调中颗粒对功能性消化不良的疗效观察及对Cajal间质细胞影响的研究
|
摘要
功能性消化不良是一种临床常见病和多发病,几乎每个人一生中都曾出现过消化不良的症状。目前有调查显示,因消化不良症状就诊者占所有内科门诊的30%左右,占消化专科门诊的70%,而功能性消化不良占消化专科门诊的30%-40%。虽然功能性消化不良不会引起严重的并发症或者威胁患者的生命,但是早饱、上腹痛、餐后饱胀不适等症状严重影响着患者的生活质量。因此找到一条行之有效的治疗功能性消化不良的方法,是目前临床和科研的热点。
目前对于功能性消化不良的发病机制尚未完全阐明,现代研究证实Caja1间质细胞作为胃肠道的“起搏”细胞,参与到胃电信号的形成和传导,与本病的发生有密切的关系。由于其临床症状有多种表现,并且易伴随出现,因此西医对于本病的治疗多以改善症状、对症处理为主。许多促胃动力如吗丁啉、西沙必利等,虽可明显缓解功能性消化不良的症状,但是作用有限,且存在停药后复发、扰乱体内激素分泌等副作用。越来越多的研究表明,中医药不仅对胃肠功能有很好的调节作用,而且更加注重对机体的整体调节。
调中颗粒是在经方半夏泻心汤基础上,结合多年临床经验化裁而来。具有调整阴阳、辛开苦降、补泻兼施的功效。本课题拟从临床观察及实验研究两方面探讨调中颗粒治疗功能性消化不良的作用机制及对ICC表达的影响。
目的：观察调中颗粒对功能性消化不良的临床疗效。
方法：82例功能性消化不良患者随机分为治疗组(调中颗粒组)42例、对照组(吗丁啉组)40例。采用规范治疗后,记录并观察患者临床疗效、前后单项症状评分、前后胃电图主频率与主功率、前后中医症状量化及不同中医证型的有效率。
结果：治疗组较对照组临床治愈率明显提高(P＜0.01)且总有效率较高(P＜0.05),达到90.48%；治疗组单项症状积分优于对照组(P＜0.05)；治疗组在中医量化积分及不同证型疗效方面均明显优于对照组(P＜0.01)；治疗组在改善胃电参数、胃电节律上优于对照组(P＜0.05),且无明显不良反应,安全性好。
结论：调中颗粒是治疗功能性消化不良的一种安全有效的药物,值得临床运用和推广。
目的：观察调中颗粒对FD大鼠胃电节律及胃窦部分Caja1间质细胞分布的影响,来判断该药物动物实验的有效性。
方法：以SD大鼠为实验对象,采用夹尾造模法复制FD模型。按照随机原则,分为正常组、模型组、调中颗粒组、半夏泻心汤组、多潘立酮组；给予不同的药物治疗后,通过胃电图设备及免疫组化方法,观察大鼠胃电参数、节律和胃窦间Caja1间质细胞的分布。
结果：各治疗组均能不同程度的改善紊乱的胃电节律及参数。与模型组比较,有差异性(P＜0.05,P＜0.01)：在胃电主频率方面,调中颗粒优于半夏泻心汤与多潘立酮(P＜0.05)；在胃电主功率方面,调中颗粒优于半夏泻心汤与多潘立酮(P＜0.05)。
各治疗组胃窦部分Caja1间质细胞分布与模型组组比较均有显著统计学差异(P＜0.01),调中颗粒优于半夏泻心汤(P＜0.05),调中颗粒优于多潘立酮(P＜0.01)。
结论：调中颗粒对改善FD大鼠紊乱的胃电节律和提高胃电参数,以及提高胃窦间Caja1间质细胞的表达均优于半夏泻心汤和多潘立酮。
The Functional Dyspepsia is a clinical common disease and frequently-occurring disease,almost everyone of us have occurded these symptoms. At present a survey, because of dyspeptic symptoms of all internal medicine outpatient treatment accounted for about 30%, accounting for 70% of specialist out-patient to digest, and functional dyspepsia accounted for 30% digestion specialist out-patient 40%. Although the functional dyspepsia does not cause serious complications or threatening the lives of patients, but early satiety, upper abdominal pain, postprandial fullness discomfort and other symptoms in patients with a serious impact on the quality of life and constitute a very high medical costs. Therefore, finding an effective treatment of functional dyspepsia approach, which is the clinical and scientific research hot spots.
