Preliminary Study On The Correlation Between COX-1 And The Pattern Type Of TCM In Nonsteroidal Anti-inflammatory Drug Gastropathy

Background: Nonsteroidal anti—inflammatory drug(NSAIDs)have been usedwidely on various kinds of rheumatic disease and cardia-cerebrovasculardisease for more than one century, but nonsteroidal anti—inflammatory druggastropathy is gradually recognized and become hot spot of study in digestmedicine。Nonsteroidal anti—inflammatory drug gastropathy is an extremelyextensive concept. It includes peptic ulcer and its serious complications, suchas bleed, perforation, dis-gastric emptying etc. besides nausea, heartburn,dyspepsiain. Even more it can cause parts of sufferers dying.People have confirmed now, Cyclooxygenase(COX) is a key enzyme in theconversion arachidonic acid to Prostaglandin H₂. There are two enzymes ofCOX, COX-1 and COX-2. The COX-1 is a kind of original enzyme constitutivelyproduced in many cell types which is important in the gut for the productionof prostaglandins. The COX-2 is a kind of induced enzyme, which expressionis induced by all kind of cell factor and tumor enhancing factors, it play animportant role in the occurrence and development in tumor.The traditional NSAIDs is diminish inflammation by blocking up COX-2, butin the same time it inhibit the COX-1. The main function of COX-1 is to protectmucous membrane of stomach, for it will stimulate to the stomach when COX-1being inhibited. The current research suggests that the mechanism of thenonsteroidal anti—inflammatory drug gastropathy is the inhibiting ofcyclooxygenase, the direct toxicity to the mucous membrane of stomach of NSAIDs,LOX vivi-theory.The modern medical science prevent nonsteroidal anti—inflammatory drug gastropathy by the changes of dosage form and developping new ramificationas well as combining other drugs and using reasonable drugs, but it stillunsolved. Now the report of current research to nonsteroidal anti—inflammatory drug gastropathy on TCM is not much. We try to do this work.Objective:Studying nonsteroidal anti—inflammatory drug gastropathy Byclinical epidemiological investigation and determination of COX-1, Thepurpose is to approach the distribution rule of its TCM pattern of syndrome,to reveal the pathogenesis of it, to approach the correlation between andCOX-1, to provide some initial objective index for determining the treatmentbased on differentiation of symptoms and signs of TCM in clinic.Research method and result: undertake the clinical epidemiologicalinvestigation of patient who diagnosis nonsteroidal anti—inflammatory druggastropathy, accordingly collect four physical examinations in TCM; parts ofthe patients have the biopsy of the Gastric Mucosa under videoendoscope todetermine COX-â… and do the fast Pylori-test with urease methods, and thenundertake the statistical treatment.Based on the study of literature, the empirical study is divided into twoparts.The first part:Multiple cross-sectional study and result:1. Descriptive statistics:the major TCM symptoms of nonsteroidal anti—inflammatory drug gastropathy include stomachache and belching, and thefrequency of them is approximation. And the main symptoms and diseases referredhave no apparent tendency. Among the patients, who diagnosed erosive gastritisunder endoscope seem to show being stomachache, belching and pantothenicingacid. The clinical manifestation surport upper gastrointestinal bleeding seemto being hemafecia.2. Rules for clinical classification:Research by Cluster analysis inmultiple statistics, the association rules will be:â‘ weakness of the spleenand stomach amphi- splenogastric hygropyrexia:the main symptom includestomachache, belching and pantothenicing acid, and the margin of the tongue isindentation, the tongue music is coated yellow.â‘¡splenogastric hygropyrexia:the main symptom include stomachache, belching and pantothenicing, hemafecia, the tongue music is coated yellow,â‘¢weakness of the spleen and stomach amphi-the collaterals in the stomach stagnation of blood: the main symptom includestomachache, hemafecia, the margin of tongue is indentation and light dim.â‘£weakness of the spleen and stomach: the main symptom include stomachache,hemafecia, the margin of tongue is indentation and the music is white, the pulseis minute.⑤deficiency of spleen-QI and stomach-QI amphi- deficiency offluid in stomach:the main symptom include stomachache, dry stool, the marginof tongue is indentation and the tongue is red with crazing.