【摘要】：目的:前期研究運用健脾清化散瘀飲治療隆起糜爛性胃炎(raised erosive gastritis,R EG)取得較好的臨床療效,本課題擬采用免疫組化檢測技術(shù),通過體內(nèi)實驗探究健脾清化散瘀飲對REG患者細(xì)胞周期蛋白D1(CyclinD1)、細(xì)胞周期蛋白依賴性激酶4(CDK4)及P21蛋白表達(dá)的影響,以期明確健脾清化散瘀飲治療REG的藥理機制,豐富REG的臨床研究。方法:納入福建中醫(yī)藥大學(xué)附屬第二人民醫(yī)院門診及病房被確診為REG并符合納入/排除標(biāo)準(zhǔn)的患者36例,予自擬方"健脾清化散瘀飲"加減治療3個月,其中2例資料不完全、2例失訪脫落,最終納入REG患者32例。對比治療前后REG患者臨床表現(xiàn)、胃鏡下隆起形態(tài)、病理組織學(xué)改變及CyclinD1、CDK4、P21表達(dá)情況,另選取我院體檢中心體檢健康者20例作空白對照組。結(jié)果:1.中醫(yī)證候療效:通過癥狀量化統(tǒng)計中醫(yī)證候療效指數(shù),(1)符合方案集:其中痊愈13例(40.62%),顯效8例(25%),有效8例(25%);總有效率90.62%。(2)全分析集:治愈13例(38.24%),顯效8例(23.53%),有效8例(23.53%),總有效率85.29%。2.胃鏡療效:(1)符合方案集:治愈16例(50%),顯效4例(12.5%),有效5例(15.62%),總有效率78.12%。(2)全分析集:治愈16例(47.06%),顯效4例(11.76%),有效5例(14.71%),總有效率73.53%。3.病理療效:(1)符合方案集:治愈11例(34.37%),顯效7例(21.85%),有效9例(28.18%),總有效率81.25%。(2)全分析集:治愈11例(32.35%),顯效7例(20.59%),有效9例(26.47%),總有效率79.41%。4.CyclinD1表達(dá)情況:(1)正常對照組 CyclinD1 IHS 值為 0.1515±0.02390,REG 組治療前 CyclinD1 IHS值為1.2713±0.08055,REG組明顯高于對照組(P0.05);(2)REG 組治療后 CyclinD1 IHS 值為 0.5653±0.21831,較治療前 CyclinD1 IHS 值明顯下降(P0.05);(3)REG組治療后CyclinD1 IHS值高于對照組(P0.05)。5.CDK4表達(dá)情況:(1)正常對照組 CDK4IHS 值為 0.1580±0.03037,REG 組治療前 CDK4 IHS 值為 1.2525±0.10280,REG組明顯高于對照組(P0.05);(2)REG組治療后CDK4 IHS值為0.5747±0.213,較治療前CDK4 IHS值顯著降低(P0.05);(3)REG組治療后CDK4 IHS值高于對照組(P0.05)。6.P21表達(dá)情況:(1)正常對照組P21 IHS值為0.1585±0.02581,REG組治療前P21 IHS值為1.2713±0.09540,REG組明顯高于對照組(P0.05);(2)REG組治療后P21 IHS值為0.5625±0.23113,較治療前P21 IHS值顯著降低(P0.05);(3)REG組治療后P21 IHS值高于對照組(P0.05)。7.不良反應(yīng):入組的REG患者治療過程未見不良事件發(fā)生。結(jié)論:1.健脾清化散瘀飲治療REG安全且臨床療效顯著。2.CyclinD1、CDK4、P21在REG患者胃粘膜呈高表達(dá),經(jīng)健脾清化散瘀飲治療后CyclinD1、CDK4、P21的表達(dá)均顯著下調(diào)。3.健脾清化散瘀飲可能是通過下調(diào)CyclinD1、CDK4、P21的表達(dá)來治療REG。
[Abstract]:Objective: to obtain a better clinical effect of Jianpi Qinghua Sanyu Yin in treating protruding erosive gastritis (raised erosive gastritis,R EG). To investigate the effects of Jianpi Qinghua Sanyu decoction on the expression of cyclin D1 (CyclinD1), cyclin dependent kinase 4 (CDK4) and P21 protein in patients with REG, in order to clarify the pharmacological mechanism of Jianpi Qinghua Sanyu Yin in the treatment of REG, and to enrich the clinical study of REG. Methods: Thirty-six patients who were diagnosed as REG in outpatient and ward of the second people's Hospital affiliated to Fujian University of traditional Chinese Medicine were treated with "Jianpi Qinghua Sanyu Yin" for 3 months. Among them, 2 cases were incomplete and 2 cases lost their visit, and 32 cases were included in REG. The clinical manifestations, histopathological changes and CyclinD1,CDK4,P21 expression of REG patients before and after treatment were compared, and 20 healthy subjects from physical examination center of our hospital were selected as blank control group. The result is 1: 1. The curative effect of TCM syndromes: (1) according to the program set, 13 cases were cured (40.62%), 8 cases were effective (25%), 8 cases were effective (25%), and the total effective rate was 