At present, for the pathogenesis of functional dyspepsia has not been fully clarified, modern research has confirmed that interstitial cells of Cajal of the gastrointestinal tract as a "pacemaker" cells, involved in the formation and conduction of gastric electrical signals, and the occurrence of this disease is closely related to. Because of its performance in a variety of clinical symptoms, and easily accompanied with other symptoms, Western medicine to alleviate the symptoms. A number of prokinetic, such as domperidone, cisapride and so on, although can significantly alleviate the symptoms of functional dyspepsia.However, a limited role, and there is recurrence after withdrawal, side effects such as disrupting hormone secretion in vivo. Growing number of studies have shown that Chinese medicine not only for the regulation of gastrointestinal function have a good role,but also pay more attention to the overall regulation of the body.
Tiaozhong granule is based on classic recipe Pinellia heart-draining decoction,and reference to many years of clinical experiences.Tiaozhong granule can adjustment of yin and yang, Acrid bitter drop, the effect of reinforcing and reducing carrot. The topics to be from clinical observation and experimental study to explore two aspects of particle transfer treatment of functional dyspepsia and the mechanism of action of the ICC expression. 1 Clinical observation of functional dyspepsia by Tiaozhong granule
Objective:To observe the tiaozhong granule on the clinical efficacy of functional dyspepsia.
Methods:82 cases of patients with functional dyspepsia were randomly divided into treatment group (Tiaozhong granule group) 42 cases, the control group (Domperidone group) 40 cases. Use of standard treatment, record and observe the clinical efficacy, before and after the individual symptom scores, before and after the EGG dominant frequency and dominant power, before and after the traditional Chinese medicine to quantify the symptoms and different types of TCM efficient.
Results:The treatment group than the control group markedly improved the clinical cure rate (P<0.01) and the total effective rate higher (P＜0.05), up 90.48 percent; treatment group the individual symptom score than the control group (P<0.05); treatment group in the Chinese integral and quantify the efficacy of different syndromes were significantly superior to the control group (P<0.01); treatment group in improving the EGG parameters and gastric electrical rhythm is superior to the control group (P<0.05), and no obvious adverse reactions, safety.
Conclusion:Tiaozhong granule can treat functional dyspepsia safety and effectively.It is worth of clinical application and promotion of. 2 Research on Tiaozhong granule on the FD rat antral gastric electrical rhythm and the right distribution of interstitial cells of Cajal.
Objective:Observe the transfer of particles to the FD, and antral gastric electric rhythm part of the distribution of interstitial cells of Cajal effects of animal experiments to determine the effectiveness of the drug.
Methods:With SD rats as the experimental objects, using folders to copy France FD modeling tail model. In accordance with the principle of randomization, were divided into normal group, the model group, adjusting particle group, Pinellia heart-draining decoction group, domperidone group; given different drug treatment, by EGG equipment and immunohistochemical method to observe the rat gastric electrical parameters, and sinus rhythm between the distribution of interstitial cells of Cajal.
Results:Treatment groups can improved to varying degrees of gastric electric rhythm disorders and parameters. Compared with model group, there are differences (P<0.05, P<0.01):in the EGG dominant frequency, the transfer of particles is superior to Pinellia heart-draining decoction and domperidone (P <0.05); in the EGG dominant power, the Transfer of particles is superior to Pinellia heart-draining decoction and domperidone (P<0.05).
The antral part of the treatment group, the distribution of interstitial cells of Cajal with model group, group differences were statistically significant (P<0.01), adjusted particles is superior to Pinellia heart-draining decoction (P<0.05), adjusted particles is superior to domperidone (P<0.01).
