基于TLR4/NF-κBp65通路探讨芩连愈疡汤辅助治疗消化性溃疡合并Hp感染效果

Effect of Qinlian Yuyang decoction on peptic ulcer complicated with Helicobacter pylori infection based on TLR4/NF-κB p65 pathway

    摘要
  • 摘要:
    目的 基于Toll样受体4(TLR4)/核因子κB-p65(NF-κB p65)通路探讨芩连愈疡汤辅助治疗消化性溃疡(PU)合并幽门螺杆菌(Hp)感染效果。
    方法 纳入2020年1月-2023年1月青岛市中医医院收治的127例PU合并Hp感染患者进行分析，依据治疗方案差异分组，试验组65例、对照组62例；对照组予以铋剂四联疗法治疗，试验组基于对照组联合芩连愈疡汤治疗；比较两组临床疗效、不良反应、Hp清除率及复发率；比较两组治疗前后的胃酸分泌功能胃酸分泌量(BAO)、最大胃酸分泌量(MAO)和高峰胃酸分泌量(PAO)、血清胃蛋白酶原和胃泌素水平胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素17(G-17)以及TLR4/NF-κB p65信号通路表达水平TLR4、NF-κB p65 mRNA。
    结果 试验组治疗后的总有效率为87.69%，较对照组的72.58%更高(χ2=4.584，P=0.032)；治疗后，两组的PGⅠ、PG Ⅱ以及G-17水平较治疗前均升高，而BAO、MAO及PAO水平较治疗前均降低，且试验组改善更优(P＜0.05)；治疗后的TLR4、NF-κB p65 mRNA水平比较，两组较治疗前均降低，且试验组显著更低(P＜0.05)；试验组治疗后的Hp清除率为87.69%，较对照组的72.58%更高(χ2=4.584，P=0.032)；而试验组Hp复发率为8.77%，较对照组的33.33%更低(χ2=9.624，P=0.002)；对照组不良反应总发生率为6.45%，试验组为3.08%，两组对比差异无统计学意义(χ2=0.228，P=0.633)。
    结论 芩连愈疡汤联合铋剂四联疗法治疗可有效改善PU合并Hp感染患者症状，调节胃酸分泌水平，降低Hp复发率，其可能与抑制TLR4/NF-κB p65通路表达有关。

     

    Abstract:
    OBJECTIVE To investigate the effect of Qinlian Yuyang decoction on peptic ulcer (PU) complicated with Helicobacter pylori (Hp) infection based on TLR4/NF-κB p65 pathway.
    METHODS A total of 127 patients with PU combined with Hp infection admitted to Qingdao Hospital of Traditional Chinese Medicine from Jan. 2020 to Jan. 2023 were selected and divided into 65 cases in the experimental group and 62 cases in the control group. The control group was treated with bismuth quadruple therapy, and the experimental group was with bismuth quadruple therapy combined with Qinlian Yuyang decoction. The clinical efficacy, adverse reactions, Hp clearance and recurrence rate were compared between the two groups. The gastric acid secretion function BAO, MAO and PAO, serum pepsinogen, gastrin levels pepsinogen Ⅰ (PG-Ⅰ), pepsinogen Ⅱ (PG-Ⅱ), gastrin 17 (G-17), TLR4 and NF-κB p65 mRNA levels were compared between pre- and post- treatment in the two groups.
    RESULTS The total effective rate of the experimental group was 87.69%, which was significantly higher than that of the control group (72.58%, χ2=4.584, P=0.032). After treatment, the levels of PG-Ⅰ, PG-Ⅱ and G-17 were all higher than those before treatment in the two groups, while the levels of BAO, MAO and PAO were lower. The efficacy in the experimental group was better than that in the control group (P < 0.05). After treatment, the mRNA levels of TLR4 and NF-κB p65 in the two groups were lower than those before treatment, and the levels in the experimental group were significantly lower than those in the control group (P < 0.05). The Hp clearance rate of the experimental group was 87.69%, which was higher than that of the control group (72.58%, χ2=4.584, P=0.032). The recurrence rate of Hp of the experimental group was 8.77%, which was lower than that of the control group (33.33%, χ2=9.624, P=0.002). The total incidence rate of adverse reactions was 6.45% in the control group and 3.08% in the experimental group, and no significant difference was found between the two groups (χ2=0.228, P=0.633).
    CONCLUSION Qinlian Yuyang Decoction combined with bismuth quadruple therapy can effectively improve the symptoms of PU patients with Hp infection, regulate the secretion of gastric acid, and reduce the recurrence of Hp infection, which may be the consequences of TLR4/NF-κB p65 pathway inhibition.

     

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