ESD联合和胃愈疡方对早期胃癌大鼠的治疗效果及安全性评价

Therapeutic Effect and Safety Evaluation of ESD Combined with Hewei Yuyang Formula on Early Gastric Cancer Rats

目的:分析内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)联合和胃愈疡方对早期胃癌大鼠的治疗效果及安全性评价。方法:采用N-甲基-N’-硝基-N-亚硝基胍(N-methyl-N’-Nitro-N-Nitrosoguanidine,MNNG)与乙醇混合液诱导大鼠胃癌模型的建立。根据处理方法不同,将40只造模成功大鼠随机分成模型组、外科组、内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)组及联合治疗组(ESD+和胃愈疡方),每组10只。另选取10只大鼠作为对照组。比较外科组与ESD组术中出血量;干预过程中对大鼠体重、行为学进行观察;干预12周后,对各组炎症因子、癌胚抗原(carcinoembryonic antigen,CEA)、表皮生长因子(epidermal growth factor,EGF)、前列腺素E_(2)(prostaglandin E_(2),PGE_(2))、CD4和CD8的表达水平,胃组织溃疡指数、溃疡抑制率及再生黏膜厚度进行检测与比较。结果:与外科组相比,ESD组术中出血量明显降低,差异有统计学意义(P<0.05)。干预12周后,与对照组相比,模型组大鼠体重、CD4、EGF、PGE_(2)、CD4/CD8及再生黏膜厚度明显降低,TNF-α、IL-8、CEA、CD8及溃疡指数均明显上升(P<0.05);与模型组相比,外科组、ESD组、联合治疗组大鼠体重、CD4的表达量、CD4/CD8、EGF、PGE_(2)、溃疡抑制率及再生黏膜厚度均明显升高,TNF-α、IL-8、CEA、CD8及溃疡指数均明显降低(P<0.05);与ESD组相比,联合治疗组大鼠体重、CD4、CD4/CD8、EGF、PGE_(2)、溃疡抑制率及再生黏膜厚度明显升高,TNF-α、IL-8、CEA、CD8及溃疡指数明显降低(P<0.05)。结论:ESD联合和胃愈疡方对早期胃癌大鼠具有较好的治疗效果,安全性较好。

Objective:To analyze therapeutic effect and safety evaluation of endoscopic submucosal dissection(ESD)combined with Hewei Yuyang Formula on early gastric cancer rats.Method:The gastric cancer model was established by using the mixture of N-methyl-N’-nitro-N-nitrosoguanidine(MNNG)and ethanol.According to different treatment methods,40 successfully modeled rats were randomly divided into model group,surgical group,endoscopic submucosal dissection(ESD)group and combined treatment group(ESD+Hewei Yuyang Formula),with 10 rats in each group.Another 10 rats were selected as the control group.The amount of intraoperative blood loss was compared between the surgical group and the ESD group.The weight and behavior of rats were observed during the intervention.After 12 weeks of intervention,the expression levels of inflammatory factors,carcinoembryonic antigen(CEA),epidermal growth factor(EGF),prostaglandin E_(2)(PGE_(2)),CD4 and CD8,gastric ulcer index,ulcer inhibition rate and thickness of regenerated mucosa in each group were detected and compared.Result:Compared with the surgical group,the amount of intraoperative blood loss in ESD group was significantly decreased,the difference was statistically significant(P<0.05).After 12 weeks of intervention,compared with the control group,body weight,CD4,EGF,PGE_(2),CD4/CD8 and regenerated mucosal thickness of model group were significantly decreased,while TNF-α,IL-8,CEA,CD8 and ulcer index were significantly increased(P<0.05).Compared with model group,body weight,CD4 expression level,CD4/CD8,EGF,PGE_(2),ulcer inhibition rate and regenerated mucosa thickness were significantly increased in surgery group,ESD group and combined treatment group,while TNF-α,IL-8,CEA,CD8 and ulcer index were significantly decreased(P<0.05).Compared with ESD group,body weight,CD4,CD4/CD8,EGF,PGE_(2),ulcer inhibition rate and regenerated mucosa thickness were significantly increased in combined treatment group,while TNF-α,IL-8,CEA,CD8 and ulcer index were significantly decreased(P<0.05).Conclusion:ESD combined with Hewei Yuyang Formula has good therapeutic effect and safety on rats with early gastric cancer.