【作者】 丁婷婷；

【导师】 董筠；

【作者基本信息】 南京中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：研究COX-2、PCNA、claudin-1在反流性食管炎大鼠模型食管粘膜的表达,及降逆护膜汤对COX-2、PCNA、claudin-1表达的影响；观察降逆护膜汤联合奥美拉唑治疗反流性食管炎的临床疗效及远期复发率。方法：采用“不全幽门结扎+贲门肌切开术”制备反流性食管炎大鼠模型,将80只大鼠分为正常组、模型组、假手术组、阳性对照组(奥美拉唑)、中药小剂量组、中剂量组、大剂量组、中西医结合组(降逆护膜汤+奥美拉畔)。给予相应处理后,取食管组织行HE染色,光镜下观察组织病理学变化,用免疫组化的方法检测COX-2、PCNA、claudin-1的表达。选择60例符合反流性食管炎诊断的患者,随机分为治疗组及对照组。治疗组予降逆护膜汤联合奥美拉唑治疗,对照组予奥美拉唑治疗,8周及疗程结束后6个月进行随访。观察两组治疗后症状改善情况及复发情况。结果：实验室研究结果显示：降逆护膜汤能显著改变反流性食管炎大鼠模型食管粘膜的病理变化,降逆护膜汤小剂量组、中剂量组、大剂量组、阳性对照组、中西医结合组的食管组织病理变化明显减轻；降逆护膜汤能显著抑制PCNA及claudin-1的表达；COX-2未见明显表达。临床观察结果显示：患者治疗前后症状改善RDQ积分变化,治疗组与对照组比较,治疗8周疗效相当,但治疗组6个月复发率远远低于对照组,组间有统计学差异(P<0.05)；治疗8周及疗程结束后6个月随访,治疗组的中医症候疗效结果明显高于对照组(P<0.05)；疗程结束后6个月随访,治疗组复发率明显低于对照组(P<0.05)。结论：降逆护膜汤联合奥美拉唑可以改善反流性食管炎患者的临床症状,降低复发率,提高患者生活质量；降逆护膜汤具有修复食管破损粘膜,抑制细胞过度增殖,控制食管上皮增生和细胞间隙增宽,防止本病进一步发展,对预防Barrett食管、食管腺癌的发生具有积极的意义。更多还原

【Abstract】 Objective:To study COX-2and PCNA in and claudin-1expression in esophageal mucosa of reflux esophagitis rat model and Jiangni retaining membrane soup of COX-2, PCNA and claudin-1expression; observed Jiangni care The clinical efficacy and recurrence rate of membrane soup plus omeprazole therapy for reflux esophagitis.Methods:Incomplete pyloric ligation cardia muscle incision,"Preparation of reflux esophagitis rat model,80rats were divided into normal group, model group and sham group, the positive control group (omeprazole), traditional Chinese medicinesmall dose group, middle dose group, high dose group, integrative medicine group (Jiangni, retaining membrane soup+omeprazole). To give appropriate treatment, the Organization for Esophageal HE staining histopathological changes observed under light microscope to detect COX-2, PCNA and claudin-1expression using immunohistochemical methods.60cases in line with the diagnosis of reflux esophagitis patients were randomly divided into treatment and control groups. The treatment group to Jiangni retaining membrane soup plus omeprazole treatment, control group I omeprazole treatment, six months after the end of8weeks treatment follow-up. Improvement of symptoms and recurrence after treatment were observed.Results:The laboratory findings showed:Jiangni retaining membrane soup can significantly change the pathological changes of the esophageal mucosa of reflux esophagitis rat model, soup, small-dose group of Jiangni retaining membrane, the middle dose group, the high-dose group, the positive control group Integrative Medicine group of esophageal pathological changes significantly reduced; Jiangni retaining membrane soup significantly inhibited the expression of PCNA and of claudin-1; The COX-2was no obvious expression..The clinical observation:symptoms improved RDQ points change before and after treatment, the treatment group compared with the control group,8weeks of treatment efficacy, but six months of the treatment group relapse rate is much lower than the control group, statistical differences between the groups (P<0.05); Chinese medicine symptom efficacy outcomes of treatment for eight weeks and the end of June follow-up, treatment group was significantly higher (P<0.05);observed after8weeks of treatment; the six month follow-up after the end of treatment, the treatment group relapse rate was significantly lower than the control group (P<0.05).Conclusion:Conclusion:Jiangni cuticle soup plus omeprazole may improve the clinical symptoms of reflux esophagitis in patients with lower relapse rates, and improve patients’ quality of life; Jiangni retaining membrane soup has to repair the esophagus damaged mucosa, inhibition of cell over-proliferation, control esophageal epithelial proliferation and cell gap widened, to prevent the further development of the disease, the prevention of Barrett’s esophagus, esophageal adenocarcinoma has a positive meaning.更多还原