加味四逆散对慢性身心应激模型大鼠胃肠结构及功能的影响
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摘要
目的
建立慢性身心应激大鼠模型，研究加味四逆散对慢性身心应激模型大鼠行为学、胃排空、小肠推进、胃电图、胃肠神经递质的影响，从不同方面探讨加味四逆散干预应激性胃肠功能障碍的机制。另建立慢性身心应激大鼠模型，研究加味四逆散对慢性身心应激模型大鼠胃粘膜形态、胃粘膜EGF、EGFR蛋白、胃粘膜三叶因子1（TFF1）、内皮素1(ET-1)mRNA表达的影响，从形态结构的角度研究加味四逆散对慢性身心应激模型大鼠的影响，并对其机制进行初步探讨。
方法
第一部分：取Wistar雄性大鼠60只，随机分为6组，即正常组、模型组、西沙比利组、加味四逆散方高，中，低剂量组，每组10只，除空白组外，其他五组均采用身心应激方式造模，连续造模4周。从第3周起加味四逆散方高，中，低剂量组灌胃治疗，西沙比利组以西沙比利混悬液灌胃治疗；空白、模型组则给予等体积生理盐水灌胃治疗。（1）造模期间，每日观察并记录各组大鼠精神状态、兴奋程度、情绪反应、行为状态、活跃状况、睡眠行为，皮肤毛发色泽和状态等情况，每天观察并记录大鼠的饮水量、进食量，分别于实验前1天和试验后的第7、14、21、28d用电子秤称量每只大鼠体重,观测大鼠体质量改变情况；造模结束后行旷场试验（Open-field法）测定实验大鼠跨格运动次数和直立运动次数并在实验室游泳池内测定大鼠游泳力竭时间。（2）经加味四逆散等干预后于4周末空腹检测模型大鼠胃肠动力，用生物机能实验系统观察试验大鼠胃电变化，了解正常组，模型组，加味四逆散高，中，低剂量组，西沙比利组大鼠的胃电活动在幅度、频率上的差异，检测完毕后对正常组，模型组，加味四逆散高，中，低剂量组，西沙比利组胃肠动力及胃电图相应数据分别进行统计学分析。（3）应激刺激造模结束后免疫组化法测定实验大鼠胃粘膜组织COX-2、结肠粘膜组织c-kit的平均光密度值变化。
第二部分：Wistar雄性大鼠60只随机分为6组，即正常组、模型组、奥美拉唑组、加味四逆散方高，中，低剂量组，每组10只，除空白组外，其他五组均给予身心应激方式造模，连续造模4周。从第3周起加味四逆散方高，中，低剂量组用加味四逆散灌胃治疗，奥美拉唑组以奥美拉唑混悬液灌胃治疗；空白、模型组则给予等体积生理盐水灌胃治疗。（1）应激刺激造模结束后行胃粘膜形态及结构，胃酸及胃粘膜血流量的检测。（2）应激刺激造模结束后行胃粘膜EGF、EGFR蛋白表达检测。（3）应激刺激造模结束后逆转录PCR法测定模型大鼠胃粘膜三叶因子1（TFF1）mRNA、内皮素1(ET-1) mRNA的表达。
结果
第一部分结果：
（1）受试大鼠在实验前均表现出良好的精神状态，随应激时间的延长，第3周以后模型组大鼠的饮水量及摄食量呈现显著的下降趋势，而加味四逆散方各剂量组及西沙比利组用药后饮水量及摄食量下降趋势不同程度减缓，至第4周,其饮水量、摄食量不同程度增加，与模型组比较，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散高剂量组大鼠饮水量及摄食量明显增加，差异有显著性意义(P＜0.05)；造模后的第4周末，与模型组比较，加味四逆散方各剂量组及西沙比利组体重增长不同程度增加，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，第4周末加味四逆散高剂量组体重增长量增加显著，差异有显著性意义(P＜0.05)；第4周末，与模型组比较，加味四逆散方各剂量组及西沙比利组跨格运动、垂直运动的得分均明显增加，差异有显著性意义(P＜0.05或P＜0.01);与西沙比利组比较，加味四逆散高剂量组跨格运动及垂直运动得分均明显增加，差异有显著性意义(P＜0.05或P＜0.01)；造模后第4周末，与模型组比较，加味四逆散方高、中、低剂量组及西沙比利组力竭游泳时间不同程度延长，差异有显著性意义(P＜0.05或P＜0.01)，与西沙比利组比较，加味四逆散高剂量组力竭游泳时间明显增加，差异有显著性意义(P＜0.05)。
（2）与模型组比较，加味四逆散各剂量组，西沙比利组胃排空率及小肠推进比均明显升高，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散高剂量组胃排空率升高不明显(P＞0.05)，而小肠推进比升高明显(P＜0.05)；与模型组比较，加味四逆散各剂量组，西沙比利组慢波节律、主频率、主功率、快波频率、胃电慢波振幅明显增强，差异有显著性意义(P＜0.05或P＜0.01)，其中加味四逆散高剂量组大鼠胃电波接近正常水平；与西沙比利组比较，加味四逆散高剂量组大鼠慢波节律及快波频率均有明显增强(P＜0.05或P＜0.01)；
（3）与模型组比较，加味四逆散各剂量组、西沙比利组大鼠胃粘膜组织COX-2平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散中，高剂量组大鼠胃粘膜组织COX-2平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）。与模型组比较，加味四逆散各剂量组、西沙比利组大鼠结肠粘膜组织c-kit平均光密度值不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散中，高剂量组大鼠结肠粘膜组织c-kit平均光密度值升高，差异有显著性意义（P＜0.05或P＜0.Ol）。
第二部分结果：
