Xiangsha, other than in the high dose group, more than all group of brain5-HT in the expression of a strong (P<0.05). Compared with model rats of Xiangsha each dose of5-HT in the brains of rats showed no significant difference (P>0.05). Compared with the model group were, for the expression of the Puri ketone group gastric5-HT was no significant difference (P>0.05).
2.1.9Stomach, brain tissue5-HTR1A mRNA expression:blank rats, in addition to Xiangsha outside the high dose group, more than groups of stomach5-HTR1A mRNA expression were higher (P>0.05). Compared with model rats Xiangsha, the high dose group rat gastric-HTRIA mRNA expression was no significant difference (P>0.05). Compared with model rats, for of Puri ketone group stomach-HTRIA mRNA expression was no significant difference (P>0.05); compared with the control group rats, except Xiangsha low, medium and high dose group outside, I each group of brain5-HTRIA mRNA expression were higher (P<0.05or P<0.01). Model group rats compared with less Xiangsha high-dose group rat brain5-HTR1A mRNA expression (P<0.01). Compared with the model group were, for of Puri ketone group stomach-HTRIA mRNA expression was no significant difference (P>0.05).
2.1.10Stomach, brain tissue of INOS mRNA in expression:blank group rats, only the stomach of INOS mRNA expression in model group a strong (P<0.05). Compared with the model group rats Xiangsha high dose group rat stomach of INOS mRNA expression less (P<0.01). Compared with model rats for Puri ketone groups stomach of INOS mRNA expression was no significant difference (P>0.05); compared with the control group rats, the same model group, the stomach of INOS mRNA expression (p<0.05). Compared with the model group rats Xiangsha high dose group of the rat brain of INOS mRNA expression less (P<0.05). Compared with the model rats, for Puri ketone group stomach of INOS mRNA expression was no significant difference (P>0.05).
Conelusion
1.1The clinical research component:
1.1.1Xiangsha Liujunzi soup to improve the TCM symptoms, presents the following advantages:1.1.1.1rapid onset.1.1.1.2symptoms improve overall.1.1.1.3Dyspeptic symptoms improved better. Such as epigastric fullness, epigastric discomfort after eating symptom efficacy compared with the control group better.1.1.1.4The improved gastrointestinal symptoms outside the better.1.1.1.5long-term efficacy.
1.1.2Xiangsha Liujunzi soup and Conventional western medicine poor treatment of Hp eradication.
1.1.3Western medicine in the improvement of the degree of inflammation in patients with Conventional western medicine decoction group is superior to traditional Chinese medicine Xiangsha Liujunzi.
1.1.4The efficacy of the quality of life showed the following characteristics:the①Xiangsha Liujunzi Tang Treatment of Spleen Deficiency CSG to improve on the quality of life in patients with more comprehensive. The②Xiangsha Six Junzi Decoction and Conventional western medicine in improving clinical symptoms, can effectively improve the quality of life of patients.
1.1.5The efficacy of therapeutic drugs and TCM symptoms improve correlation with the SF-36scale points, Hp infection, the degree of pathological inflammation, and the activity degree wireless association.
2.1The animal experiments:
2.1.1Xiangsha Six Junzi Decoction can improve the weight loss of the spleen and stomach Qi CSG rats in the short term, but difficult to reach normal levels in the short term.
2.1.2The Xiangsha of high doses of Six Junzi Decoction can improve gastric emptying function of the spleen and stomach Qi CSG, can reach normal levels.
2.1.3Improvement of mucosal inflammation, Xiangsha Liujunzi soup no more prominent advantages.
2.1.4spleen and stomach Qi CSG model, there may be increased SP content of the lesion; Xiangsha Liujunzi soup, high doses can reduce the stomach, brain expression of SP, and basically reached the normal level. In this regard, Conventional western medicine Xiangsha high dose group, especially the efficacy of high dose group there are some gaps.
2.1.5Xiangsha in dose can be reduced to central nervous system and peripheral nerve INOS expression; peripheral gastric nervous system INOS expression of strong and weak may be the central nervous system of INOS RNA expression intensity associated; may the Xiangsha Liujunzi soup to improve the experimental rat gastric emptying function mechanism.
