| 1. BACKGROUND AND AIMSDiabetes is one of the high-incidence diseases. With the development of the diabetic disease, gastrointestinal lesions often occur. The rate of gastro-intestinal motility disorder in diabetes have been reported to25%-76%. Di-abetic gastroparesis (DGP) can cause vomiting, abdominal distension, anepi-thymia and other gastrointestinal symptoms, all of which can cause the int-erference of antidiabetic drug’s application, and hypoglycemia,ketoacidosis and other dangerous situation often happen. So many scholars has payed great attention to the treatment of DGP. However, western medicine treatment of D GP has many side effects. Looking for a treatment of DGP from TCM has impo-rtant significance and broad prospects. Tong Xiaolin has been studying the treatment of diabetes and its complications for more than30years, forming a "Treatment of glycemia, collaterals, and complications" system and often has good therapeutic effect. It has clinical significance to look for his effective prescription for DGP. So far, scintigraphy has been the "Gold st-andard" for the gastric emptying. However, clinical and animal experiments rarely use it for the high price and complex method. And animal experiments often use small intestinal propulsion rate as gastrointestinal motility ev-aluation index; Braingut potido has played an important role in the pathog-enesis of gastrointestinal lesions of diabetes. The injury of smooth muscle cells also is an important cause of the gastrointestinal lesion. So, after the summary of my tutor’s treatment, of DGP,an objectively and authoritative observation of Tangweian Fang’s effect of the gastrointestinal motility th-rough an application of scintigraphy in the animal experiments and the exp-loration of diabetic gastrointestinal lesions’mechanism by the combination study of initiating agent(blood glucose), controlling factor (braingut pet i-do) and mi crochanged (injury of smooth musele cells) has important signify-canc. Therefore during my postgraduate; study, I have done some study work on DGP as follows1. Reviewed the related literatures on DGP’s diagnosis, curative effect ev-aluation, treatment, mechanism, and traditional Chinese medicine etiology and pathogenesis on DGP and got a general understanding on DGP. 2.Taking tutor’ s outpatients medical records as data rescource, analysed Tutor’ s treatment efficacy and effective prescriptions of DGP.3.Taking Tangweianfang as the study object, investigated its effect on di-abetic rats’ gastrointestinal motility and its possible mechanism.2. METHODS1.Taking tutor’ s outpatients medical records from January2006to October2012as data rescource, the patients meeting the inclusion criteria were e-nrolled. Symptom scores were recorded according to the case records and te-lephone interviews supplemented. The main symptoms scores and blood glucose levels of patients’ s each visit were anylysed. At the same time, the presc-riptions professor Tong commonly used for DGP were analyed.2. Purchased120male Wistar rats, selected20rats randomly as the control group. The other rats were injected by1%STZ via abdomen. Three days after the1injection, if the PPG greater than or equal to In’.9mmol/L, the diabetic rat model was established. The diabetic rats were then divided into four g-ruups according to the FPG and body weight: model group(distilled water is perfused once a day), high dose group (high dose drug is perfused once a day), middle dose group (middle dose drug is perfused once a day), low dose group (low close drug is perfused once a day). Weight was recorded every week and PPG was recorded every4weeks. After8weeks, gastric emptying test and g-astric propulsion rate experiment were performed to evaluate the gastroint-estinal motility of rats, mitochondria! morphology changes in gastric antr-al smooth muscle cell were examined by TEM; GSP content was tested by colo-rimeiric method, contents of serum somatotatin (SS), vasoact ive intestinal, pepiide (VIP) and substance P (SP) were measured by radio immunity.3. RESULTS1.Symptoms especially vomiting were improved.significantly. At the same time, blond sugar level also showed a tendency to improve. Through anaylysing the priscription Professor Tong commoly used, we found that Sulianyin, Xiaoban-xia decoction were the main prescriptions used for vomiting symptom, Zhi/hu pill, Xiaobanxia decoction wort; the main prescriptions used for abdominal distension syndrome, and Sulianyin, Zhizhu pill were the main prescriptions used fo anorexia syndrome.2. The experimental results from animal studies found:8weeks after the di-abetic model established, the diabetic rats performed the accelerated gast-ric emptying and the slowed gastrointestinal propulsion rate, GSP, VIP,and SP increased(P<0.05),and SS showed increasing trend (P>0.05). The gastric e-mptying between treatment groups and model group had no significant differ-ence (P>0.05); Treatment groups improved GSP and gastrointestinal rate (P<0.05), H-igh dose group could reduce the serum SS, VIP (P<0.05); High, middle dose could reduce the serum SP (P<0.05); Effect on serum SP of low dose gr-oup was not obvious (P>0.05); Electron microscope observation of normal mi-tochondrial showed that matrix density, crest clear and complete; model gr-oup mitochondrial swelling, vacuolar change, the aristae reduced and disap-peared; high and medium dose group showed increased number of mitochondria, cristae reduced and disappeared, some vaeuoles change; low dose group als showed increased number of mitochondria, increased and aggregation, crista-e reduced, disappeared, most mitochondria showed vaeuoles change4. CONCLUSIONS1. Professor Tong payed much attention to the treatment of nausea and vomit-ing symptom, and the curative effect was remarkable. The symptom of abdomi-nal distension and loss of appetite was improved relatively slowly. The overall effect of treatment on DGP may need1or3months. Zhizhu pill, Xiao banxia decoction, Dahuanghuanglianxiexin decoction were the main prescripti-ons used for abdominal distension syndrome, which is the main composition of Tangweian prescription.2. Eight weeks after the diabetic model established, the diabetic rats per-formed the accelerated gastric emptying and the slowed gastrointestinal pr-opulsion, which may be a transition period of diabetic gastrointestinal le-sions. Tangweian-prescription can reduce the blood sugar, promote intestin-al peristalsis, but have no obvious effect on the gastric emptying function. Decreasing the levels of scrum VIP and SP, protecting smooth muscle cell may be one of its mechanisms. |