（1）各组大鼠胃粘膜血流量变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜血流量不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜血流量升高，差异有显著性意义（P＜0.05或P＜0.Ol）。各组大鼠胃液总酸度（pH值）变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃液PH值不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃液PH值升高不明显，差异无显著性意义（P＞0.05）。各组大鼠肉眼下胃粘膜形态变化的比较：加味四逆散高剂量组大鼠胃粘膜损伤减轻最明显，已接近正常水平，奥美拉唑组、加味四逆散中剂量组及加味四逆散低剂量组大鼠胃粘膜不同程度好转。各组大鼠胃粘膜损伤溃疡指数(UI)变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜损伤溃疡指数(UI)不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散高剂量组大鼠胃粘膜损伤溃疡指数(UI)明显降低，差异有显著性意义（P＜0.05）。各组大鼠胃黏膜病理组织学观察及损伤程度评级变化的比较：模型组大鼠胃粘膜出血坏死溃疡明显。加味四逆散高剂量组镜下可见胃粘膜病损程度较模型组显著减轻，加味四逆散中、低剂量组可见胃粘膜不同程度好转。各组大鼠胃粘膜上皮细胞超微结构变化比较：模型组大鼠胃粘膜上皮细胞坏死明显。加味四逆散高剂量组大鼠胃粘膜上皮细胞间连接紧密，胞膜结构完整，细胞核形态正常。奥美拉唑组大鼠胃粘膜上皮细胞胞膜结构基本完整，胞浆中细胞器分布欠均匀。加味四逆散中、低剂量组大鼠胃粘膜上皮细胞不同程度恢复正常；
（2）各实验组大鼠胃粘膜组织的EGF及EGFR蛋白平均光密度值比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜组织EGF蛋白平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜组织EGF蛋白平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）；与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜组织EGFR蛋白平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜组织EGFR蛋白平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）。
（3）各组大鼠胃粘膜三叶因子1（TFF1）、内皮素1(ET-1) mRNA的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜三叶因子1（TFF1）mRNA相对表达量不同程度升高，差异有显著性(P﹤0.05或P﹤0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜三叶因子1（TFF1）mRNA相对表达量不同程度升高，差异有显著性（P＜0.05或P＜0.Ol）；与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜内皮素1(ET-1)mRNA相对表达量不同程度降低，差异有显著性(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜内皮素1(ET-1)mRNA相对表达量降低，差异有显著性（P＜0.05或P＜0.Ol）；
结论
从第一部分可知：
（1）加味四逆散可显著改善慢性身心应激模型大鼠行为学的异常，解除因应激导致的模型大鼠的抑郁状况。
（2）加味四逆散能够明显改善慢性身心应激大鼠的胃电波异常，可促进胃排空和小肠推进，其作用可能是通过促进胃电活动，增快胃平滑肌收缩等途径而实现的，同时加味四逆散促进大鼠胃肠动力的效应呈量效关系。
（3）加味四逆散可显著改善慢性身心应激模型大鼠胃肠神经递质的异常，缓解因胃肠神经递质紊乱导致的模型大鼠胃肠功能失调。
从第二部分可知：
（1）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜形态及结构，胃酸及胃粘膜血流量的异常，解除因慢性身心应激对模型大鼠胃粘膜的损伤。
（2）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜组织细胞的功能，解除因应激导致的模型大鼠的胃粘膜组织EGF、EGFR蛋白表达的异常。
（3）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜三叶因子1（TFF1）、内皮素1(ET-1)mRNA表达的异常，解除因应激导致的模型大鼠胃粘膜的损害。
Objective
to establish a rat model of chronic physical and psychological stressstress, observe the effect of jiaweisinisan(JWSNS)on behavior, the rateof gastric emptying, intestinal propulsion ratio, electrogastrography,gastrointestinal neurotransmitter, and explore different aspectsmechanism of JWSNS interventioning stress-induced gastrointestinaldysfunction. At the same time, set up chronic physical and psychologicalstress rat model, and observe the effect of JWSNS on gastric mucosa, gastricmucosal EGF, EGFR protein expression, gastric mucosa trefoil factor1(TFF1), endothelin1(ET-1) mRNA expression of chronic physical andpsychological stress rat model, from the morphological structure to observethe effect of JWSNS on chronic physical and psychological stress rats, anddiscuss the mechanism.
