基于Wnt/β-catenin通路探讨针药联合治疗湿热型溃疡性结肠炎不典型增生的临床观察

Clinical observation of acupuncture combined with medicine inhibition of atypical dysplasia of ulcerative colitis based on Wnt/β-catenin pathway

目的:观察针药联合治疗湿热型溃疡性结肠炎不典型增生临床疗效及安全性,并探讨其分子机制。方法:将2016年7月至2018年7月于重庆市中医院肛肠科就诊的141例湿热型溃疡性结肠炎患者随机分为M1组、M2组及M3组,各47例。M1组采用针刺联合愈溃宁方灌肠,M2组以愈溃宁方灌肠,M3组予美沙拉嗪灌肠剂灌肠。比较3组患者治疗前后中医证候积分、结肠黏膜不典型增生例数、β-catenin、GSK-3β表达水平、临床疗效及不良反应。结果:M2组、M3组治疗前后中医证候积分差值与M1组比较具有显著差异(P<0.05);治疗后,M1组患者溃疡性结肠炎不典型增生减少例数高于M3组(P<0.05);M1组患者结肠黏膜GSK-3β水平显著高于M2组及M3组(P<0.05),β-catenin水平显著低于M2组及M3组(P<0.05)。3组患者临床治疗有效率及不良反应发生无显著差异。结论:针药联合可显著抑制湿热型溃疡性结肠炎不典型增生,不良反应较轻,这与其抑制Wnt/β-catenin通路异常激活有关。

Objective:To observe the clinical efficacy and safety of acupuncture combined with inhibition of dampheat type ulcerative colitis atypical hyperplasia,and to explore its molecular mechanism.Methods:A total of 141 patients with damp-heat ulcerative colitis who were admitted to the Department of proctology of Chongqing Traditional Chinese Medicine Hospital from July 2016 to July 2018 were randomly divided into M1 group,M2 group and M3 group,47 cases in each group.M1 group were treated with acupuncture combined with Yukuining Formula enema.M2 group were treated with Yukuining Formula enema.M3 group were treated with mesalazine enema.The TCM syndrome scores,colonic mucosal dysplasia,β-catenin,GSK-3βexpression,clinical efficacy and adverse reactions were compared before and after treatment.Results:The difference of TCM syndrome scores before and after treatment in M2 group and M3 group was significantly different from that in M1 group(P<0.05).After treatment,the number of cases of ulcerative colitis atypical hyperplasia in M1 group was higher than that in M3 group(P<0.05);the level of GSK-3βin colonic mucosa of M1 group was significantly higher than that of M2 group and M3 group(P<0.05),and the level ofβ-catenin was lower than that of M2 group and M3 group(P<0.05).There was no significant difference in the clinical treatment efficiency and adverse reactions between the three groups.Conclusion:The combination of acupuncture and medicine can significantly inhibit the atypical hyperplasia of damp-heat type ulcerative colitis,and the adverse reactions are mild,which is related to abnormal activation of the Wnt/β-catenin pathway.