2.1.6Xiangsha, dose can be effectively lowered the expression of the central nervous system and peripheral nerves of5-HT; gastric5-HT expression of the strength of central nervous system5-HT1A receptor RNA expression strength of the association; through the digestive tract and central nervous5-HT and5-HT1A effectively lowered, may be Xiangsha Liujunzi soup to improve the experimental rat stomach indigestion state mechanism.
一、通过文献研究系统了解对CSG的中西医研究进展。
二、探讨香砂六君子汤对该病的治疗效应,明确其治疗优势。
三、动物实验作为临床研究的延伸,进一步探讨香砂六君子汤治疗脾胃气虚型CSG的作用机制。
方法：
一、文献研究部分：查阅资料,分析资料,系统对CSG的中西医研究进展进行了整理及综述。
二、临床研究部分：以临床最常见的脾胃虚气虚型CSG患者为研究对象,设立香砂六君子汤治疗组、西药常规治疗对照组,对两组患者进行前瞻性对照研究。对中医证候、临床有效率、胃镜、Hp感染、炎症病理以及生存质量等几个项目并进行观察对比。
三、动物实验部分：以SD大鼠为研究对象,设立空白对照组、模型组、香砂六君子汤高剂量组、香砂六君子汤中剂量组、香砂六君子汤低剂量组及替普瑞酮组,分别施以不同的处理因素,继而观察各组大鼠一般状态、HE染色观察胃组织病理、胃排空实验观察大鼠胃肠运动功能、免疫组化观察胃及大脑SP、INOS、5-HT表达、荧光PCR观察INOS mRNA以及5-HT mRNA等指标的表达。
结果：
一、临床研究部分：
(一)治疗14天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、嗳气反酸、食少纳呆、疲乏无力6个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘疼痛、烧心2个症候有显著改善(p<0.05orp<0.01)。治疗组与对照组组间对比：胃脘胀满症候改善较好(p<0.05)。
(二)治疗28天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力8个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、疲乏无力3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：食后胃脘不适症候改善较好(p<0.05)。
(三)治疗56天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力、舌质、舌苔10个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、烧心力3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：胃脘胀满、食后胃脘不适症候改善较好(p<0.05)。
(四)治疗84天后中医症候积分比较：治疗组自身前后对比：胃脘胀满、食后胃脘不适、胃脘疼痛、烧心、嗳气反酸、食少纳呆、大便稀溏、疲乏无力、舌苔9个症候有显著改善(p<0.05or p<0.01)；对照组自身前后对比：胃脘胀满、胃脘疼痛、烧心3个症候有显著改善(p<0.05or p<0.01)。治疗组与对照组组间对比：胃脘胀满、食后胃脘不适症候改善较好(p<0.05)。
(五)治疗后两组患者疗效比较
1.中医症候疗效：治疗56及84天后治疗组总有效率与对照组相比,有统计学差异(p<0.05)。
2.治疗后胃镜疗效：治疗组与对照组粘膜恢复情况比较,有统计学差异(p<0.05)。Hp感染情况(快速尿素酶试验)治疗组自身前后对比,无统计学差异(p>0.05)。对照组自身前后对比,有统计学差异(p<0.05)。2组治疗后对比,有统计学差异(p<0.05),其中Hp阴性患者中行三联根除Hp疗法患者有14人。
3.治疗56天后复查病理,治疗组与对照组炎症程度情况比较,对照组炎症程度的改善要优于治疗组,有统计学差异(p<0.05)。治疗组自身前后比较,无统计学差异(p>0.05)。对照组自身前后比较有明显改善,具有统计学差异(p<0.05)。；而炎症活动度比较,治疗后2组无统计学差异(p>0.05)。治疗组与对照组自身前后比较无统计学差异(p>0.05)。
4.两组CSG患者SF-36生存质量疗效：治疗组与对照组各维度积分对比无显著差异(P>0.05)；治疗组自身前后对比各维度均有显著改善,有统计学差异(P<0.05orP<0.01)。对照组自身前后对比在生理功能、躯体疼痛、精神健康、健康变化自评、躯体健康、精神健康总评上有显著改善,有统计学差异(P>0.05)。