Conclusion:Tiaozhong granule to improve the FD rat gastric electric rhythm disorder and improve the electrical parameters of the stomach and improve gastric antrum between the expression of interstitial cells of Cajal are superior to Pinellia heart-draining decoction and domperidone.
目前对于功能性消化不良的发病机制尚未完全阐明,现代研究证实Caja1间质细胞作为胃肠道的“起搏”细胞,参与到胃电信号的形成和传导,与本病的发生有密切的关系。由于其临床症状有多种表现,并且易伴随出现,因此西医对于本病的治疗多以改善症状、对症处理为主。许多促胃动力如吗丁啉、西沙必利等,虽可明显缓解功能性消化不良的症状,但是作用有限,且存在停药后复发、扰乱体内激素分泌等副作用。越来越多的研究表明,中医药不仅对胃肠功能有很好的调节作用,而且更加注重对机体的整体调节。
调中颗粒是在经方半夏泻心汤基础上,结合多年临床经验化裁而来。具有调整阴阳、辛开苦降、补泻兼施的功效。本课题拟从临床观察及实验研究两方面探讨调中颗粒治疗功能性消化不良的作用机制及对ICC表达的影响。
目的：观察调中颗粒对功能性消化不良的临床疗效。
方法：82例功能性消化不良患者随机分为治疗组(调中颗粒组)42例、对照组(吗丁啉组)40例。采用规范治疗后,记录并观察患者临床疗效、前后单项症状评分、前后胃电图主频率与主功率、前后中医症状量化及不同中医证型的有效率。
结果：治疗组较对照组临床治愈率明显提高(P＜0.01)且总有效率较高(P＜0.05),达到90.48%；治疗组单项症状积分优于对照组(P＜0.05)；治疗组在中医量化积分及不同证型疗效方面均明显优于对照组(P＜0.01)；治疗组在改善胃电参数、胃电节律上优于对照组(P＜0.05),且无明显不良反应,安全性好。
结论：调中颗粒是治疗功能性消化不良的一种安全有效的药物,值得临床运用和推广。
目的：观察调中颗粒对FD大鼠胃电节律及胃窦部分Caja1间质细胞分布的影响,来判断该药物动物实验的有效性。
方法：以SD大鼠为实验对象,采用夹尾造模法复制FD模型。按照随机原则,分为正常组、模型组、调中颗粒组、半夏泻心汤组、多潘立酮组；给予不同的药物治疗后,通过胃电图设备及免疫组化方法,观察大鼠胃电参数、节律和胃窦间Caja1间质细胞的分布。
结果：各治疗组均能不同程度的改善紊乱的胃电节律及参数。与模型组比较,有差异性(P＜0.05,P＜0.01)：在胃电主频率方面,调中颗粒优于半夏泻心汤与多潘立酮(P＜0.05)；在胃电主功率方面,调中颗粒优于半夏泻心汤与多潘立酮(P＜0.05)。
各治疗组胃窦部分Caja1间质细胞分布与模型组组比较均有显著统计学差异(P＜0.01),调中颗粒优于半夏泻心汤(P＜0.05),调中颗粒优于多潘立酮(P＜0.01)。
结论：调中颗粒对改善FD大鼠紊乱的胃电节律和提高胃电参数,以及提高胃窦间Caja1间质细胞的表达均优于半夏泻心汤和多潘立酮。
The Functional Dyspepsia is a clinical common disease and frequently-occurring disease,almost everyone of us have occurded these symptoms. At present a survey, because of dyspeptic symptoms of all internal medicine outpatient treatment accounted for about 30%, accounting for 70% of specialist out-patient to digest, and functional dyspepsia accounted for 30% digestion specialist out-patient 40%. Although the functional dyspepsia does not cause serious complications or threatening the lives of patients, but early satiety, upper abdominal pain, postprandial fullness discomfort and other symptoms in patients with a serious impact on the quality of life and constitute a very high medical costs. Therefore, finding an effective treatment of functional dyspepsia approach, which is the clinical and scientific research hot spots.
