Investigation Of The Effect Of Qi Huang Decoction On Gastrointestinal Motility Based On The Mechanism Of Neuroendocrine And Gastrointestinal Hormone

1 ObjectiveConservative treatment plays a significant role in treatment for gastrointestinal motility disorder after abdominal surgery,while traditional Chinese medicine is rarely applied after the surgery.The clinical purpose of this study is to study the effect of gastrointestinal hormones on gastrointestinal function as well as the focus of animal experiments is to explore the molecular mechanism of neuroendocrine after gastric cancer surgery through the application of Qihuang decoction.2 Methods2.1 The observation of clinical2.1.1 The method of case grouping:83 patients conforming to the diagnosis of gastric cancer were selected.finally 39cases of the control group and 44 cases of Qihuang decoction group were allocated in the end which is according to the random number table method combined with envelope method within 1:1 parallel random and unqualified cases were eliminated in the middle.2.1.2 Treatment:(1)the control group:The procedure of(operation using bi?type or Roux en-Y type)was performed after perfect preoperative preparation of admission and exclusion of surgical contraindications enteral nutrition support was applied after postoperative day 1 with twice a day until 7 days besides conventional treatment.(2)Qihuang decoction group:treatment of 150 ml huang decoction was dripped basis of the enteral nutrition after 15 min.2.1.3 The methods of observation indicators and their detection:(1)Observation of gastrointestinal evacuation(bowel sound recovery time,anal exhaust and defecation and feeding time):dedicated auscultation method;(2)Gastrointestinal angiography:panying glucamine angiography;Classification of complications and acute gastrointestinal functional injury(AGI)(the method of grouping recording).research the secretion of gastrointestinal hormones(promoting hormones:GAS,MOT,CCK and inhibiting hormones:GIP,VIP,SS):the methodbalanced saturation analysis and radioimmunoassay.2.1.4 The methods of Statistical:SPSS21.0(SPSSInc,Chicago,IL,USA)was used for data analysis.The normal data of the measurement data were expressed as?x±s and the non-normal distribution was expressed as M(range).In dependent sample t test or rank sum test(mann-whitney U test)were used for the data of two independent samples;The data of multi-group matching were analyzed by repeated measurements if not the test of the rank sum(Friedman test),LSD was used for the pairwise comparison test after the event;the counting data were expressed as cases or percentages,and?~2 or Fisher exact probability test was used for comparison.P<0.05 was considered statistically significant.2.2 The experiment of animals2.2.1 The method of Modeling and Grouping:The enteral nutrition catheterization was used to establish the jejunal nutrition channel of silicone tube which technique previously was studied by us.they were divided into 4 groups which are sham operation group,standard enteral nutrition group,immune enteral nutrition group and Qihuang decoction group within 20 in each group by the method of random number table.2.2.2 The intervention methods of each group:Incision and suture were performed in the sham operation group as well as gastric resection was not allowed with free drinking water.Fresubin?Supportan(huarui pharmaceutical co.,LTD.)120k J/kg.d and Qihuang decoction 5g/(kg.d)+Fresubin120k J/kg.d were used respectively in the group of standard enteral nutrition?immune enteral nutrition and Qihuang decoction for 7 d.2.2.3 The methods of observation indicators and their detection:The 10cm upper small intestine from the pylorus was removed and cutted into2.0cm×2.0cm segments which was frozen by liquid nitrogen.The m RNA expression levels of ACh E,SP,VIP,NOS,M3R,VIP2R and NK1R were detected by RT-PCR and the post-transcriptional protein translation was detected by Western blot.Statistical software SPSS21.0(SPSS Inc,Chicago,IL,USA)was used for data analysis.Measurement data were expressed as?x±s.One-way analysis of variance(AVOVA)test was used when the data conforming to normal distribution,otherwise Kruskal-wall test was used.If the variance is homogeneous,LSD method is adopted for the pantwise comparison;otherwise,Dunnett,s method and bilateral test are adopted,P<0.05 was considered statistically significant.3 Results3.1 The results of clinical observation3.1.1 comparison