5.疗效的回归分析：治疗后有效率与组别、中医症候积分、SF-36量表积分、Hp感染、病理炎症程度以及活动度的相关性分析表明疗效与治疗组别和中医症候改善有相关性(P<0.05or P<0.01),与SF-36量表积分、Hp感染、病理炎症程度以及活动度无相关性。
6.两组患者安全性观察：两组患者治疗期间均未发现明显的药物不良反应。
二、动物实验部分：
(一)脾胃气虚型CSG造模后大鼠的一般表现：造模各组大鼠体重1-6d体重与空白组比较,增长速度无显著差异；7d开始体重逐渐下降,11d起体重明显下降。
(二)大鼠体重：造模后各造模组与空白组比较体重有显著差异(P<0.01)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组组大鼠体重均明显增加,有显著性差异(P<0.05)。而香砂六君子汤各剂量组之间对比未见明显差异,与模型组比较,替普瑞酮组在给药后体重未见明显增加。
(三)大鼠进食量：造模后各造模组与空白组比较有显著差异(P<0.01)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组大鼠进食量均明显增加,有显著性差异(P<0.01),而香砂六君子汤各剂量组之间对比未见明显差异,但是仍低于空白组大鼠的进食量(P<0.01)。
(四)大鼠的饮水量：造模后各造模组饮水量少于与空白组,有显著差异(P<0.01or P<0.05)。给予药物干预后,与模型组大鼠相比,香砂六君子汤各剂量组大鼠饮水量均明显增加,有显著性差异(P<0.01or P<0.05),而香砂六君子汤各剂量组之间以高剂量组改善最为显著,但香砂各剂量组仍低于空白组大鼠的饮水量(P<0.01)。
(五)大鼠的胃排空功能：与空白组大鼠比较,除香砂高剂量组以外,余各组胃排空功能均较弱(P<0.01or P<0.05)。与模型组大鼠相比,香砂各剂量组大鼠胃排空量均更强,有显性差异(P<0.01or P<0.05)。
(六)普通光镜观察病理：与空白组比较,其他各组胃粘膜下层见有淋巴细胞浸润,局部血管少许充血等慢性炎症改变,炎症细胞浸润主要在黏膜浅层,腺体保持完整。与模型组比较,香砂各剂量组炎症有一定减轻,而替普瑞酮组炎症减轻最明显。
(七)大鼠胃及大脑SP表达：与空白组大鼠比较,除香砂中、高剂量组以外,余各组胃SP的表达均较强(P<0.01or P<0.05)。与模型组大鼠相比,香砂各剂量组大鼠胃SP的表达均较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃SP的表达也较弱(P<0.01)。而与空白组大鼠比较,除香砂高剂量组以外,余各组大脑SP的表达均较强(P<0.01or P<0.05),与模型组大鼠相比,香砂各剂量组大鼠大脑SP的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃SP的表达无明显差异性。
(八)大鼠胃及大脑INOS表达：可以发现,与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组胃INOS2的表达均较强(P<0.0lor P<0.05)。与模型组大鼠相比,香砂高剂量组大鼠胃INOS2的表达较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃INOS的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂中、高剂量组以外,余各组大脑INOS2的表达均较强(P<0.05),。与模型组大鼠相比,香砂各剂量组大鼠大脑INOS的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃INOS的表达无明显差异性。
(九)大鼠胃及大脑5-HT表达：与空白组大鼠比较,除模型组以外,余各组胃5-HT的表达均较无显著差异(P>0.05)。与模型组大鼠相比,香砂中、高剂量组大鼠胃5-HT的表达较弱(P<0.01)。与模型组大鼠相比,替普瑞酮组胃5-HT的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组大脑5-HT的表达均较强(P<0.05),。与模型组大鼠相比,香砂各剂量组大鼠大脑5-HT的表达无明显差异性(P>0.05)。与模型组大鼠相比,替普瑞酮组胃5-HT的表达无明显差异性(P>0.05)。
(十)胃、脑组织5-HTR1A mRNA表达：空白组大鼠比较,除香砂中、高剂量组以外,余各组胃5-HTR1A mRNA的表达均较多(P>0.05)。与模型组大鼠相比,香砂中、高剂量组大鼠胃5-HTR1A mRNA的表达无明显差异(P>0.05)。与模型组大鼠相比,替普瑞酮组胃5-HTR1A mRNA的表达无明显差异(P>0.05)；而与空白组大鼠比较,除香砂低、中、高剂量组以外,余各组大脑5-HTRlAmRNA的表达均较多(P<0.05or P<0.01)。模型组大鼠相比,香砂高剂量组大鼠大脑5-HTR1A mRNA的表达较少(P<0.01)。与模型组大鼠相比,替普瑞酮组胃5-HTR1A mRNA的表达无明显差异性(P>0.05)。