Methods
The first part:60male Wistar rats were randomly divided into6groups,namely the normal group, model group, cisapride group, JWSNS high,middle,low doses groups,10rats in each group.Except the blank group, the otherfive groups were given physical and mental stress to make model, molding4week continuously. From third weeks on, at the same time,supplementedJWSNS high, middle,low dose group with JWSNS to gastric lavage and treat,cisapride Group were supplemented cisapride suspension to gastric lavage and treat; blank, model group were treated with normal saline to gastriclavage and treat.(1) During molding, rats were observed and recorded dailyincluding mental state, excitement level, emotional response, behavioralstate, active status, sleep behavior, skin and hair color and condition,everyday observation and record the water intake and food intake amountof every rat respectively, in the day before the experiment and in the7th,14th,21th,28th d after test,use electronic balance to weigh each ratbody weight, body mass changes observed in rats; when molding end, byopen-field test (Open-field) determine cross grid movement times andupright exercise times of experimental rat in the lab and in swimming poolmeasure swimming exhaustive time of experimental rat.(2) After the JWSNSintervention,in the4th weekend, detection gastrointestinal motility inrats, use biological and functional experimental system to observationelectrogastrogram of test rats, and understand the gastric electricalactivity in amplitude and the difference in frequency of the normal group,model group, JWSNS high,middle, low dose group, cisapride group rats. aftertesting, the gastrointestinal motility and electrogastrogram data in thenormal group, model group, JWSNS high,middle, low dose group and cisapridegroup were given corresponding statistical analysis respectively.(3)After stress model,immunohistochemical determination was used todetermine gastric mucosa COX-2, colonic mucosal c-kit average values ofoptical density changes of experimental rat.
The second part:60male Wistar rats were randomly divided into6groups,namely the normal group, model group, the omeprazole group, JWSNS high,middle,low dose groups,10rats in each group.Except the blank group, theother five groups were given physical and mental stress model, continuousmolding for4weeks. From third week on, during making model, supplementedJWSNS high, middle,low dose groups with JWSNS to gastric lavage and treat, supplemented omeprazole suspension to omeprazole group to gastric lavagetreatment; blank and model group were lavaged and treated with normal saline.(1) After stress molding end,gastric mucosal morphology and structure,gastric acid and gastric mucosal blood flow were detectioned.(2) Afterstress molding end,gastric mucosal EGF and EGFR protein expression weredetectioned.(3) After stress model,RT-PCR method was used to determinationthe gastric mucosa trefoil factor1(TFF1) and endothelin1(ET-1) mRNAexpression in rat model.
Results
The first part experiment results:
(1) All the rats before the experiment showed a good mental state,and with the stress time tend, third week later, the amount of drinkingwater and food intake in model group rats showed a significant downwardtrend, but after JWSNS each dose group and cisapride group were treated,the decreased tendency of drinking water and food intake were slower indifferent degree.Later period to fourth weeks, compared with the modelgroup, after drug intervention in third and fourth weeks, the drinking waterand food intake of JWSNS each dose group and cisapride group increased indifferent degrees, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, drinking water and foodintake in JWSNS high dose group rats increased significantly, and therewas significant difference (P＜0.05); after the fourth weekend of themodel, compared with the model group, the weight growth in JWSNS each dosegroup and cisapride group increased to varying degrees, difference thereis significant (P＜0.05or P＜0.01); and compared with the cisapridegroup, in fourth weekend, the body weight of JWSNS high dose group increasedsignificantly, and there was significant difference (P＜0.05); in fourthweekend, compared with the model group, the cross grid movement and vertical movement scores in JWSNS each dose group and cisapride group weresignificantly increased, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, the cross gridmovement and vertical movement scores of JWSNS high dose group weresignificantly increased, and there was significant difference (P＜0.05or P＜0.01); after fourth weekend of model, compared with the model group,exhaustive swimming time of JWSNS high, middle, low dose groups andcisapride group extended in different degree, and there was significantdifference (P＜0.05or P＜0.01), and compared with the cisapride group,exhaustive swimming time of JWSNS high dose group were significantlyincreased, and there was significant difference (P＜0.05).
(2) compared with the model group, the rate of gastric emptying andsmall intestinal propulsion ratio of JWSNS each dose group and cisapridegroup were significantly increased, and there was significant difference(P＜0.05or P＜0.01); and compared with the cisapride group, rate ofgastric emptying of JWSNS high dose group was not elevated (P＞0.05),and small intestinal propulsion ratio increased significantly (P＜0.05);compared with the model group, slow wave rhythm, frequency, power, wavefrequency, gastric slow wave amplitude of JWSNS each dose group andcisapride group increased, there was a significant difference (P＜0.05,P＜0.01), wherein gastric waves of JWSNS high dose group were near normallevels; and compared with the cisapride group, slow wave rhythm and fastfrequency of JWSNS high dose group rats were significantly enhanced (P＜0.05or P＜0.01);
(3) compared with the model group, mean optical density of gastricmucosa COX-2of the normal group, JWSNS each dose group and cisapride grouprats decreased, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, mean optical density of gastric mucosa tissue COX-2in JWSNS middle,high dose groups rats decreased,and there was significant difference (P＜0.05or P＜0.0l). Comparedwith the model group, colonic mucosa c-kit average optical density valuesof the normal group, JWSNS each dose group and cisapride group ratsincreased in different degree, and the difference was significant (P＜0.05or P＜0.01); and compared with the cisapride group, colonic mucosatissue c-kit average optical density values of JWSNS middle,high dosegroups rats increased, and there was a significant difference (P＜0.05or P＜0.0l).