At present, for the pathogenesis of functional dyspepsia has not been fully clarified, modern research has confirmed that interstitial cells of Cajal of the gastrointestinal tract as a "pacemaker" cells, involved in the formation and conduction of gastric electrical signals, and the occurrence of this disease is closely related to. Because of its performance in a variety of clinical symptoms, and easily accompanied with other symptoms, Western medicine to alleviate the symptoms. A number of prokinetic, such as domperidone, cisapride and so on, although can significantly alleviate the symptoms of functional dyspepsia.However, a limited role, and there is recurrence after withdrawal, side effects such as disrupting hormone secretion in vivo. Growing number of studies have shown that Chinese medicine not only for the regulation of gastrointestinal function have a good role,but also pay more attention to the overall regulation of the body.
Tiaozhong granule is based on classic recipe Pinellia heart-draining decoction,and reference to many years of clinical experiences.Tiaozhong granule can adjustment of yin and yang, Acrid bitter drop, the effect of reinforcing and reducing carrot. The topics to be from clinical observation and experimental study to explore two aspects of particle transfer treatment of functional dyspepsia and the mechanism of action of the ICC expression. 1 Clinical observation of functional dyspepsia by Tiaozhong granule
Objective:To observe the tiaozhong granule on the clinical efficacy of functional dyspepsia.
Methods:82 cases of patients with functional dyspepsia were randomly divided into treatment group (Tiaozhong granule group) 42 cases, the control group (Domperidone group) 40 cases. Use of standard treatment, record and observe the clinical efficacy, before and after the individual symptom scores, before and after the EGG dominant frequency and dominant power, before and after the traditional Chinese medicine to quantify the symptoms and different types of TCM efficient.
Results:The treatment group than the control group markedly improved the clinical cure rate (P<0.01) and the total effective rate higher (P＜0.05), up 90.48 percent; treatment group the individual symptom score than the control group (P<0.05); treatment group in the Chinese integral and quantify the efficacy of different syndromes were significantly superior to the control group (P<0.01); treatment group in improving the EGG parameters and gastric electrical rhythm is superior to the control group (P<0.05), and no obvious adverse reactions, safety.
Conclusion:Tiaozhong granule can treat functional dyspepsia safety and effectively.It is worth of clinical application and promotion of. 2 Research on Tiaozhong granule on the FD rat antral gastric electrical rhythm and the right distribution of interstitial cells of Cajal.
Objective:Observe the transfer of particles to the FD, and antral gastric electric rhythm part of the distribution of interstitial cells of Cajal effects of animal experiments to determine the effectiveness of the drug.
Methods:With SD rats as the experimental objects, using folders to copy France FD modeling tail model. In accordance with the principle of randomization, were divided into normal group, the model group, adjusting particle group, Pinellia heart-draining decoction group, domperidone group; given different drug treatment, by EGG equipment and immunohistochemical method to observe the rat gastric electrical parameters, and sinus rhythm between the distribution of interstitial cells of Cajal.
Results:Treatment groups can improved to varying degrees of gastric electric rhythm disorders and parameters. Compared with model group, there are differences (P<0.05, P<0.01):in the EGG dominant frequency, the transfer of particles is superior to Pinellia heart-draining decoction and domperidone (P <0.05); in the EGG dominant power, the Transfer of particles is superior to Pinellia heart-draining decoction and domperidone (P<0.05).
The antral part of the treatment group, the distribution of interstitial cells of Cajal with model group, group differences were statistically significant (P<0.01), adjusted particles is superior to Pinellia heart-draining decoction (P<0.05), adjusted particles is superior to domperidone (P<0.01).
Conclusion:Tiaozhong granule to improve the FD rat gastric electric rhythm disorder and improve the electrical parameters of the stomach and improve gastric antrum between the expression of interstitial cells of Cajal are superior to Pinellia heart-draining decoction and domperidone.
引文
[1]郭海军,林洁.功能性消化不良的动物模型研究.中国中西医结合消化杂志,2001；9(3)：141-142.
[2]龙庆林,王振华.内源性一氧化氮与胃电节律失常关系的实验研究.第三军医大学学报,2001；23(9)：1065-1067.
