RESUMO
ObjectiveTo explore the clinical efficacy of Huanglian Jiedutang as an adjunctive treatment for acute cerebral infarction complicated with gastric motility disorder. MethodSixty patients with acute cerebral infarction complicated with gastric motility disorder with fire toxin syndrome were randomly divided into a western medicine control group （control group） and a traditional Chinese medicine （TCM） combined treatment group （observation group）， with 30 cases in each group. The control group received basic treatment for cerebral infarction and relevant western medical symptomatic treatment based on the patients' gastrointestinal symptoms. The observation group received Huanglian Jiedutang in addition to the treatment provided to the control group. The treatment course was 7 days. Neurological deficit scores and gastrointestinal dysfunction scores were assessed in both groups before treatment and on the 4th and 7th days of treatment. Gastrointestinal electrographic parameters， serum citrulline （CIT）， and motilin （MTL） levels were measured in both groups before treatment and on the 7th day of treatment. Clinical efficacy was compared between the two groups. ResultCompared with the baseline in both groups， the neurological deficit scores and gastrointestinal dysfunction scores were significantly reduced on the 4th and 7th days of treatment （P<0.05）. The reductions in these scores were more significant on the 7th day compared with those on the 4th day of treatment （P<0.05）. On the 4th and 7th days of treatment， the observation group showed a significantly greater reduction in neurological deficit scores and gastrointestinal dysfunction scores compared with the control group （P<0.05）. On the 7th day of treatment， compared with the baseline， both groups showed a significant increase in gastric antral and gastric body electric wave amplitudes as well as serum CIT and MTL levels （P<0.05）， and there were no statistically significant differences in the frequency of gastric antral and gastric body electric waves. On the 7th day of treatment， compared with the control group， the observation group had a significant increase in gastric antral and gastric body electric wave amplitudes as well as serum CIT and MTL levels （P<0.05）， and there were no statistically significant differences in the frequency of gastric antral and gastric body electric waves. After 7 days of treatment， the total effective rate in the observation group was 90.00% （27/30）， higher than 76.67% （23/30） in the control group， but the difference was not statistically significant. ConclusionAdjunctive treatment with Huanglian Jiedutang can effectively improve the symptoms of neurological function impairment and gastrointestinal dysfunction in patients with acute cerebral infarction complicated with gastric motility disorder， increase gastric antral and gastric body electric wave amplitudes， improve gastric motility disorder， and increase serum CIT and MTL levels， thereby improving the imbalanced secretion function of the gastrointestinal tract.
RESUMO
Objective To investigate the dynamic characteristic changes of gastrointestinal mucosa and its relationship with disease progression in rats with acute cerebral infarction. Methods Fifty-six male Wistar rats were selected as the study subjects, and they were divided into three groups: normal control, sham operation and cerebral infarction model groups by random number table method. The middle cerebral artery occlusion (MCAO) model was prepared by the modified Longa thread embolic method. The levels of gastrin (GAS) were monitored in each group after modeling for 24 hours, 4 days and 7 days; after the rats were killed, the sections of gastric antrum and small intestine were taken and stained with hematoxylin-eosin (HE) staining method, the histopathological changes of gastric and small intestinal mucosa were observed under light microscope, in the mean time the gastric and small intestinal mucosal pathological scores were also performed, and the differences of pathological scores among the three groups were compared. Results There were no statistical significant differences in GAS, gastrointestinal mucosa and small intestinal mucosal pathological scores between the normal control group and sham operation group at each time point (all P > 0.05); the GAS level in cerebral infarction model group was decreased gradually with time prolongation, reaching the lowest level 7 days after modeling, but the GAS level in cerebral infarction model group was significantly higher than that in normal group and shamoperation group (ng/L: 205.02±7.68 vs. 130.51±8.03, 145.29±7.68, both P < 0.05). The pathological scores of gastrointestinal mucosa and small intestinal mucosa in the cerebral infarction model group were increased first and then decreased with time prolongation, peaked on 4th day and decreased significantly on 7th day, the pathological scores of gastrointestinal mucosa and small intestinal mucosa in the cerebral infarction model group at each time point were significantly higher than those in the normal control group and sham-operated group (gastric mucosal pathological score: 82.50±2.95 vs. 21.38±1.57, 36.10±3.41; small intestinal mucosal pathological score: 62.00±2.78 vs. 18.25±1.39, 25.55±1.75, all P < 0.05). Under light microscopy, the normal control group showed complete normal morphological appearance, normal structure, orderly arrangement of villi and no infiltration of inflammatory cells; in shamoperation group, inflammatory cells infiltrated the lamina propria at each time point, and there were villi slightly uneven, enlarged stroma, congestion, edema occasionally seen and no obvious ulcer; in cerebral infarction model group, the various layers of gastrointestinal mucosal were not very clear, the glands were arranged irregularly and the capillaries dilated, and in part of tissues, congestion, hemorrhage, edema and inflammatory cell infiltration were seen obviously. Conclusion The injury of gastrointestinal mucosa in acute stage of cerebral infarction should be related to the stress stimulation and disease progress of cerebral infarction itself, not due to the abnormal secretion of GAS.
