本文選題：榮胃理氣方 + 守宮��； 參考：《湖北中醫(yī)藥大學》2017年博士論文

【摘要】：研究目的:通過建立慢性萎縮性胃炎(chronic atrophic gastritis,CAG)大鼠模型,從形態(tài)學(HE染色,CD34染色切片)、抗氧化損傷(SOD、MDA)、細胞增殖與凋亡(P53,PCNA)、信號通路(Wnt通路)多方面進行研究,觀察榮胃理氣方聯(lián)合守宮對CAG模型大鼠胃粘膜的修復作用和機制。研究方法:選用72只健康純種SPF級SD雄性大鼠,將其飼養(yǎng)在SPF環(huán)境中。適應性喂養(yǎng)1周后,給予去氧膽酸鈉溶液自由飲用聯(lián)合酒精灌服及饑飽失常喂養(yǎng)法刺激大鼠誘發(fā)CAG模型。將造模成功的大鼠進行隨機分組,分別為空白對照組(K)、模型組(M)、中藥治療組(Z)、胃復春組(W)、葉酸組(Y),每組10只。造模成功后于第三天開始灌胃給藥,藥物干預28天后進行采血以及取材。應用HE染色法觀察各組大鼠胃粘膜的病理變化,應用CD34免疫組化染色法檢測大鼠胃粘膜的微血管數(shù)量及微血管密度;使用ELISA法檢測大鼠血清中胃泌素(GAS)、超氧化物歧化酶(S OD)/丙二醛(MDA),血清生長抑素(SS)/血清前列腺素E2(PGE2)的含量;應用免疫組織化學法檢測各組大鼠胃粘膜中P53以及PCNA的基因表達水平;同時應用免疫組化法檢測大鼠胃粘膜中β-catenin、GSK-3β、cyclin D1以及COX-2蛋白的表達水平。結果:1.對CAG模型大鼠組織形態(tài)的影響通過HE染色,結果顯示,模型組大鼠的胃粘膜出現(xiàn)了充血、水腫以及腺管排列紊亂等表現(xiàn),并且黏液層脫落增多,胃小凹可見變淺,而粘膜固有層變薄并且出現(xiàn)了萎縮,腺體腔變小以及數(shù)目減少,伴有囊性擴張,粘膜下層水腫明顯,炎性細胞散在分布,固有層內出現(xiàn)淋巴細胞浸潤等病變。中藥治療組中的各大鼠胃粘膜罕見糜爛和缺損,并未出現(xiàn)胃潰瘍病灶,且粘膜層的厚度大致都是正常的,腺體排列也是基本整齊的,數(shù)量并未見明顯減少,亦無腸上皮化生以及不典型增生等病變。胃復春組的大鼠胃粘膜有少許的糜爛和缺損,偶可見有潰瘍病灶,粘膜層稍有增厚,腺體排列略顯紊亂,數(shù)量減少大致約二分之一左右,偶可見腸上皮化生以及不典型增生等改變。葉酸片組中的大鼠胃炥膜少見糜爛、缺損,偶有潰瘍的病灶,粘膜變厚,腺體排列略顯紊亂,數(shù)量減少大致有1/2左右,偶有腸上皮化生等形態(tài)變化。通過CD34染色,然后檢測大鼠胃粘膜微血管數(shù)量(MVC)以及微血管密度(MVD),結果顯示,與空白對照組比較,模型組大鼠MVD值明顯降低(P0.01);與模型組比較,中藥治療組數(shù)值明顯升高(P0.01);免疫組化染色顯示空白組胃黏膜有不同程度的充血反應,模型組可見胃黏膜上皮及固有腺體細胞增生,黏膜固有層和黏膜下層間質有血管數(shù)量減少。經中藥方治療后胃黏膜微血管密度增多,接近正常,中藥治療組與胃復春組及葉酸組比較亦有統(tǒng)計學意義(P0.05)。2.對慢性萎縮性胃炎大鼠血清GAS、SS、PGE2、SOD、MDA的影響與空白對照組比較,模型組大鼠胃泌素(GAS)水平明顯降低(P0.01);與模型組比較,中藥治療組血清胃泌素(GAS)水平均明顯升高(P0.01);與胃復春組比較,中藥治療組血清胃泌素(GAS)水平升高具有統(tǒng)計學意義(P0.05);中藥治療組與葉酸組比較,血清胃泌素(GAS)水平無統(tǒng)計學差異(P0.05)。與空白對照組比較,模型組大鼠血清生長抑素(SS)和前列腺素(PGE2)水平顯著降低(P0.01);與模型組比較,中藥治療組大鼠血清生長抑素(SS)和前列腺素(PGE2)水平顯著升高P0.01),與葉酸組、胃復春組比較,血清生長抑素(SS)和前列腺素(PGE2)變化上無統(tǒng)計學差異(P0.05)。與空白對照組比較,模型組大鼠血清超氧化物歧化酶(SOD)活力降低,丙二醛(MDA)數(shù)值升高(P0.05);與模型組比較,中藥治療組SOD活力明顯升高,MDA水平明顯降低(P0.01),與胃復春組、葉酸組比較,中藥治療組在SOD、MDA變化上無統(tǒng)計學差異。3.對慢性萎縮性胃炎大鼠胃黏膜P53、PCNA基因表達的影響與空白對照組相比,模型組大鼠胃黏膜組織P53水平明顯高于正常組(P0.01),胃黏膜組織病變明顯。不同治療組的P53指數(shù)明顯降低,胃黏膜病理組織學改變明顯。中藥治療組與模型組比較差異顯著(P0.01);中藥治療組與胃復春組比較差異顯著(P0.01),中藥治療組與葉酸組比較無明顯差異(P0.05)。與空白對照組相比,模型組大鼠胃黏膜組織PCNA水平明顯高于正常組(P0.01),胃黏膜組織病變明顯。不同治療組的PCNA指數(shù)明顯降低,胃黏膜病理組織學改變明顯。中藥治療組與模型組比較差異顯著(P0.01);中藥治療組與胃復春組、葉酸組比較差異顯著(P0.01)。4.對慢性萎縮性胃炎大鼠胃黏膜Wnt信號通路的影響與空白組相比,模型組GSK-3β的表達顯著降低,差異有統(tǒng)計學意義(P0.01)。中藥治療組、葉酸組、胃復春組GSK-3β的表達均升高,中藥治療組GSK-3β蛋白的表達情況要明顯優(yōu)于胃復春組和葉酸組(P0.01)。與空白組相比,模型組β-catenin的表達顯著升高,差異有顯著統(tǒng)計學意義(P0.01)。中藥治療組、葉酸組、胃復春組GSK-3β的表達均降低,中藥治療組β-catenin蛋白的表達情況要明顯優(yōu)于胃復春組和葉酸組(P0.05)。與空白對照組相比較,模型組cyclin D1的表達增強,差異有顯著統(tǒng)計學意義(P0.01)。中藥治療組、葉酸組、胃復春組GSK-3β的表達均降低,與模型對照組相比差異有顯著統(tǒng)計學意義(P0.05)。中藥治療組療效明顯優(yōu)于胃復春組和葉酸組(P0.01)。與空白對照組相比較,模型組COX-2的表達增強,差異有顯著統(tǒng)計學意義(P0.01)。中藥治療組、葉酸組、胃復春組GSK-3β的表達均明顯降低,與模型對照組相比差異有顯著統(tǒng)計學意義(P0.01)。中藥治療組療效明顯優(yōu)于胃復春組和葉酸組(P0.01)。結論:榮胃理氣方聯(lián)合守宮可以明顯改善胃黏膜萎縮狀態(tài),增加胃黏膜區(qū)新生血管數(shù)目,對胃黏膜具有促血管新生作用,其效果優(yōu)于胃復春和葉酸。榮胃理氣方聯(lián)合守宮可增加胃泌素,生長抑素及前列腺素E2的水平,降低丙二醛含量,抑制炎癥反應,修復受損的胃黏膜,并能增加SOD活力。其對胃黏膜的修復作用可能與增加胃泌素、生長抑素、前列腺素E2水平、提升SOD活力,降低MDA含量有關。榮胃理氣方聯(lián)合守宮抑制胃黏膜P53、PCNA基因的過度表達,從而防止慢性萎縮性胃炎向胃癌轉化,說明榮胃理氣方聯(lián)合守宮具有一定的優(yōu)勢,且其對胃黏膜修復作用可能與抑制P53、PCNA基因的過度表達有關。榮胃理氣方聯(lián)合守宮能明顯提高胃黏膜GSK-3β、cyclin D1以及COX-2的表達,降低胃黏膜β-catenin的表達,其對胃黏膜修復的作用機制可能在于提高胃黏膜中相關生長因子,激活Wnt通路進而逆轉胃黏膜萎縮,達到修復胃黏膜的作用。榮胃理氣方聯(lián)合守宮具有較好的胃黏膜修復作用,效果優(yōu)于胃復春和葉酸。其能有效地抑制胃黏膜的氧化應激反應,提高胃黏膜的修復能力,發(fā)揮中醫(yī)藥整體調節(jié)、多靶點的作用特點,為榮胃理氣方聯(lián)合守宮臨床治療慢性萎縮性胃炎提供了部分實驗依據(jù)。