(十一)胃、脑组织INOS mRNA表达：与空白组大鼠比较,只有模型组胃INOS mRNA的表达较强(P<0.05)。与模型组大鼠相比,香砂高剂量组大鼠胃INOS mRNA的表达较少(P<0.01)。与模型组大鼠相比,替普瑞酮组胃INOS mRNA的表达无明显差异(P>0.05)；而与空白组大鼠比较,同样只有模型组胃INOS mRNA的表达较强(p<0.05)。与模型组大鼠相比,香砂高剂量组大鼠大脑INOS mRNA的表达较少(P<0.05)。与模型组大鼠相比,替普瑞酮组胃INOS mRNA的表达无明显差异性(P>0.05)。
结论：
一、临床研究部分：
(一)香砂六君子汤改善中医症候方面呈现如下几个优势：1.起效较快。2.症候改善全面。3.对消化不良症状侯改善效果较好。如胃脘胀满、食后胃脘不适症候的疗效较对照组更优。4.对消化道外症状改善效果较好。5.远期疗效较好。
(二)香砂六君子汤Hp的治疗效果不佳。
(三)常规西药对照组在对患者炎症程度的改善上要优于中药香砂六君子汤组。
(四)对生存质量的疗效呈以下几个特点：1.香砂六君子汤治疗脾胃气虚型CSG对患者生活质量的提高较为全面。2.香砂六君子汤和常规西药对照组在改善临床症状后均能有效提高患者生活质量。
(五)疗效与治疗药物和中医症候改善具有相关性,与SF-36量表积分、Hp感染、病理炎症程度以及活动度无线性关联。
二、动物实验部分：
(一)香砂六君子汤能在短期内改善脾胃气虚型CSG大鼠的体重减轻情况,但是在短期内难以达到正常水平。
(二)高剂量的香砂六君子汤对脾胃气虚型的CSG大鼠胃排空功能改善作用较强,可达到正常水平。
(三)对于胃粘膜炎症的改善,香砂六君子汤并无较为突出的优势。
(四)脾胃气虚型CSG模型可出现病变部位SP含量的增高；香砂六君子汤中、高剂量能减少胃、脑SP的表达,并且基本达到正常水平。在此方面,替普瑞酮与香砂高、中剂量组,尤其是高剂量组的疗效存在一定差距。
(五)香砂高、中剂量可以减少中枢神经及外周神经INOS的表达；外周胃神经系统的INOS表达强弱可能与中枢神经系统INOS mRNA表达强弱有关联；可能是香砂六君子汤改善实验大鼠胃排空功能的机理。
(六)香砂高、中剂量可以有效下调中枢神经及外周神经5-HT的表达；胃5-HT表达强弱可能与中枢神经系统5-HT1A mRNA表达强弱有关联；通过对消化道及中枢神经的5-HT及5-HT1A有效下调,可能是香砂六君子汤改善实验大鼠胃消化不良状态的机理。
Objective
1.1To reviewe iterature to understand the chronic superficial gastritis(CSG) research progress of Chinese and Western Medicine.
1.2To investigated the treatment effect, of Xiangsha Liujunzi Decoction of CSG and clear the therapeutic advantage. Alpha
1.3Animal experiments as an extension of the clinical research, to further explore the mechanism of action of Xiangsha Six Gentlemen Decoction tr-eatment of spleen qi deficiency type CSG.
1.4Literature parts:reviewed and analyzed literature to understand the chronic superficial gastritis(CSG) research progress of Chinese and Western Medicine.
Method
1.1Clinical study parts:patients with CSG owing to Spleen-Stomach Qi Deficiency were assigned to2groups:the therapy group were treat with Xiangsha Liujunzi decoction and control group were treat with Conventional western medicine. To observe the traditional Chinese medicine syndrome, clinical efficiency, gastroscopy, Hp infection, the inflammatory pathology and quality of life and compared.