The second part experiment results:
(1) under the effect of JWSNS, compare the change of gastric mucosalblood flow: compared with the model group, the gastric mucosal blood flowin JWSNS each dose group and omeprazole group rats increased in differentdegree, and the difference was significant (P＜0.05or P＜0.01); andcompared with the omeprazole group, gastric mucosal blood flow of JWSNSmiddle,high dose groups rats increased, and there was a significantdifference (P＜0.05or P＜0.0l). under the effect of JWSNS, comparethe change of gastric juice acidity (pH value) change comparison: comparedwith the model group, gastric juice pH of JWSNS each dose group andomeprazole group rats increased in different degree, and the differencewas significant (P＜0.05or P＜0.01); and compared with the omeprazolegroup, gastric juice pH value of JWSNS middle,high dose groups rats wasnot elevated,and without significant difference (P＞0.05). under theeffect of JWSNS, compare the change of of gastric mucosa action in ratsunder the naked eye: gastric mucosa damage loss in JWSNS high dose grouprat is most obvious, and was close to the normal level, gastric mucosa ofthe omeprazole group, JWSNS middle and low dose group rats were in differentdegree improved. under the effect of JWSNS, compare the change of gastric mucosa ulcer index (UI): compared with the model group, gastric mucosaulcer index (UI) of JWSNS each dose group and omeprazole group ratsincreased in different degree, and the difference was significant (P＜0.05or P＜0.01); and compared with the omeprazole group, gastric mucosaulcer index (UI) of JWSNS high dose groups rats increased significantly,and there was significant difference (P＜0.05). under the action ofJWSNS, the comparison of gastric mucosa pathological observation andinjury severity rating change of each group rat: gastric mucosal bleedingnecrotic ulcer is apparent in the rats of the model group. microscopicallygastric mucosal lesion degree of JWSNS high dose groups rats,compared withthe model group,was significantly reduced, gastric mucosaes in JWSNSmiddle and low dose group were in different degree improves; under theeffect of JWSNS, compare the change of gastric mucosal epithelial cellsultrastructure: in the model group rats, the gastric epithelial cellnecrosis was evident. gastric mucosal epithelial cells of JWSNS high dosegroups rats were closely connected, the structure of cells membrane areintegrity, and cell morphology were in normal. In Omeprazole group rat,thegastric mucosa epithelial cell membrane structure were integrity basicly,cytoplasmic organelles were in the lack of uniform distribution. In JWSNSmiddle and low dose group rats,gastric mucosa epithelial cells return tonormal in different levels；
(2) the comparison of gastric mucosa tissue EGF and EGFR proteinaverage optical density value change of all experiment groups: comparedwith the model group, gastric mucosa tissue EGF protein average opticaldensity of JWSNS each dose group and omeprazole group rats decreased, andthere was significant difference (P＜0.05or P＜0.01); and compared withthe omeprazole group, gastric mucosa EGF protein average optical densityvalue of JWSNS middle,high dose groups rats decreased, and there was significant difference (P＜0.05or P＜0.0l); compared with the modelgroup, gastric mucosa average optical density values of EGFR protein inJWSNS each dose group and omeprazole group rats decreased, and there wassignificant difference (P＜0.05or P＜0.01); and compared with theomeprazole group, gastric mucosa EGFR protein average optical density valueof JWSNS middle,high dose groups rats decreased, and the difference wereof significant meaning (P＜0.05or P＜0.0l)；
(3) compared with the model group, gastric mucosa trefoil factor1(TFF1) relative expression levels in JWSNS each dose group and omeprazolegroup rats increased in different degree, and there were significantdifferences (P＜0.05or P＜0.01); and compared with the omeprazole group,gastric mucosa trefoil factor1(TFF1) the relative expression levelsof JWSNS middle,high dose groups rats increased in different degree, andthere were significant differences (P＜0.05or P＜0.0l);Compared withthe model group, gastric mucosa endothelin1(ET-1) mRNA relativeexpression levels of JWSNS each dose group and omeprazole group ratsdecreased, and there was significant difference (P＜0.05or P＜0.01);and compared with the omeprazole group, gastric mucosa endothelin1(ET-1)mRNA relative expression levels of JWSNS middle,high dose groups ratsdecreased, and there was significant difference (P＜0.05or P＜0.0l)；Conclusion
From the first part,we can know that:
(1) JWSNS can improve significantly behavioral abnormalities ofchronic stress rat model, and lift depression of model rat caused by stress；
(2) JWSNS can significantly improve gastric wave anomaly of chronicpsychological stress rats, promote gastric emptying and small intestinalpropulsion.Its role may be realized through promoting gastric electricalactivity, increasing gastric smooth muscle contraction and other pathways, at the same time,JWSNS promote gastrointestinal motility of rats withdose-effect effects relationship.
(3) JWSNS can improve significantly gastrointestinal neurotransmitterabnormalities of chronic stress model rats, ease gastrointestinaldysfunction of a rat model resulted in due to gastrointestinalneurotransmitter disorders.
From second part, we can know that:
(1) JWSNS can improve significantly gastric mucosal morphology andstructure, gastric acid and gastric mucosal blood flow abnormalities ofchronic stress rat model, and lift gastric mucosal injury of the rat modelleaded to due to chronic stress.
(2) JWSNS can improve significantly gastric mucosal tissue cellfunction of chronic stress rat model, and lift gastric mucosa tissue EGF,EGFR protein abnormal expression caused by stress in a rat model.
(3) JWSNS can improve significantly abnormal expression of gastricmucosa trefoil factor1(TFF1), endothelin1(ET-1) mRNA of chronicstress rat model, and lift gastric mucosal damage caused by stress in arat model.