[Abstract]:Objective: to establish a rat model of chronic atrophic gastritis (chronic atrophic gastritis, CAG), from morphologic (HE staining, CD34 stained section), antioxidant injury (SOD, MDA), cell proliferation and apoptosis (P53, PCNA), and signal pathway (Wnt pathway), observe the repair of gastric mucosa in rat model of Rong Wei Qi Fang and Gong Gong on the rat model of CAG model. The study method: 72 healthy pure SPF grade SD male rats were selected to be fed in the SPF environment. After 1 weeks of adaptive feeding, the rats were given free drinking of sodium deoxycholate combined with alcohol irrigation and hunger satiety feeding to induce CAG model in rats. The rats were randomly divided into blank pairs. Group (K), model group (M), Chinese medicine treatment group (Z), gastric Fuchun group (W), folic acid group (Y), 10 in each group. After the success of the model, the medicine was administered at third days. After 28 days of drug intervention, the blood collection and material were collected. The pathological changes of gastric mucosa in each group were observed by HE staining. The microvessels of gastric mucosa of rats were detected by CD34 immunohistochemical staining. Quantity and microvascular density; the content of serum gastrin (GAS), superoxide dismutase (S OD) / malondialdehyde (MDA), serum somatostatin (SS) / serum prostaglandin E2 (PGE2) in rats were detected by ELISA, and the gene expression level of P53 and PCNA in gastric mucosa of each group was detected by immunohistochemical method; and immunohistochemical method was used to detect the gene expression in the gastric mucosa of rats. The expression level of beta -catenin, GSK-3 beta, cyclin D1 and COX-2 protein in the gastric mucosa of rats was measured. Results: the effects of 1. on the tissue morphology of CAG model rats were stained by HE. The results showed that the gastric mucosa of the rat model group showed hyperemia, edema, and the disorder of the gland tube arrangement, and the mucous layer exfoliated and the gastric fovea became shallow and sticky. The lamina propria of the membrane became thinner and atrophied, the cavity of the gland became smaller and the number was reduced, with the cystic dilatation, the edema of the submucosa, the distribution of the inflammatory cells, the infiltration of lymphocytes in the lamina propria. The gastric mucosa of the rats in the Chinese medicine treatment group was rare and the gastric ulcer was rare and there was no gastric ulcer focus and the thickness of the mucosa. The glandular arrangement was basically normal, the glandular arrangement was also basic and neatly. There was no obvious decrease in quantity, no intestinal metaplasia