摘要
目的 观察脾胃培源丸联合艾灸治疗慢性萎缩性胃炎脾胃虚弱证患者的临床疗效及其机制。方法 收集2022年6月—2023年12月就诊于安徽中医药大学第二附属医院脾胃科的慢性萎缩性胃炎脾胃虚弱证患者,将符合纳排标准的96例患者采用随机数字表法分为对照组、中药组及联合组,每组32例(每组各脱落2例)。对照组患者给予瑞巴派特片联合叶酸片治疗(均3次/d),中药组患者予脾胃培源丸(8 g,3次/d),联合组在中药组基础上加艾灸(1次/d),连续12周。观察3组患者治疗前后胃黏膜萎缩情况;进行胃黏膜病理评分;患者报告结局(PRO)量表评价患者身心状态、生活质量;酶联免疫吸附测定法检测各组患者血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β、IL-4、IL-10、IL-37、转化生长因子(TGF)-β含量;实时荧光定量PCR法检测各组患者信号转导和转录激活因子3(STAT3)、哺乳动物雷帕霉素靶蛋白(mTOR) mRNA表达;蛋白质印迹法检测STAT3/mTOR信号通路相关蛋白表达,记录并比较药物不良反应与不良事件。结果 3组患者年龄、性别、病程、消化道肿瘤家族史、饮酒史、体质量指数差异无统计学意义。对照组、中药组与联合组治疗胃黏膜萎缩总有效率分别为66.67%(20/30)、86.67%(26/30)、90.00%(27/30)(P<0.05)。与治疗前比较,各组患者治疗后胃黏膜病理评分、PRO量表评分降低,TNF-α、IL-1β、IL-37、TGF-β含量降低,STAT3、mTOR mRNA相对表达量及STAT3、p-STAT3、mTOR、p-mTOR蛋白相对表达量均降低(P<0.05),IL-4、IL-10含量均升高(P<0.05)。治疗后,与对照组比较,中药组与联合组胃黏膜病理评分、PRO量表评分,TNF-α、IL-1β、IL-37、TGF-β含量,STAT3、mTOR mRNA相对表达量及STAT3、p-STAT3、mTOR、p-mTOR蛋白相对表达量均降低(P<0.05),IL-4、IL-10含量均升高(P<0.05)。治疗后,与中药组比较,联合组STAT3、mTOR mRNA及STAT3、p-STAT3、mTOR、p-mTOR蛋白相对表达量均降低(P<0.05)。结论 脾胃培源丸联合艾灸可能通过抑制STAT3/mTOR信号通路异常活化,调控机体炎症机制,上调相关抗炎因子水平,下调促炎因子表达,并增加相关修复因子的表达,促进萎缩胃黏膜恢复,减轻患者不适症状,改善慢性萎缩性胃炎脾胃虚弱证患者的身心状态。
Objective To determine the clinical efficacy and mechanism of Piwei Peiyuan Pill(PPP) combined with moxibustion for treating patients with chronic atrophic gastritis(CAG) with spleen and stomach weakness syndrome.Methods Ninety-six CAG patients with spleen and stomach weakness syndrome who met the inclusion and exclusion criteria were enrolled at the Department of Spleen and Stomach Diseases of the Second Affiliated Hospital of Anhui University of Chinese Medicine from June 2022 to December 2023.The patients were randomly divided into a control,a Chinese medicine,and a combined group using a random number table method,with 32 cases in each group(two cases per group were excluded).The control group was treated with rabeprazole combined with folic acid tablets(both thrice daily),the Chinese medicine group was treated with PPP(8 g,thrice daily),and the combined group was treated with moxa stick moxibustion(once daily) on the basis of the Chinese medicine group for 12 consecutive weeks.Gastric mucosa atrophy in the three groups was observed before and after treatment.The gastric mucosal pathological score was evaluated.The Patient Reported Outcome(PRO) scale was used to evaluate the patients′ physical and mental health status and quality of life.An enzyme-linked immunosorbent assay was used to detect serum tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-4,IL-10,IL-37,and transforming growth factor(TGF)-β levels in each group.Real-time fluorescence PCR was used to detect the relative expression levels of signal transducer and activator of transcription 3(STAT3) and mammalian target of rapamycin(mTOR) mRNA in each group.Western blotting was used to detect the relative expression levels of proteins related to the STAT3/mTOR signaling pathway,and the adverse drug reactions and events were recorded and compared.Results There was no statistical difference in age,gender,disease duration,family history of gastrointestinal tumors,alcohol consumption history,and body mass index among the three groups of patients.The total therapeutic efficacy rates of the control,Chinese medicine,and combined groups in treating gastric mucosal atrophy were 66.67%(20/30),86.67%(26/30),and 90.00%(27/30),respectively(P<0.05).Compared to before treatment,the pathological and PRO scale scores of gastric mucosa in each group decreased after treatment,and TNF-α,IL-1β,IL-37,and TGF-β levels decreased.The relative STAT3 and mTOR mRNA expression levels,as well as the relative STAT3,p-STAT3,mTOR,and p-mTOR protein expression levels decreased(P<0.05),whereas the IL-4 and IL-10 levels increased(P<0.05).After treatment,compared to the control group,the pathological score of gastric mucosa,PRO scale score,TNF-α,IL-1β,IL-37,TGF-β content,relative STAT3 and mTOR mRNA expression levels,and relative STAT3,p-STAT3,mTOR,and p-mTOR protein expression levels in the Chinese medicine and combined groups after treatment were reduced(P<0.05),whereas the IL-4 and IL-10 levels increased(P<0.05).After treatment,compared to the Chinese medicine group,the combined group showed a decrease in relative STAT3,mTOR mRNA expression levels,and STAT3,p-STAT3,mTOR,and p-mTOR protein expression levels(P<0.05).Conclusion The combination of PPP and moxibustion may regulate the inflammatory mechanism of the body by inhibiting the abnormal activation of the STAT3/mTOR signaling pathway,upregulating related anti-inflammatory factor levels,downregulating pro-inflammatory factor expression,and increasing related repair factor expression,thereby promoting the recovery of atrophic gastric mucosa,reducing discomfort symptoms,and improving the physical and mental state of CAG patients with spleen and stomach weakness syndrome.
作者
吴凯瑞
叶宇
裴蓓
宋标
张艺
李婷婷
杨琦
刘云
李学军
WU Kairui;YE Yu;PEI Bei;SONG Biao;ZHANG Yi;LI Tingting;YANG Qi;LIU Yun;LI Xuejun(Craduate School of Anhui University of Chinese Medicine,Hefei 230012,China;Department of Spleen and Stomach Diseases of The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061,China)
出处
《北京中医药大学学报》
北大核心
2025年第2期280-290,共11页
Journal of Beijing University of Traditional Chinese Medicine
基金
安徽省重点研究与开发项目(No.2022e07020023)
安徽省卫生健康科研项目(No.AHWJ2023BBa20018)
安徽省重大疑难疾病中西医协同攻关项目(No.0708-2021)。
关键词
脾胃培源丸
慢性萎缩性胃炎
信号转导和转录激活因子3/哺乳动物雷帕霉素靶蛋白信号通路
炎症机制
身心状态
Piwei Peiyuan Pill
chronic atrophic gastritis
signal transducer and activator of transcription 3/mammalian target of rapamycin signaling pathway
inflammatory mechanism
physical and mental state