1.2Animal experiments:Establishing CSG model rats with spleen-Stomach Qi deficiency type as the objective, then establish the blank control group, the model group,the Xiangsha Liujunzi decoction high-dose group, the Xiangsha Liujunzi decoction dose group, the Xiangsha Liujunzi decoction low dose group and Conventional western medicine group were treated with different processing factors, and then to observe the general status of rats in each group, HE staining of gastric tissue pathology, gastrointestinal motor function in rats. To observe the exopression of SP, INOS and5-HT in the brain and stomach by immunohisto-chemistry. To observe the exopression of INOS RNA, and5-HT RNA. By fluorescent PCR.
Result
1.1The clinical research:
1.1.1The TCM syndrome score comparison of14days after treatment:the treatment group before and after comparison:epigastric fullness, epigastric discomfort, epigastric pain, belching and acid reflux, poor appetite and indigestion, fatigue after eating were significantly improved (p<0.05or p <0.01);the control group before and after comparison:epigastric pain, heartburn symptoms significantly improved (p<0.05or p<0.01). Epigastric fullness symptoms was improve better in the treatment group (p<0.05).
1.1.2The TCM syndrome score comparison of28days after treatment:lthe treatment group before and after comparison:epigastric fullness after eating, epigastric discomfort, epigastric pain, heartburn, belching and acid reflux, poor appetite and indigestion, loose stool, fatigue, weakness8symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, fatigue, weakness three symptoms have significantly improved (p<0.05or p<0.01). After eating epigastric discomfort symptoms was improve better in the treatment group (p <0.05).
1.1.3The TCM syndrome score comparison of56days after treatment:the treatment group before and after comparison:epigastric fullness, epigastric discomfort after eating, epigastric pain, heartburn, belching and acid reflux, food poor appetite, loose stool, fatigue, weakness, tongue quality,10symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, burning effort three symptoms significantly improved (p<0.05or p<0.01). The epigastric fullness, epigastric discomfort symptoms after eating were improve better in the treatment group(p<0.05).
1.1.4The TCM syndrome score comparison of84days after treatment:the treatment group before and after comparison:epigastric fullness after eating, epigastric discomfort, epigastric pain, heartburn, belching and acid reflux, food less poor appetite, loose stool, fatigue, weakness, tongue10symptoms have significantly improved (p<0.05or p<0.01); the control group before and after comparison:epigastric fullness, epigastric pain, heartburn three symptoms significantly improved (p<0.05or p<0.01). The epigastric fullness, epigastric discomfort symptoms after eating were improve better in the treatment group (p<0.05).
1.1.5The efficacy comparison in two groups after treatment:
1.1.5.1TCM symptoms of the therapeutic effect:the total efficiency to56and84days after the treatment group compared with the control group has better therapeutic effect (p<0.05).
1.1.5.2The gastroscopic effect:treatment group and control group has a significant difference in mucosal recovery (p<0.05). Hp infection:treatment group before and after contrast has no significant difference (p>0.05). The control group itself before and after contrast has a significant difference (p<0.05). contrast between two groups After treatment, there has a significant difference (p<0.05).
1.1.5.3The pathological inflammation therapeutic effect:compared with the treatment group in the degree of inflammation, the control group is better, there has statistically significant (p<0.05). Treatment group before and after comparison has no significant difference (p>0.05). The control group before and after comparison has a significant difference (p<0.05), And the degree of inflammatory activity after treatment has no significant difference (p>0.05). there has no significant difference in before and after comparison in both group (p>0.05).
1.1.6The quality of life effect:integral comparison of the treatment group and control group in each dimension has no significant difference (P>0.05); treatment group itself before and after treatment comparison of each dimension improved significantly (P<0.05or P<0.01). The control group itself before and after treatment comparison has significantdifference in6dimension.1.1.7Efficacy of the regression analysis:It shows that there has relationship between efficacy and the different treatment, as well as Chinese medicine symptoms (P<0.05or P<0.01), there has no relationship between efficacy and the SF-36scale points, Hp infection, the degree of pathological inflammation, and activity analysis.
1.1.8Observation safety in two groups of patient:two groups of patients during treatment were not found significant adverse drug reactions.