and atypical hyperplasia. The gastric mucosa of the rats of the Fuchun group of the stomach had a little erosion and defect, occasionally the ulcer focus, the thickening of the mucous layer, the glandular arrangement slightly disorder, and the decrease of approximately 1/2. The changes in intestinal metaplasia and atypical hyperplasia were seen occasionally. In the Folic Acid Tablets group, the rat gastric membrane was rarely erosive, defective, occasionally ulcerated, thickened and slightly disordered in the glandular arrangement. The number decreased roughly 1/2, occasionally in intestinal metaplasia and other morphologic changes. The number of microvascular microvessels in the gastric mucosa of rats was detected by CD34 and then the microvascular number of gastric mucosa in rats was detected. The volume (MVC) and microvascular density (MVD) showed that, compared with the blank control group, the MVD value of the model group was significantly lower (P0.01). Compared with the model group, the value of the Chinese medicine treatment group was significantly higher (P0.01). The immunohistochemical staining showed that the gastric mucosa of the blank group had different degree of congestion reaction, and the model group could see the gastric mucosa epithelium and the intrinsic gland cells. The number of blood vessels in the mucous lamina propria and submucosa decreased. The microvascular density of the gastric mucosa increased after the Chinese medicine treatment, which was close to normal. The effect of.2. on GAS, SS, PGE2, SOD and MDA in the serum of rats with chronic atrophic gastritis was compared with that of the blank control group. The level of gastrin (GAS) in the model group was significantly lower (P0.01). Compared with the model group, the level of serum gastrin (GAS) in the Chinese medicine treatment group increased significantly (P0.01). Compared with the stomach Fuchun group, the serum gastrin (GAS) level in the Chinese medicine treatment group was statistically significant (P0.05), and the serum gastrin (GAS) level in the Chinese medicine treatment group was compared with the folic acid group, and the level of serum gastrin (GAS) was no more than that of the Chinese traditional medicine group. Statistical difference (P0.05). Compared with the blank control group, the level of serum somatostatin (SS) and prostaglandin (PGE2) in the model group was significantly lower (P0.01). Compared with the model group, the serum somatostatin (SS) and the prostaglandin (PGE2) level in the Chinese medicine treatment group increased significantly, and the serum somatostatin (SS) and the serum somatostatin (SS) and the folic acid group and the gastric Fuchun group were compared with that of the model group. There was no statistical difference in the changes of prostaglandin (PGE2) (P0.05). Compared with the blank control group, the activity of serum superoxide dismutase (SOD) decreased and the malondialdehyde (MDA) value increased (P0.05) in the model group. Compared