90.622.The total effective rate was 90.62%. (2) the total effective rate was 90.62 2%. (2) the total effective rate was 90.62% (38.24%), 8 cases (23.53%), 8 cases (23.53%), 85.29.2%. The total effective rate was 78.12%. (2) the total effective rate was 78.12% (47.06%), 4 cases (11.76%) were cured, 5 cases (14.71%) were effective, and the total effective rate was 73.53%. Pathological efficacy: (1) according to the protocol set, 11 cases (34.37%) were cured, 7 cases (21.85%) were cured, 9 cases (28.18%) were effective, and the total effective rate was 81.25%. (2) Total analysis set: 11 cases (32.35%) were cured, 7 cases (20.59%) were effective, 9 cases (26.47%) were effective. The expression of total effective 79.41%.4.CyclinD1: (1) CyclinD1 IHS value of normal control group. The CyclinD1 IHS value before treatment in the 0.1515 鹵0.02390 REG group was 1.2713 鹵0.08055, significantly higher than that in the control group (P0.05); (2). The CyclinD1 IHS value in the REG group was 0.5653 鹵0.21831 after treatment, which was significantly lower than that in the REG group before treatment (P0.05); (3) and the CyclinD1 IHS value in the REG group was higher than that in the control group (P0.05). 5. CDK4 expression: (1) the normal control group had higher CyclinD1 IHS value than the control group (P0.05). 5. CDK4 expression in the REG group was significantly higher than that in the control group (P0.05). The CDK4IHS value was 0.1580 鹵0.03037 CDK4 IHS before treatment in the CDK4 IHS group (1.2525 鹵0.10280) and 0.5747 鹵0.213 in the REG group (P0.05); (2), which was significantly lower than that before treatment (P0.05); (3) CDK4 IHS value in REG group was significantly higher than that in control group (P0.05) .6.P21 expression: (1) P21 expression in normal control group was significantly lower than that before treatment (P0.05); (3) in REG group: (1) P21 expression in normal control group was significantly lower than that in control group (P0.05). 6. P21 expression in REG group was significantly lower than that in control group (P0.05). The P21 IHS of the IHS group before treatment was 1.2713 鹵0.09540 IHS significantly higher than that of the control group (P0.05); (2), the P21 IHS value of the REG group was 0.5625 鹵0.23113, which was significantly lower than that of the pre-treatment P21 IHS group (P0.05); (3) and the P21 IHS value of the REG group was higher than that of the control group (P0.05. 7). Adverse reactions: there were no adverse events in REG patients. Conclusion 1. Jianpi Qinghua Sanyu Yin was safe in the treatment of REG. 2. Cyclin D1 + CDK4P21 was highly expressed in gastric mucosa of REG patients, and the expression of CyclinD1,CDK4,P21 was significantly down-regulated by Jianpi Qinghua Sanyu Yin. Jianpi Qinghua Sanyu Yin may treat REG. by down-regulating the expression of CyclinD1,CDK4,P21
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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