RESUMO
Objective To observe the effect of Tongqiao Huoxue decoction on the changes of motilin (MTL) and vasoactive intestinal peptide (VIP) and its protective effect on gastric mucosa in rats with cerebral infarction at acute stage.Methods According to random number table, 96 Wistar rats were divided into six groups: normal control, sham operation, cerebral infarction model, cimetidine, Tongqiao Huoxue decoction routine dose and low dose groups, eachn = 16. Cerebral infarction model group was established by using a suture to ligate the middle cerebral artery, resulting in its occlusion. The rats of cerebral infarction model group and sham operation group were lavaged with 2 mL of normal saline. Tongqiao Huoxue decoction routine dose group was lavaged with 2 mL of Tongqiao Huoxue decoction (1.3 g/mL), while Tongqiao Huoxue decoction low dose group was lavaged with 1 mL of Tongqiao Huoxue decoction (1.3 g/mL) plus 1 mL of normal saline. Cimetidine group was lavaged with cimetidine (0.1 g/kg), and nothing was done for the normal control group. On the 4th and 7th day after the delivery of treatment, inferior vena venous blood samples were collected to detect the plasma MTL and VIP concentrations. Then the gastric tissues were obtained and examined under an electron microscope.Results There were no statistically significant differences between the normal control group and sham operation group in plasma levels of MTL and VIP (bothP > 0.05). The plasma levels of MTL and VIP at 4 days and 7 days after the delivery of treatment in cerebral infarction model group were higher than those in the normal control group and sham operation group [4 days MTL (ng/L): 189.51±13.48 vs. 117.01±11.38, 117.67±12.73, VIP (ng/L): 94.86±4.14 vs. 60.98±5.42, 62.55±6.60, bothP < 0.05; 7 days: MTL (ng/L): 183.05±14.49 vs. 119.79±10.64, 120.27±11.48, VIP (ng/L): 91.92±3.77 vs. 59.63±4.29, 58.10±4.99, bothP < 0.05]. Plasma levels of MTL and VIP in cimetidine group, Tongqiao Huoxue decoction routine dose group and low dose group were significantly lower than those in cerebral infarction model group. Compared with Tongqiao Huoxue decoction low dose group and cimetidine group, the degrees of descent in plasma levels of MTL and VIP were apparently lower on the 7th day in Tongqiao Huoxue decoction routine dose group [MTL (ng/L): 138.72±8.02 vs. 152.16±12.66, 156.60±11.87, bothP < 0.05; VIP (ng/L):68.18±3.41 vs. 81.12±3.98, 78.89±2.13, bothP < 0.05]. The results of electron microscope: compared with normal control group and sham operation group, obvious pathological changes in gastric mucosa in model group were found. In Tongqiao Huoxue decoction routine group, Tongqiao Huoxue decoction low dose group and cimetidine group, the gastric mucosal lesions were milder, and the curative effects of Tongqiao Huoxue decoction routine group were much better.Conclusions During the acute stage of cerebral infarction, significant damage is seen in gastric mucosa in rats. Tongqiao Huoxue decoction not only can effectively regulate the expression levels of MTL and VIP, but also has certain protective effect on gastric mucosa, and its efficacy being directly proportional to the dosage.