with the model group, the SOD activity in the Chinese medicine treatment group was significantly increased, the MDA level was significantly reduced (P0.01), compared with the gastric Fuchun group, folic acid group, and the treatment of traditional Chinese medicine. There was no statistical difference in the changes of SOD and MDA in the treatment group. The effect of.3. on the P53, PCNA gene expression in the gastric mucosa of the rats with chronic atrophic gastritis was significantly higher than that in the blank control group. The level of P53 in the gastric mucosa of the model group was significantly higher than that of the normal group (P0.01), and the pathological changes in the gastric mucosa were obvious. The P53 index in the different treatment groups was significantly reduced and the gastric mucosa was histopathologically histopathological. There was significant difference between the traditional Chinese medicine treatment group and the model group (P0.01), and there was significant difference between the Chinese medicine treatment group and the stomach Fuchun group (P0.01). There was no significant difference between the Chinese medicine treatment group and the folic acid group (P0.05). Compared with the blank control group, the level of PCNA in the gastric mucosa of the model group was significantly higher than that of the normal group (P0.01), and the pathological changes of the gastric mucosa were obvious. The PCNA index of the different treatment groups was obviously decreased and the pathological changes of gastric mucosa were obvious. The difference of the Chinese traditional medicine treatment group and the model group was significant (P0.01); the difference of the folic acid group between the Chinese medicine treatment group and the stomach Fuchun group was significant (P0.01) the effect of.4. on the Wnt signaling pathway in the gastric mucosa of the rats with chronic atrophic gastritis was compared with the blank group, and the model group was GSK-3 beta The expression of GSK-3 beta in the Chinese medicine treatment group, the folic acid group and the stomach Fuchun group increased significantly. The expression of GSK-3 beta protein in the Chinese medicine treatment group was significantly better than that of the gastric Fuchun group and the folic acid group (P0.01). Compared with the blank group, the expression of beta -catenin in the model group was significantly higher than that in the blank group, and the difference was significant statistically significant (P0.01). P0.01). The expression of GSK-3 beta in the Chinese medicine treatment group, the folic acid group and the Wei Fuchun group decreased. The expression of beta -catenin protein in the Chinese medicine treatment group was obviously better than that of the Wei Fuchun group and the folic acid group (P0.05). Compared with the blank control group, the expression of cyclin D1 in the model group was enhanced, the difference was statistically significant (P0.01). Chinese