建立慢性身心应激大鼠模型，研究加味四逆散对慢性身心应激模型大鼠行为学、胃排空、小肠推进、胃电图、胃肠神经递质的影响，从不同方面探讨加味四逆散干预应激性胃肠功能障碍的机制。另建立慢性身心应激大鼠模型，研究加味四逆散对慢性身心应激模型大鼠胃粘膜形态、胃粘膜EGF、EGFR蛋白、胃粘膜三叶因子1（TFF1）、内皮素1(ET-1)mRNA表达的影响，从形态结构的角度研究加味四逆散对慢性身心应激模型大鼠的影响，并对其机制进行初步探讨。
方法
第一部分：取Wistar雄性大鼠60只，随机分为6组，即正常组、模型组、西沙比利组、加味四逆散方高，中，低剂量组，每组10只，除空白组外，其他五组均采用身心应激方式造模，连续造模4周。从第3周起加味四逆散方高，中，低剂量组灌胃治疗，西沙比利组以西沙比利混悬液灌胃治疗；空白、模型组则给予等体积生理盐水灌胃治疗。（1）造模期间，每日观察并记录各组大鼠精神状态、兴奋程度、情绪反应、行为状态、活跃状况、睡眠行为，皮肤毛发色泽和状态等情况，每天观察并记录大鼠的饮水量、进食量，分别于实验前1天和试验后的第7、14、21、28d用电子秤称量每只大鼠体重,观测大鼠体质量改变情况；造模结束后行旷场试验（Open-field法）测定实验大鼠跨格运动次数和直立运动次数并在实验室游泳池内测定大鼠游泳力竭时间。（2）经加味四逆散等干预后于4周末空腹检测模型大鼠胃肠动力，用生物机能实验系统观察试验大鼠胃电变化，了解正常组，模型组，加味四逆散高，中，低剂量组，西沙比利组大鼠的胃电活动在幅度、频率上的差异，检测完毕后对正常组，模型组，加味四逆散高，中，低剂量组，西沙比利组胃肠动力及胃电图相应数据分别进行统计学分析。（3）应激刺激造模结束后免疫组化法测定实验大鼠胃粘膜组织COX-2、结肠粘膜组织c-kit的平均光密度值变化。
第二部分：Wistar雄性大鼠60只随机分为6组，即正常组、模型组、奥美拉唑组、加味四逆散方高，中，低剂量组，每组10只，除空白组外，其他五组均给予身心应激方式造模，连续造模4周。从第3周起加味四逆散方高，中，低剂量组用加味四逆散灌胃治疗，奥美拉唑组以奥美拉唑混悬液灌胃治疗；空白、模型组则给予等体积生理盐水灌胃治疗。（1）应激刺激造模结束后行胃粘膜形态及结构，胃酸及胃粘膜血流量的检测。（2）应激刺激造模结束后行胃粘膜EGF、EGFR蛋白表达检测。（3）应激刺激造模结束后逆转录PCR法测定模型大鼠胃粘膜三叶因子1（TFF1）mRNA、内皮素1(ET-1) mRNA的表达。
结果
第一部分结果：
（1）受试大鼠在实验前均表现出良好的精神状态，随应激时间的延长，第3周以后模型组大鼠的饮水量及摄食量呈现显著的下降趋势，而加味四逆散方各剂量组及西沙比利组用药后饮水量及摄食量下降趋势不同程度减缓，至第4周,其饮水量、摄食量不同程度增加，与模型组比较，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散高剂量组大鼠饮水量及摄食量明显增加，差异有显著性意义(P＜0.05)；造模后的第4周末，与模型组比较，加味四逆散方各剂量组及西沙比利组体重增长不同程度增加，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，第4周末加味四逆散高剂量组体重增长量增加显著，差异有显著性意义(P＜0.05)；第4周末，与模型组比较，加味四逆散方各剂量组及西沙比利组跨格运动、垂直运动的得分均明显增加，差异有显著性意义(P＜0.05或P＜0.01);与西沙比利组比较，加味四逆散高剂量组跨格运动及垂直运动得分均明显增加，差异有显著性意义(P＜0.05或P＜0.01)；造模后第4周末，与模型组比较，加味四逆散方高、中、低剂量组及西沙比利组力竭游泳时间不同程度延长，差异有显著性意义(P＜0.05或P＜0.01)，与西沙比利组比较，加味四逆散高剂量组力竭游泳时间明显增加，差异有显著性意义(P＜0.05)。
（2）与模型组比较，加味四逆散各剂量组，西沙比利组胃排空率及小肠推进比均明显升高，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散高剂量组胃排空率升高不明显(P＞0.05)，而小肠推进比升高明显(P＜0.05)；与模型组比较，加味四逆散各剂量组，西沙比利组慢波节律、主频率、主功率、快波频率、胃电慢波振幅明显增强，差异有显著性意义(P＜0.05或P＜0.01)，其中加味四逆散高剂量组大鼠胃电波接近正常水平；与西沙比利组比较，加味四逆散高剂量组大鼠慢波节律及快波频率均有明显增强(P＜0.05或P＜0.01)；
（3）与模型组比较，加味四逆散各剂量组、西沙比利组大鼠胃粘膜组织COX-2平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散中，高剂量组大鼠胃粘膜组织COX-2平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）。与模型组比较，加味四逆散各剂量组、西沙比利组大鼠结肠粘膜组织c-kit平均光密度值不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与西沙比利组比较，加味四逆散中，高剂量组大鼠结肠粘膜组织c-kit平均光密度值升高，差异有显著性意义（P＜0.05或P＜0.Ol）。
第二部分结果：