[3]张晓光,胡品津,林金坤.功能性消化不良患者胃感觉运动功能的研究.中华消化杂志,2003；23(4)：227-229.
[4]唐红卫,刘莉,黄裕新.功能性消化不良胃电图与胃排空检测的同步研究.第四军医大学学报,2003；24(19)：1783-1786.
[5]Tuneberg L.Interstitial cells of Cajal:intestinal pacemaker cells Abv Embryol Cell Biol 1982; 71:1-130.
[6]周吕,王礼建,袁勃.胃动素对Cajal间质细胞引起的大鼠胃平滑肌收缩的作用.中华医学杂志,2003；83(6)：1422-1427.
[7]王伟,王景杰.胃肠道Cajal间质细胞的研究现状.中国中西医结合消化杂志,2007；15(6)：415-416.
[8]傅诚强.c-kit间质细胞控制肠动力的作用.国外医学.外科学分册,1997; 24(6)：323-325.
[9]李宇航,王庆国,杨美娟.半夏泻心汤及其拆方对胃电节律失常大鼠胃间ICC含量的影响.北京中医药大学学报,2004；27(1)：21-23.
[1]Dougas A, Diosm R. The functional gastrointestinal disorder and Rome Ⅲ process. Gastroenterology,2006; 130:1377-1390.
[2]张晓光,胡品津,岳殿超,等.功能性消化不良患者胃感觉运动功能的研究.中华消化杂志,2003；23(4)：227-229
[3]何美蓉,宋于刚,何春容.胃肠激素与功能性消化不良患者胃肠动力障碍的关系.解放军医学杂志,2003；28(10)：924-925
[4]张晓光,胡品津,王启仪,等.功能性消化不良患者心理因素和自主神经功能的研究.胃肠病学,2006；11(5)：295-297
[5]刘文忠.幽门螺杆菌感染与功能性消化不良.临床消化病杂志,2006；18(2)：72-74
[6]石灯汉,徐珊.NO与功能性消化不良的相关性研究.浙江中医药大学学报,2009；33(3)：443-445
[7]孙燕,侯晓华.心理应激与胃肠道动力紊乱的研究.中国实用内科杂志,2006;26(10)：725-726
[8]徐敏, 卜平,时乐,等.功能性消化不良222例证候病机分析.实用中 医药杂志,2006；22(4)：246-247
[9]谢建群,龚丽萍.功能性消化不良的中医辨证论治.上海中医药杂志,1998；32(6)：16-17
[10]于家军,李志民.李寿山治疗功能性消化不良经验.辽宁中医杂志,1998；25(6)：255-256
[11]姚明全.和胃通气汤治疗功能性消化不良腹胀.湖北中医杂志,1999；21(6)：268-269
[12]吴敏.理气活血汤治疗功能性消化不良.湖北中医杂志,2000；22(5)：286-287
[13]张声生,汪红兵,李乾构.功能性消化不良中医诊疗规范(草案)中国中西医结合消化杂志,2002；10(4)：194
[14]李乾构,周斌.功能性消化不良的辩证论治探析.中国中西医结合脾胃杂志,2005；13(2)：35
[15]刘松林,梅国强,赵映前,等.功能性消化不良的中医临床辨证规研究.中国医药学报,2004；19(8)：499-501
[16]范汉淮.辨证分型治疗功能性消化不良45例总结.四川中医,2006；24(3)：52-53
[17]管荣朝.疏肝和胃治疗功能性消化不良.四川中医,2005；23(12)：58
[18]臧军现,李克强.中医辨证治疗功能性消化不良219例.辽宁中医杂志,2003；30(1)：36-37
[19]冯璐,房莉萍,丛鹏.中药结合心力疏导治疗痞满证肝胃不和型60例.中国中医药信息杂志,2005；12(7)：9-11
[20]储浩然,马骏,孔红兵.针药并用治疗功能性消化不良的疗效观察.安徽中医学院学报,2004；23(3)：25-26
[2]龙庆林,王振华.内源性一氧化氮与胃电节律失常关系的实验研究.第三军医大学学报,2001；23(9)：1065-1067.