medicine treatment group, folic acid group, gastric Fuchun group were significantly different. The expression of GSK-3 beta in the group was significantly lower than that in the model control group (P0.05). The curative effect of the Chinese medicine treatment group was obviously better than that of the Wei Fuchun group and the folic acid group (P0.01). Compared with the blank control group, the expression of COX-2 in the model group was enhanced, the difference was statistically significant (P0.01). The Chinese medicine treatment group, the folic acid group, the stomach Fuchun group GSK-3 beta group. The expression of the treatment group was significantly lower than that of the model control group (P0.01). The curative effect of the Chinese medicine treatment group was obviously superior to that of the Wei Fuchun group and the folic acid group (P0.01). Conclusion: the combination of the rhono Stomach Qi Fang and the palace of conservation can obviously improve the atrophy of gastric mucosa, increase the number of new blood vessels in the gastric mucosa, and promote the neovascularization of the gastric mucosa. Its effect is superior to gastric Fuchun and folic acid. It can increase the level of gastrin, somatostatin and prostaglandin E2, reduce the content of malondialdehyde, inhibit the inflammatory reaction, repair the damaged gastric mucosa, and increase the activity of SOD. Its effect on gastric mucosa may be associated with increased gastrin, somatostatin, and prostaglandin E2 levels. To improve the activity of SOD and reduce the content of MDA. Rong Wei Qi Qi Fang combined with the palace to inhibit the overexpression of P53 and PCNA genes in the gastric mucosa, thus preventing the transformation of chronic atrophic gastritis to gastric cancer, indicating that the Junwei Qi Fang combined with the conservative palace has some advantages, and its application to the gastric mucosa repair may be related to the inhibition of the overexpression of the P53 and PCNA genes. The expression of GSK-3 beta, cyclin D1 and COX-2 in gastric mucosa and the expression of gastric mucosa beta -catenin can be significantly increased by the combination of stomach qi and Qi Fang, and the mechanism of the effect on gastric mucosa repair may be to improve the growth factors in the gastric mucosa, activate Wnt pathway and reverse the gastric mucosal atrophy, and to repair the gastric mucosa. The palace has a better effect of gastric mucosal repair, the effect is better than the gastric Fuchun and folic acid. It can effectively inhibit the oxidative stress reaction of the gastric mucosa, improve the ability to repair the gastric mucosa, play the role of the overall regulation of traditional Chinese medicine and multi target, and provide some experiments for the clinical treatment of chronic atrophic gastritis by the Junwei Qi Qi Fang and the palace. Basis.

【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R285.5;R-332

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