（1）各组大鼠胃粘膜血流量变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜血流量不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜血流量升高，差异有显著性意义（P＜0.05或P＜0.Ol）。各组大鼠胃液总酸度（pH值）变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃液PH值不同程度升高，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃液PH值升高不明显，差异无显著性意义（P＞0.05）。各组大鼠肉眼下胃粘膜形态变化的比较：加味四逆散高剂量组大鼠胃粘膜损伤减轻最明显，已接近正常水平，奥美拉唑组、加味四逆散中剂量组及加味四逆散低剂量组大鼠胃粘膜不同程度好转。各组大鼠胃粘膜损伤溃疡指数(UI)变化的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜损伤溃疡指数(UI)不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散高剂量组大鼠胃粘膜损伤溃疡指数(UI)明显降低，差异有显著性意义（P＜0.05）。各组大鼠胃黏膜病理组织学观察及损伤程度评级变化的比较：模型组大鼠胃粘膜出血坏死溃疡明显。加味四逆散高剂量组镜下可见胃粘膜病损程度较模型组显著减轻，加味四逆散中、低剂量组可见胃粘膜不同程度好转。各组大鼠胃粘膜上皮细胞超微结构变化比较：模型组大鼠胃粘膜上皮细胞坏死明显。加味四逆散高剂量组大鼠胃粘膜上皮细胞间连接紧密，胞膜结构完整，细胞核形态正常。奥美拉唑组大鼠胃粘膜上皮细胞胞膜结构基本完整，胞浆中细胞器分布欠均匀。加味四逆散中、低剂量组大鼠胃粘膜上皮细胞不同程度恢复正常；
（2）各实验组大鼠胃粘膜组织的EGF及EGFR蛋白平均光密度值比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜组织EGF蛋白平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜组织EGF蛋白平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）；与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜组织EGFR蛋白平均光密度值不同程度降低，差异有显著性意义(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜组织EGFR蛋白平均光密度值降低，差异有显著性意义（P＜0.05或P＜0.Ol）。
（3）各组大鼠胃粘膜三叶因子1（TFF1）、内皮素1(ET-1) mRNA的比较：与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜三叶因子1（TFF1）mRNA相对表达量不同程度升高，差异有显著性(P﹤0.05或P﹤0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜三叶因子1（TFF1）mRNA相对表达量不同程度升高，差异有显著性（P＜0.05或P＜0.Ol）；与模型组比较，加味四逆散各剂量组、奥美拉唑组大鼠胃粘膜内皮素1(ET-1)mRNA相对表达量不同程度降低，差异有显著性(P＜0.05或P＜0.01)；与奥美拉唑组比较，加味四逆散中，高剂量组大鼠胃粘膜内皮素1(ET-1)mRNA相对表达量降低，差异有显著性（P＜0.05或P＜0.Ol）；
结论
从第一部分可知：
（1）加味四逆散可显著改善慢性身心应激模型大鼠行为学的异常，解除因应激导致的模型大鼠的抑郁状况。
（2）加味四逆散能够明显改善慢性身心应激大鼠的胃电波异常，可促进胃排空和小肠推进，其作用可能是通过促进胃电活动，增快胃平滑肌收缩等途径而实现的，同时加味四逆散促进大鼠胃肠动力的效应呈量效关系。
（3）加味四逆散可显著改善慢性身心应激模型大鼠胃肠神经递质的异常，缓解因胃肠神经递质紊乱导致的模型大鼠胃肠功能失调。
从第二部分可知：
（1）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜形态及结构，胃酸及胃粘膜血流量的异常，解除因慢性身心应激对模型大鼠胃粘膜的损伤。
（2）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜组织细胞的功能，解除因应激导致的模型大鼠的胃粘膜组织EGF、EGFR蛋白表达的异常。
（3）加味四逆散可显著改善慢性身心应激模型大鼠胃粘膜三叶因子1（TFF1）、内皮素1(ET-1)mRNA表达的异常，解除因应激导致的模型大鼠胃粘膜的损害。
Objective
to establish a rat model of chronic physical and psychological stressstress, observe the effect of jiaweisinisan(JWSNS)on behavior, the rateof gastric emptying, intestinal propulsion ratio, electrogastrography,gastrointestinal neurotransmitter, and explore different aspectsmechanism of JWSNS interventioning stress-induced gastrointestinaldysfunction. At the same time, set up chronic physical and psychologicalstress rat model, and observe the effect of JWSNS on gastric mucosa, gastricmucosal EGF, EGFR protein expression, gastric mucosa trefoil factor1(TFF1), endothelin1(ET-1) mRNA expression of chronic physical andpsychological stress rat model, from the morphological structure to observethe effect of JWSNS on chronic physical and psychological stress rats, anddiscuss the mechanism.