of postoperative gastrointestinal empties of the Qihuang decoction group and the control group in terms of time,pan-shadow glucamine imaging,gastrointestinal complications,and AGI classification:Postoperative gastrointestinal empties in the Qihuang decoction group were as follows:the time of bowel sounds recovered,anal exhaust and defecation,food intake resumed as well as phantasmography of meglumine:time to ascending colon,transverse colon and descending colon were significantly shortened(P=0.002?P=0.006?P=0.005?P=0.001?P=0.003?P=0.023?P=0.038).the cases of Abdominal pain and abdominal distension as well as AGI??level IV decreased obviously(P=0.037?P=0.041).3.1.2 postoperative changes of gastrointestinal hormones between the Qihuang decoction group and the control group.Compared within the group,the decrease was the lowest 3 days after operation in the two groups,and the SS in the Qihuang decoction group increased 14 days after the operation compared with that before the operation(P<0.001).The MOT and GAS decrease and the GIP increase were not significant(P=0.325?P=0.243?P=0.104).comparison among groups which indicated that GAS increased significantly and VIP and SS decreased significantly in the Qihuang decoction group 3,7 and 14days after operation compared with the control group(P=0.012?P=0.020?P=0.001and P=0.006?P=0.025?P<0.001;P=0.015?P<0.001?P<0.001).MOT increased significantly and GIP decreased significantly at 7 and 14 days after surgery(P<0.001,P<0.001 and P<0.001,P=0.005),while CCK increased significantly at 14days after surgery(P<0.001).3.2 The results of Animal experiment3.2.1 m RNA expressions of Ach,SP,VIP,n NOS,M3R,VIP2R and NK1R were detected by RT-PCR.(1)Compared with the sham operation group,the transcription of ACh E,SP,M3R and NK1R m RNA in the Qihuang decoction group decreased significantly(P=0.001,P=0.003,P=0.001,P<0.001),while the transcription of VIP,NOS and VIP2R increased significantly(P=0.039,P=0.015,P=0.006);Compared with the standard enteral nutrition group and the immune enteral nutrition group,the transcription of ACh E,SP,M3R and NK1R m RNA in the Qihuang decoction group increased significantly(P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P=0.001,P=0.017,P<0.001),VIP and VIP2R decreased significantly(P<0.001,P=0.042,P<0.001,P=0.046),and NOS decreased not significantly(P=0.052?P=0.098).(2)Compared with the sham group,the transcription of ACh E,SP,M3R and NK1R m RNA in the standard enteral nutrition group decreased significantly(P<0.001,P<0.001,P<0.001,P<0.001,P<0.001),while the transcription of VIP,NOS and VIP2R increased significantly(P<0.001,P<0.001,P<0.001).3.2.2 protein expressions of Ach,SP,VIP,n NOS,M3R,VIP2R and NK1R were detected by Western Blot.(1)compared with the sham operation group,the expression of SP and M3R protein in the Qihuang decoction group decreased significantly(P<0.001?P<0.001),the expression of ACh E and NK1R protein decreased not significantly(P=0.140?P=0.052),and the expression of VIP,NOS and VIP protein increased significantly(P<0.001?P<0.001?P=0.001);Compared with the standard enteral nutrition group and the immune enteral nutrition group,the protein expression of ACh E,SP,M3R and NK1R in the group of Qihuang decoction was significantly increased(P<0.001?P<0.001?P<0.001?P<0.001?P<0.001?P<0.001?P<0.001?P<0.001).VIP,NOS and VIP2R were significantly reduced(P<0.001?P<0.001?P<0.001?P=0.021?P=0.002?P=0.009).(2)Compared with the sham group,ACh E,SP,M3R,NK1R protein expression in the standard enteral nutrition group was significantly decreased(P<0.001,P<0.001,P<0.001,P<0.001,P<0.001),while VIP,NOS and VIP2R were significantly increased(P<0.001,P<0.001,P<0.001).4 Conclusions4.1 Qihuang decoction promotes the recovery of gastrointestinal motility within regulating the secretion of gastrointestinal hormones after gastric cancer surgery.4.2 Mechanism of gastrointestinal movement is regulated by the neurotransmitters(gastrointestinal movement neurotransmitters of promote and inhibitory),abdominal surgery stress increased levels of the neurotransmitter inhibition of gastric bowel movement and lower promote gastrointestinal movement of the neurotransmitter levels,Qihuang decoction is not only can relieve the operation-stress effect on gastrointestinal function but reduce the inhibition of gastric bowel movement neurotransmitter levels combined with improving the level of promote gastrointestinal movement of the neurotransmitter.