â‘¥splenicasthenia and stagnation of QI: the main symptom include stomachache, belching,the margin of tongue is indentation and the music is white.3. in addition, the results show mono- classification of diseas eithtermay appear one element of symptom, or comprise several element of symptom. Butthe orthodox analysis of differentiation of symptoms and signs is shown inthe study.The second part:Observation by macroscopic index combine to microcosmic index, theresults below:(1) Empirical study on the correlation between COX-1 and the Pattern Typeof TCM in Nonsteroidal anti—inflammatory drug gastropathy, between the agecomposition of the experimental group and the control group, there is nosignificant correlation, but there is a significant correlation between theconstituent ratio of male and female.(2) By clinical epidemiology, the distribution of the Pattern Type ofTCM between the experimental group and the control group, there is nosignificant correlation (a=0.05), we think it may be the sample size isnot big enough, but it seem as the weakness of the spleen and stomach amphi-splenogastric hygropyrexia is the main pattern of syndrome on the experimentalgroup, and splenogastric hygropyrexia is the main pattern of syndrome on thecontrol group.(3) The positive rates of Hp between the experimental group and thecontrol group, there is no significant correlation, it indicates that theinfection of Hp has no correlation on the onste of nonsteroidal anti—inflammatory drug gastropathy.(4) The positive rates of COX-1 (+～++) between the experimental groupand the control group, there is significant correlation, this indicates that the positive expression of COX-1 (+～++) is inhibited by nonsteroidal anti—inflammatory drug.(5) The Binary Logistic between the distribution of the Pattern Type ofTCM and COX-1 on 28 cases of nonsteroidal anti—inflammatory drug gastropathy,the expression of COX-1 (+～++) and splenogastric hygropyrexia to submitpositive correlation, the expression of COX-1 (+～++) and weakness of thespleen and stomach to submit negative correlation.Conclusion:(1) The first part of our study confines to the sample size, the centraltendency of cluster is not obviously, it seems that the maxlmum ratio ofdistribution of Pattern Type of TCM of nonsteroidal anti—inflammatory druggastropathy is weakness of the spleen and stomach amphi-splenogastrichygropyrexia, others include splenogastric hygropyrexia, weakness of thespleen and stomach amphi-the collaterals in the stomach stagnation of blood,weakness of the spleen and stomach, deficiency of spleen-QI and stomach-QIamphi-deficiency of fluid in stomach. To do this, it initially testify a modelof determining the treatment based on differentiation of symptoms and signsof nonsteroidal anti—inflammatory drug gastropathy, but we should inlarge theSample Size for further research.(2) The second part of our study is on one hand the survey study aboutthe Pattern Type of TCM in nonsteroidal anti—inflammatory drug gastropathygroup(EG) and in erosive gastritis group(CG) by clinical epidemiologyresearch, there is no significant (p＞0.05) on the composition of the PatternType of TCM, we think it relate to the small sample size. But the tendency inEG is weakness of the spleen and stomach amphi-splenogastric hygropyrexia＞weakness of the spleen and stomach＞splenogastric hygropyrexia＞deficiencyof spleen-QI and stomach-QI amphi-deficiency of fluid in stomach, the tendencyin CG is splenogastric hygropyrexia＞weakness of the spleen and stomach amphi-splenogastric hygropyrexia, weakness of the spleen and stomach, deficiency ofspleen-QI and stomach-QI amphi-deficiency of fluid in stomach.On the other hand, statistically, the positive rates of COX-1(+～++)between the experimental group and the control group, there is significantcorrelation, she empirical study correlation, the positive rates of COX-1(+～++) in CG is much high than in EG, this indicates that the positive rate of COX-1 (+～++) is inhibited in nonsteroidal anti—inflammatory druggastropathy. For the first time, we draw a model of microcosmic syndromedifferentiation index of the Pattern Type of TCM in nonsteroidal anti—inflammatory drug gastropathy.Furthermore, The Binary Logistic between the distribution of the PatternType of TCM and COX-1 in nonsteroidal anti—inflammatory drug gastropathy,we find out the expression of COX-1 is stable correlation with some PatternType of TCM, so we establish an initial probability model of the Pattern Typeof TCM for nonsteroidal anti—inflammatory drug gastropathy.