Methods
The first part:60male Wistar rats were randomly divided into6groups,namely the normal group, model group, cisapride group, JWSNS high,middle,low doses groups,10rats in each group.Except the blank group, the otherfive groups were given physical and mental stress to make model, molding4week continuously. From third weeks on, at the same time,supplementedJWSNS high, middle,low dose group with JWSNS to gastric lavage and treat,cisapride Group were supplemented cisapride suspension to gastric lavage and treat; blank, model group were treated with normal saline to gastriclavage and treat.(1) During molding, rats were observed and recorded dailyincluding mental state, excitement level, emotional response, behavioralstate, active status, sleep behavior, skin and hair color and condition,everyday observation and record the water intake and food intake amountof every rat respectively, in the day before the experiment and in the7th,14th,21th,28th d after test,use electronic balance to weigh each ratbody weight, body mass changes observed in rats; when molding end, byopen-field test (Open-field) determine cross grid movement times andupright exercise times of experimental rat in the lab and in swimming poolmeasure swimming exhaustive time of experimental rat.(2) After the JWSNSintervention,in the4th weekend, detection gastrointestinal motility inrats, use biological and functional experimental system to observationelectrogastrogram of test rats, and understand the gastric electricalactivity in amplitude and the difference in frequency of the normal group,model group, JWSNS high,middle, low dose group, cisapride group rats. aftertesting, the gastrointestinal motility and electrogastrogram data in thenormal group, model group, JWSNS high,middle, low dose group and cisapridegroup were given corresponding statistical analysis respectively.(3)After stress model,immunohistochemical determination was used todetermine gastric mucosa COX-2, colonic mucosal c-kit average values ofoptical density changes of experimental rat.
The second part:60male Wistar rats were randomly divided into6groups,namely the normal group, model group, the omeprazole group, JWSNS high,middle,low dose groups,10rats in each group.Except the blank group, theother five groups were given physical and mental stress model, continuousmolding for4weeks. From third week on, during making model, supplementedJWSNS high, middle,low dose groups with JWSNS to gastric lavage and treat, supplemented omeprazole suspension to omeprazole group to gastric lavagetreatment; blank and model group were lavaged and treated with normal saline.(1) After stress molding end,gastric mucosal morphology and structure,gastric acid and gastric mucosal blood flow were detectioned.(2) Afterstress molding end,gastric mucosal EGF and EGFR protein expression weredetectioned.(3) After stress model,RT-PCR method was used to determinationthe gastric mucosa trefoil factor1(TFF1) and endothelin1(ET-1) mRNAexpression in rat model.
Results
The first part experiment results:
(1) All the rats before the experiment showed a good mental state,and with the stress time tend, third week later, the amount of drinkingwater and food intake in model group rats showed a significant downwardtrend, but after JWSNS each dose group and cisapride group were treated,the decreased tendency of drinking water and food intake were slower indifferent degree.Later period to fourth weeks, compared with the modelgroup, after drug intervention in third and fourth weeks, the drinking waterand food intake of JWSNS each dose group and cisapride group increased indifferent degrees, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, drinking water and foodintake in JWSNS high dose group rats increased significantly, and therewas significant difference (P＜0.05); after the fourth weekend of themodel, compared with the model group, the weight growth in JWSNS each dosegroup and cisapride group increased to varying degrees, difference thereis significant (P＜0.05or P＜0.01); and compared with the cisapridegroup, in fourth weekend, the body weight of JWSNS high dose group increasedsignificantly, and there was significant difference (P＜0.05); in fourthweekend, compared with the model group, the cross grid movement and vertical movement scores in JWSNS each dose group and cisapride group weresignificantly increased, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, the cross gridmovement and vertical movement scores of JWSNS high dose group weresignificantly increased, and there was significant difference (P＜0.05or P＜0.01); after fourth weekend of model, compared with the model group,exhaustive swimming time of JWSNS high, middle, low dose groups andcisapride group extended in different degree, and there was significantdifference (P＜0.05or P＜0.01), and compared with the cisapride group,exhaustive swimming time of JWSNS high dose group were significantlyincreased, and there was significant difference (P＜0.05).
(2) compared with the model group, the rate of gastric emptying andsmall intestinal propulsion ratio of JWSNS each dose group and cisapridegroup were significantly increased, and there was significant difference(P＜0.05or P＜0.01); and compared with the cisapride group, rate ofgastric emptying of JWSNS high dose group was not elevated (P＞0.05),and small intestinal propulsion ratio increased significantly (P＜0.05);compared with the model group, slow wave rhythm, frequency, power, wavefrequency, gastric slow wave amplitude of JWSNS each dose group andcisapride group increased, there was a significant difference (P＜0.05,P＜0.01), wherein gastric waves of JWSNS high dose group were near normallevels; and compared with the cisapride group, slow wave rhythm and fastfrequency of JWSNS high dose group rats were significantly enhanced (P＜0.05or P＜0.01);
(3) compared with the model group, mean optical density of gastricmucosa COX-2of the normal group, JWSNS each dose group and cisapride grouprats decreased, and there was significant difference (P＜0.05or P＜0.01); and compared with the cisapride group, mean optical density of gastric mucosa tissue COX-2in JWSNS middle,high dose groups rats decreased,and there was significant difference (P＜0.05or P＜0.0l). Comparedwith the model group, colonic mucosa c-kit average optical density valuesof the normal group, JWSNS each dose group and cisapride group ratsincreased in different degree, and the difference was significant (P＜0.05or P＜0.01); and compared with the cisapride group, colonic mucosatissue c-kit average optical density values of JWSNS middle,high dosegroups rats increased, and there was a significant difference (P＜0.05or P＜0.0l).