2.1The animal experiments:
2.1.1The body weight of rats:after modeling, there has significant difference between model ing-made modules and blank group (P<0.01). Giving drug intervention, compared with the model group rats, the rats in all dose group of Xiangsha Liujunzi decoction were significantly increased, there was significant difference (P<0.05). There has no significant difference among each dose group of Xiangsha Liujunzi decoction, compared with model group, Conventional western medicine group, has no significant increase in body weight after intervention.
2.1.2Food quantity intake in rats:after modeling, there has significantly different between each modeling group and the blank group (P<0.01). Given the drug intervention, compared with the model group rats, Xiangsha Liujunzi decoction each dose group rats eating volume increased significantly, there are significant differences (P<0.01), while there has no significant difference among each dose group of Xiangsha Liujunzi decoction, but eating volume of these groups still lower than the blank group rats (P<0.01).
2.1.3Water quantity intake of rats:there has significantly different between each modeling group and the blank group (P<0.01or P<0.05). Given the drug intervention, each dose group compared with the model group rats Xiangsha Six Junzi Decoction in rats drinking water volume increased significantly, there are significant differences (P<0.01or P<0.05), while Xiangsha liujunzi Decoction dose group between the most significant improvement of the high dose group, but Xiangsha each dose group was still lower than the blank water intake of rats (P<0.01).
2.1.4Gastric emptying of rats:compared with the blank group rats, except Xiangsha high dose group, other groups gastric emptying is weaker (P<0.01or P<0.05). Compared with the model group, gastric emptying are better in Xiangsha each dose group.(P<0.01or P<0.05).
2.1.5Ordinary light microscope pathology:Compared with blank group, other groups of gastric mucosa presents lymphocytic infiltration of chronic inflammatory changes of the local vascular little congestion, inflammatory cell infiltration in the mucosa shallow glands remain intact. Compared with model group, Xiangsha inflammation in each dose group must reduce the inflammation for Purell ketone group to reduce the most obvious.
2.1.6In rat stomach and brain SP expression:blank group, in addition to Xiangsha outside the high dose group, Ⅰ group the stomach of SP expression (P<0.01or, P<0.05). Compared with model group rats, Xiangsha each dose group rat gastric SP expression were weaker (P<0.01). Compared with the model group were also weak (P<0.01), for the expression of SP Puri ketone group stomach. And compared with the control group, rats, other than the addition to Xiangsha high dose group, Ⅰ brain SP expression are stronger (P<0. Olor P<0.05), compared with the model rats, Xiangsha each dose group SP expression of rat brain was no significant difference (P>0.05). Compared with the model rats, no significant difference for the expression of SP Puri ketone group stomach.
2.1.7In rat stomach and brain INOS expression:can be found, compared with the control group rats, in addition to low Xiangsha, other than in the high dose group, the expression of more than groups of stomach INOS2strong (P<0.01or P<0.05). Compared with model group rats, the expression of the Xiangsha high dose groups stomach INOS2weaker (P<0.01). Rats compared with the model group, on behalf of the stomach the INOS the expression of the the Puri ketone group, no significant difference (P>0.05); compared with the control group rats, in addition to the in Xiangsha in the high dose group, I group of brain INOS2expression of strong (P<0.05). Compared with model rats, Xiangsha each dose group rat brain INOS expression was no significant difference (P>0.05). Compared with the model rats, no significant difference for the stomach the INOS the expression of the the Puri ketone group.
2.1.8In rat stomach and brain5-HT expression:blank rats In addition to the model group, the expression of I group of the stomach of5-HT compared with those without a significant difference (P>0.05). Compared with model rats, Xiangsha in weak expression of the rat stomach of the high dose group of5-HT (P<0.01). Compared with the model rats, for the expression of the Puri ketone group gastric5-HT was no significant difference (P>0.05); comparison with the control group rats, in addition to low Xiangsha, other than in the high dose group, more than all group of brain5-HT in the expression of a strong (P<0.05). Compared with model rats of Xiangsha each dose of5-HT in the brains of rats showed no significant difference (P>0.05). Compared with the model group were, for the expression of the Puri ketone group gastric5-HT was no significant difference (P>0.05).
