疏肝健脾活血法对胃溃疡患者胃黏膜表皮生长因子及受体表达的影响

1、疏肝健脾活血法对胃溃疡患者胃黏膜表皮生长因子及受体表达的影响         11-02-25 13:44:00     作者：古学文,廖永州    编辑：studa20【摘要】  【目的】观察疏肝健脾活血法对胃溃疡(GU)患者胃液表皮生长因子（EGF）及胃黏膜表皮生长因子受体（EGFR）表达的影响。【方法】将60例经胃镜检查确诊的GU患者,随机分为疏肝健脾活血法中药治疗组（简称中药组）和西药对照组（简称西药组）各30例，另设

2、15例为正常对照组（简称对照组）。主要观察临床疗效及治疗前后胃液EGF、胃黏膜EGFR的变化情况。【结果】（1）在疗效方面，中药组治愈25例，显效3例，无效2例，总有效率为9333%；西药组治愈23例，显效4例，无效3例，总有效率为9000%；2组比较差异无显著性意义（P>005），表明中药组疗效与西药组相仿。（2）中药组和西药组均能显著提高胃液EGF及胃黏膜EGFR的表达,中药组与西药组比较差异有显著性意义(P<005)。【结论】提高胃液EGF及胃黏膜EGFR的表达,可能是疏肝健脾活血法治疗胃溃疡疗效显著、复发率低的机制之一。 【关键词】  胃溃疡/中药疗法 四逆散/治

3、疗应用 四君子汤/治疗应用 丹参饮/治疗应用Abstract: ObjectiveTo investigate the effect of therapy of soothing liver, strengthening spleen and activating blood on expression of epidermal growth factor (EGF) and its receptor (EGFR) in patients with gastric ulcer (GU). MethodsSixty GU patients confirmed by gastroscope exa

4、mination were equally randomized into two groups: the herbal treatment group was given herbal medicine with the actions of soothing liver, strengthening spleen and activating blood, and the western medical treatment group was given routine western medicine. Fifteen healthy volunteers served as the n

5、ormal control group. After treatment, the therapeutic effectwasevaluated, andthe changes of EGF in the gastric juice as well as EGFR in the gastric mucosa were observed before and after treatment. ResultsAfter treatment, 25 patients were cured, 3 markedly effective, 2 ineffective and the total effec

6、tive rate was 9333% in the herbal treatment group; 23 patients were cured, 4 markedly effective, 3 ineffective and the total effective rate was 9000% in the western medical treatment group. The total therapeutic effect in the herbal treatment group was similar to that in the western medical treatmen

7、t group (P>005). EGF expression in the gastric juice and EGFR expression level in the gastric mucosa were increased in the two treatment groups after treatment (P<005 or P<001 compared with those before treatment), and the improvement in the herbal treatment group was superior to that in th

8、e western medical treatment group (P<005). ConclusionIncrease of EGF expression in the gastric juice and EGFR expression level in the gastric mucosa is probably contributed to the mechanism of therapy of soothing liver, strengthening spleen and activating blood for the treatment of gastric ulcer

9、with low recurrence rate.Key words:GASTRIC ULCER/TCD therapy;SINI POWDER/therapeutic use;SIJUNZI DECOCTION/therapeutic use;DANSHEN DECOCTION/therapeutic use疏肝健脾活血法是治疗胃溃疡的常用方法,临床疗效显著,具有治愈率高、复发率低、毒副作用少的特点,但其作用机制仍未完全明了。本研究通过观察疏肝健脾活血法中药对胃溃疡(GU)患者胃液表皮生长因子(epidermal growth factor,EGF)及胃黏膜表皮生长因子受体(epiderma

10、l growth factor receptor,EGFR)表达的影响,旨在探讨其防治胃溃疡的作用机制。现将结果报道如下。1资料与方法1.1一般资料参照中药新药临床研究指导原则(2002版)中胃溃疡西医诊断及分期标准,选择经胃镜检查证实的1865岁的活动期(A1期)胃溃疡患者60例,排除药物性、应激性或其他慢性病所致的胃溃疡以及并发出血、穿孔及癌变的病例,按照随机、对照的原则,将入选病例分为疏肝健脾活血法中药治疗组(简称中药组)30例和西药对照组（简称西药组）30例,同时选择经我院预防保健科体检合格且排除有胃溃疡病史的1865岁健康人15例作为正常对照组（简称对照组）。1.2治疗方法中药组以四

11、逆散、四君子汤合丹参饮加减组方：柴胡10 g,白芍20 g,枳壳15 g,党参20 g,白术15 g,茯苓15 g,甘草6 g,丹参20 g,砂仁(后下)6 g。每天1剂,水煎分2次服。西药组给予奥美拉唑胶囊20 mg,每天1次口服。幽门杆菌(HP)阳性者先使用奥美拉唑20 mg克拉霉素500 mg阿莫西林1 000 mg,每天2次,连用7 d,以行抗HP治疗。2组均4周为1个疗程,连续治疗3个疗程。正常对照组不给予药物治疗。1.3观察项目1.3.12组临床疗效参照中药新药临床研究指导原则(2002版)中胃溃疡的疗效评定标准。1.3.2EGF和EGFR检测中药组和西药组治疗前后行胃镜检查并取材

12、检测EGF及EGFR,正常对照组也于同期检测上述指标。1.3.2.1标本采集胃液收集：胃镜检查前禁食12 h,禁用消泡剂,经内镜活检孔以聚乙烯塑料管抽吸胃液约34 mL,置入试管中,立即煮沸510 min,-20冰箱低温保存待测。胃黏膜采集：在溃疡边缘采集胃黏膜组织34块,标本迅速浸入40 g/L多聚甲醛(以01 mol/L PBS配制,pH为74)中固定16 h,脱水,常规石蜡包埋,制备5 m厚连续切片。1.3.2.2检测方法采用放射免疫法检测胃液EGF。125IEGF放射免疫分析试剂盒购自中国原子能科学研究院。按试剂盒说明操作。采用免疫组化法检测胃黏膜EGFR。链酶亲和素生物素过氧化物酶复合物(SABC)试剂盒、EGFR免疫组化试剂盒均为武汉博士德生物工程公司产品。按试剂盒说明操作，并在光学显微镜下观察显色反应,阳性细胞胞质着色均呈棕黄色,应用计算机图像分析仪定量测