[3]张晓光,胡品津,林金坤.功能性消化不良患者胃感觉运动功能的研究.中华消化杂志,2003；23(4)：227-229.
[4]唐红卫,刘莉,黄裕新.功能性消化不良胃电图与胃排空检测的同步研究.第四军医大学学报,2003；24(19)：1783-1786.
[5]Tuneberg L.Interstitial cells of Cajal:intestinal pacemaker cells Abv Embryol Cell Biol 1982; 71:1-130.
[6]周吕,王礼建,袁勃.胃动素对Cajal间质细胞引起的大鼠胃平滑肌收缩的作用.中华医学杂志,2003；83(6)：1422-1427.
[7]王伟,王景杰.胃肠道Cajal间质细胞的研究现状.中国中西医结合消化杂志,2007；15(6)：415-416.
[8]傅诚强.c-kit间质细胞控制肠动力的作用.国外医学.外科学分册,1997; 24(6)：323-325.
[9]李宇航,王庆国,杨美娟.半夏泻心汤及其拆方对胃电节律失常大鼠胃间ICC含量的影响.北京中医药大学学报,2004；27(1)：21-23.
[1]Dougas A, Diosm R. The functional gastrointestinal disorder and Rome Ⅲ process. Gastroenterology,2006; 130:1377-1390.
[2]张晓光,胡品津,岳殿超,等.功能性消化不良患者胃感觉运动功能的研究.中华消化杂志,2003；23(4)：227-229
[3]何美蓉,宋于刚,何春容.胃肠激素与功能性消化不良患者胃肠动力障碍的关系.解放军医学杂志,2003；28(10)：924-925
[4]张晓光,胡品津,王启仪,等.功能性消化不良患者心理因素和自主神经功能的研究.胃肠病学,2006；11(5)：295-297
[5]刘文忠.幽门螺杆菌感染与功能性消化不良.临床消化病杂志,2006；18(2)：72-74
[6]石灯汉,徐珊.NO与功能性消化不良的相关性研究.浙江中医药大学学报,2009；33(3)：443-445
[7]孙燕,侯晓华.心理应激与胃肠道动力紊乱的研究.中国实用内科杂志,2006;26(10)：725-726
[8]徐敏, 卜平,时乐,等.功能性消化不良222例证候病机分析.实用中 医药杂志,2006；22(4)：246-247
[9]谢建群,龚丽萍.功能性消化不良的中医辨证论治.上海中医药杂志,1998；32(6)：16-17
[10]于家军,李志民.李寿山治疗功能性消化不良经验.辽宁中医杂志,1998；25(6)：255-256
[11]姚明全.和胃通气汤治疗功能性消化不良腹胀.湖北中医杂志,1999；21(6)：268-269
[12]吴敏.理气活血汤治疗功能性消化不良.湖北中医杂志,2000；22(5)：286-287
[13]张声生,汪红兵,李乾构.功能性消化不良中医诊疗规范(草案)中国中西医结合消化杂志,2002；10(4)：194
[14]李乾构,周斌.功能性消化不良的辩证论治探析.中国中西医结合脾胃杂志,2005；13(2)：35
[15]刘松林,梅国强,赵映前,等.功能性消化不良的中医临床辨证规研究.中国医药学报,2004；19(8)：499-501
[16]范汉淮.辨证分型治疗功能性消化不良45例总结.四川中医,2006；24(3)：52-53
[17]管荣朝.疏肝和胃治疗功能性消化不良.四川中医,2005；23(12)：58
[18]臧军现,李克强.中医辨证治疗功能性消化不良219例.辽宁中医杂志,2003；30(1)：36-37
[19]冯璐,房莉萍,丛鹏.中药结合心力疏导治疗痞满证肝胃不和型60例.中国中医药信息杂志,2005；12(7)：9-11
[20]储浩然,马骏,孔红兵.针药并用治疗功能性消化不良的疗效观察.安徽中医学院学报,2004；23(3)：25-26