The second part experiment results:
(1) under the effect of JWSNS, compare the change of gastric mucosalblood flow: compared with the model group, the gastric mucosal blood flowin JWSNS each dose group and omeprazole group rats increased in differentdegree, and the difference was significant (P＜0.05or P＜0.01); andcompared with the omeprazole group, gastric mucosal blood flow of JWSNSmiddle,high dose groups rats increased, and there was a significantdifference (P＜0.05or P＜0.0l). under the effect of JWSNS, comparethe change of gastric juice acidity (pH value) change comparison: comparedwith the model group, gastric juice pH of JWSNS each dose group andomeprazole group rats increased in different degree, and the differencewas significant (P＜0.05or P＜0.01); and compared with the omeprazolegroup, gastric juice pH value of JWSNS middle,high dose groups rats wasnot elevated,and without significant difference (P＞0.05). under theeffect of JWSNS, compare the change of of gastric mucosa action in ratsunder the naked eye: gastric mucosa damage loss in JWSNS high dose grouprat is most obvious, and was close to the normal level, gastric mucosa ofthe omeprazole group, JWSNS middle and low dose group rats were in differentdegree improved. under the effect of JWSNS, compare the change of gastric mucosa ulcer index (UI): compared with the model group, gastric mucosaulcer index (UI) of JWSNS each dose group and omeprazole group ratsincreased in different degree, and the difference was significant (P＜0.05or P＜0.01); and compared with the omeprazole group, gastric mucosaulcer index (UI) of JWSNS high dose groups rats increased significantly,and there was significant difference (P＜0.05). under the action ofJWSNS, the comparison of gastric mucosa pathological observation andinjury severity rating change of each group rat: gastric mucosal bleedingnecrotic ulcer is apparent in the rats of the model group. microscopicallygastric mucosal lesion degree of JWSNS high dose groups rats,compared withthe model group,was significantly reduced, gastric mucosaes in JWSNSmiddle and low dose group were in different degree improves; under theeffect of JWSNS, compare the change of gastric mucosal epithelial cellsultrastructure: in the model group rats, the gastric epithelial cellnecrosis was evident. gastric mucosal epithelial cells of JWSNS high dosegroups rats were closely connected, the structure of cells membrane areintegrity, and cell morphology were in normal. In Omeprazole group rat,thegastric mucosa epithelial cell membrane structure were integrity basicly,cytoplasmic organelles were in the lack of uniform distribution. In JWSNSmiddle and low dose group rats,gastric mucosa epithelial cells return tonormal in different levels；
(2) the comparison of gastric mucosa tissue EGF and EGFR proteinaverage optical density value change of all experiment groups: comparedwith the model group, gastric mucosa tissue EGF protein average opticaldensity of JWSNS each dose group and omeprazole group rats decreased, andthere was significant difference (P＜0.05or P＜0.01); and compared withthe omeprazole group, gastric mucosa EGF protein average optical densityvalue of JWSNS middle,high dose groups rats decreased, and there was significant difference (P＜0.05or P＜0.0l); compared with the modelgroup, gastric mucosa average optical density values of EGFR protein inJWSNS each dose group and omeprazole group rats decreased, and there wassignificant difference (P＜0.05or P＜0.01); and compared with theomeprazole group, gastric mucosa EGFR protein average optical density valueof JWSNS middle,high dose groups rats decreased, and the difference wereof significant meaning (P＜0.05or P＜0.0l)；
(3) compared with the model group, gastric mucosa trefoil factor1(TFF1) relative expression levels in JWSNS each dose group and omeprazolegroup rats increased in different degree, and there were significantdifferences (P＜0.05or P＜0.01); and compared with the omeprazole group,gastric mucosa trefoil factor1(TFF1) the relative expression levelsof JWSNS middle,high dose groups rats increased in different degree, andthere were significant differences (P＜0.05or P＜0.0l);Compared withthe model group, gastric mucosa endothelin1(ET-1) mRNA relativeexpression levels of JWSNS each dose group and omeprazole group ratsdecreased, and there was significant difference (P＜0.05or P＜0.01);and compared with the omeprazole group, gastric mucosa endothelin1(ET-1)mRNA relative expression levels of JWSNS middle,high dose groups ratsdecreased, and there was significant difference (P＜0.05or P＜0.0l)；Conclusion
From the first part,we can know that:
(1) JWSNS can improve significantly behavioral abnormalities ofchronic stress rat model, and lift depression of model rat caused by stress；
(2) JWSNS can significantly improve gastric wave anomaly of chronicpsychological stress rats, promote gastric emptying and small intestinalpropulsion.Its role may be realized through promoting gastric electricalactivity, increasing gastric smooth muscle contraction and other pathways, at the same time,JWSNS promote gastrointestinal motility of rats withdose-effect effects relationship.
(3) JWSNS can improve significantly gastrointestinal neurotransmitterabnormalities of chronic stress model rats, ease gastrointestinaldysfunction of a rat model resulted in due to gastrointestinalneurotransmitter disorders.
From second part, we can know that:
(1) JWSNS can improve significantly gastric mucosal morphology andstructure, gastric acid and gastric mucosal blood flow abnormalities ofchronic stress rat model, and lift gastric mucosal injury of the rat modelleaded to due to chronic stress.
(2) JWSNS can improve significantly gastric mucosal tissue cellfunction of chronic stress rat model, and lift gastric mucosa tissue EGF,EGFR protein abnormal expression caused by stress in a rat model.
(3) JWSNS can improve significantly abnormal expression of gastricmucosa trefoil factor1(TFF1), endothelin1(ET-1) mRNA of chronicstress rat model, and lift gastric mucosal damage caused by stress in arat model.
引文
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