2.1.9Stomach, brain tissue5-HTR1A mRNA expression:blank rats, in addition to Xiangsha outside the high dose group, more than groups of stomach5-HTR1A mRNA expression were higher (P>0.05). Compared with model rats Xiangsha, the high dose group rat gastric-HTRIA mRNA expression was no significant difference (P>0.05). Compared with model rats, for of Puri ketone group stomach-HTRIA mRNA expression was no significant difference (P>0.05); compared with the control group rats, except Xiangsha low, medium and high dose group outside, I each group of brain5-HTRIA mRNA expression were higher (P<0.05or P<0.01). Model group rats compared with less Xiangsha high-dose group rat brain5-HTR1A mRNA expression (P<0.01). Compared with the model group were, for of Puri ketone group stomach-HTRIA mRNA expression was no significant difference (P>0.05).
2.1.10Stomach, brain tissue of INOS mRNA in expression:blank group rats, only the stomach of INOS mRNA expression in model group a strong (P<0.05). Compared with the model group rats Xiangsha high dose group rat stomach of INOS mRNA expression less (P<0.01). Compared with model rats for Puri ketone groups stomach of INOS mRNA expression was no significant difference (P>0.05); compared with the control group rats, the same model group, the stomach of INOS mRNA expression (p<0.05). Compared with the model group rats Xiangsha high dose group of the rat brain of INOS mRNA expression less (P<0.05). Compared with the model rats, for Puri ketone group stomach of INOS mRNA expression was no significant difference (P>0.05).
Conelusion
1.1The clinical research component:
1.1.1Xiangsha Liujunzi soup to improve the TCM symptoms, presents the following advantages:1.1.1.1rapid onset.1.1.1.2symptoms improve overall.1.1.1.3Dyspeptic symptoms improved better. Such as epigastric fullness, epigastric discomfort after eating symptom efficacy compared with the control group better.1.1.1.4The improved gastrointestinal symptoms outside the better.1.1.1.5long-term efficacy.
1.1.2Xiangsha Liujunzi soup and Conventional western medicine poor treatment of Hp eradication.
1.1.3Western medicine in the improvement of the degree of inflammation in patients with Conventional western medicine decoction group is superior to traditional Chinese medicine Xiangsha Liujunzi.
1.1.4The efficacy of the quality of life showed the following characteristics:the①Xiangsha Liujunzi Tang Treatment of Spleen Deficiency CSG to improve on the quality of life in patients with more comprehensive. The②Xiangsha Six Junzi Decoction and Conventional western medicine in improving clinical symptoms, can effectively improve the quality of life of patients.
1.1.5The efficacy of therapeutic drugs and TCM symptoms improve correlation with the SF-36scale points, Hp infection, the degree of pathological inflammation, and the activity degree wireless association.
2.1The animal experiments:
2.1.1Xiangsha Six Junzi Decoction can improve the weight loss of the spleen and stomach Qi CSG rats in the short term, but difficult to reach normal levels in the short term.
2.1.2The Xiangsha of high doses of Six Junzi Decoction can improve gastric emptying function of the spleen and stomach Qi CSG, can reach normal levels.
2.1.3Improvement of mucosal inflammation, Xiangsha Liujunzi soup no more prominent advantages.
2.1.4spleen and stomach Qi CSG model, there may be increased SP content of the lesion; Xiangsha Liujunzi soup, high doses can reduce the stomach, brain expression of SP, and basically reached the normal level. In this regard, Conventional western medicine Xiangsha high dose group, especially the efficacy of high dose group there are some gaps.
2.1.5Xiangsha in dose can be reduced to central nervous system and peripheral nerve INOS expression; peripheral gastric nervous system INOS expression of strong and weak may be the central nervous system of INOS RNA expression intensity associated; may the Xiangsha Liujunzi soup to improve the experimental rat gastric emptying function mechanism.
2.1.6Xiangsha, dose can be effectively lowered the expression of the central nervous system and peripheral nerves of5-HT; gastric5-HT expression of the strength of central nervous system5-HT1A receptor RNA expression strength of the association; through the digestive tract and central nervous5-HT and5-HT1A effectively lowered, may be Xiangsha Liujunzi soup to improve the experimental rat stomach indigestion state mechanism.
引文
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