健脾清化散瘀饮对脾虚湿热血瘀型隆起糜烂性胃炎患者NLRC4/caspase-1/IL-1β信号通路的影响
Effect of Jianpi Qinghua Sanyu Drink on REG with Spleen Deficiency, Dampness, Heat and Blood Stasis Syndrome by Inhibiting NLRC4/caspase-1/IL-1β Signal Pathway

目的：观察健脾清化散瘀饮对隆起糜烂性胃炎(raised erosive gastritis, REG)患者NLRC4/caspase-1/ IL-1β信号通路的活化情况，探讨健脾清化散瘀饮治疗REG的可能作用机制。方法：REG组选取我院门诊/病区确诊为REG并符合纳入、排除标准的患者36例，予以“健脾清化散瘀饮”治疗3个月。36例REG患者中，1例临床资料不完整，1例失访脱落，均予剔除，最终共34例进入统计分析。正常对照组选取健康志愿者20人。观察REG组治疗前后临床症状、胃镜下表现、病理组织学变化情况以及观察正常对照组、REG组治疗前后NLRC4、caspase-1、IL-1β的表达情况。结果：1) 中医证候疗效：根据症状积分评定，健脾清化散瘀饮治疗后治愈14例(41.17%)，显效10例(29.41%)，有效8例(23.52%)，总有效率为94.10%。2) 胃镜疗效：根据镜下观察标准，胃镜治愈15例(44.12%)，显效4例(11.76%)，有效7例(20.59%)，总有效率为79.41%。3) 病理疗效：根据病理分析结果标准，病理治愈8例(23.52%)，显效7例(20.59%)，有效9例(26.47%)，总有效率为70.59%。4) NLRC4表达情况：REG组患者(治疗前) NLRC4较正常对照组显著升高(P < 0.01)；REG组患者(治疗后) NLRC4较治疗前显著下降(P < 0.01)，但高于正常对照组(P < 0.01)。5) caspase-1表达情况：REG组患者(治疗前) caspase-1较正常对照组显著升高(P < 0.01)；REG组患者(治疗后) caspase-1较治疗前明显降低(P < 0.01)，但高于正常对照组(P < 0.01)。6) IL-1β表达情况：REG组患者(治疗前) IL-1β较正常对照组显著升高(P < 0.01)；REG组患者(治疗后) IL-1β较治疗前明显降低(P < 0.01)，但高于正常对照组(P < 0.01)。结论：1) 健脾清化散瘀饮对REG患者在临床症状、体征，镜下和病理组织学病变的改善方面具有明显疗效。2) REG患者胃黏膜组织中的NLRC4、caspase-1、IL-1β较正常对照组胃黏膜组织呈明显升高趋势，提示NLRC4/caspase-1/IL-1β信号通路异常激活可能是REG重要的发病机制。3) 健脾清化散瘀饮治疗REG的疗效机制可能是通过抑制NLRC4/caspase-1/IL-1β信号通路的活化而起效。
Objective: To observe the effect of Jianpi Qinghua Sanyu Drink on NLRC4/caspase-1/IL-1β signal pathway in patients with raised erosive gastritis (REG) and explore the possible mechanism of Jianpi Qinghua Sanyu Drink in the treatment of REG. Method: The research selected 36 REG patients treated with Jianpi Qinghua Sanyu Drink for 3 months. The patients met with the inclusion and exclusion criteria who were from the department of gastroenterology clinics/wards in our hospital. Among 36 cases, the clinically relevant information of one case was incomplete and one case was lost, so there are 34 cases sent into the final statistical analysis. We observed and compared the changes of the symptom, endoscopic morphology, pathologic histology and the expression of NLRC4, caspase-1 and IL-1β in the REG patients before and after treatment. The level of NLRC4, caspase-1 and IL-1β was tested by immunohistochemistry. And chose 20 people qualified by health examination to test NLRC4/caspase-1/IL-1β level for comparison. Results: 1) The effect of TCM syndromes: it was determined by the symptom score before and after therapy. The cure rate was 41.17% while the markedly effective rate was 29.41%. The effective rate was 23.52% and the total effective rate was 94.10%. 2) The effect of endoscopic morphology: the cure rate was 44.12%, while the markedly effective rate was 11.76%. The effective rate was 20.59% and the total effective rate was 79.41%. 3) The pathological efficacy: the cure rate was