Objective To evaluate the efficacy of Anzhong-Fuyuan decoction combined with western routine therapy in the treatment of helicobacter pyiori(H.pylori)-positive chronic atrophic gastritis (CAG).Methods A total of 110 H.pylori positive CAG patients who met the inclusion criteria were divided into two groups according to random number table method,55 in each group.The control group was treated with quadruple therapy.On the basis of the control group,the study group was treated with Anzhong-Fuyuan decoction.Both groups were treated continuously for 40 days.The serum level of pepsinogen Ⅰ (Pepsinogen Ⅰ,PG Ⅰ),pepsinogen Ⅱ (PG Ⅱ),gastrin (GAS),endothelin (ET),CRP,IL-6 and TNF-α were detected by ELISA.The eradication rate of H.pylori was measured by 14C urea breath test,and the clinical efficacy was evaluated.Results The total effective rate was 92.7％ (51/55) in the study group and 78.2％ (43/55) in the control group.There were significant differences between the two groups (x2=4.681,P=0.031).The eradication rate of H.pylori was 89.1％ (49/55) in the study group and 76.4％ (42/55) in the control group.There was significant difference between the two groups (x2=3.911,P=-0.048).After treatment,the level of serum PG Ⅰ (84.87 ± 13.95 g/L vs.78.05 ± 12.69 g/L,t=3.434) and PG Ⅰ/PG Ⅱ (6.71 ± 1.26 vs.5.86 ± 1.13,t=2.861) in the study group was significantly higher than those in the control group (P＜0.05),and PG Ⅱ (12.64 ± 1.94 g/L vs.13.31 ± 2.10 g/L,t=3.725) was significantly lower than those in the control group (P＜0.01).The serum level of gastrin (10.76 ± 3.06 mmol/L vs.8.11 ± 2.84 mmol/L,t=4.707) was higher than that of control group (P＜0.01),endothelin (56.64 ± 4.42 ng/L vs.60.42 ± 5.13 ng/L,t=4.140) was significantly lower than that of control group (P＜0.01).After treatment,the level of CRP,IL-6 and TNF-α in the study group was significantly lower than those in the control group (t=11.100,9.571 and 8.687,respectively,all Ps＜ 0.001).Conclusions The Anzhong-Fuyuan decoction combined with routine therapy can significantly enhance the gastric mucosal secretion ability of H.pylori positive CAG patients,increase the ratio of PG Ⅰ/PG Ⅱ,promote the repair and regeneration of gastric mucosa,reduce the level of inflammatory cytokines.

Objective:To investigate interleukin (IL)-36 expression in patients with myasthenia gravis (MG), and to study the modulatory function of IL-36 on regulatory T cells (Tregs) and Th17 cells in MG patients.Methods:Fifty-one MG patients (MG group) and 25 healthy controls (control group) were enrolled in this study in Xinxiang Central Hospital between July 2016 and August 2021. Peripheral blood was collected. Plasma and peripheral blood mononuclear cells (PBMCs) were isolated. Plasma IL-36α, IL-36β, IL-36γ, IL-36RA, IL-35, and IL-17 levels were measured by enzyme-linked immunosorbent assay. The percentages of Tregs and Th17 cells were measured by flow cytometry. Forkhead box protein P3 (FoxP3) and retinoid-related orphan receptor gamma t (RORγt) mRNA expressions were measured by real-time polymerase chain reaction. PBMCs or purified Tregs from MG patients were stimulated with recombinant IL-36β (5 ng/ml). Changes of Tregs and Th17 cell percentages, IL-35 and IL-17 secretions, FoxP3 and RORγt mRNA expressions, as well as immunosuppressive activity of Tregs were analyzed.Results:There were no statistically significant differences of IL-36α, IL-36γ, or IL-36RA between the control group and the MG group (all P>0.05). IL-36β level was notably higher in the MG group compared with the control group [(73.43±13.91) pg/ml vs (60.91±12.65) pg/ml, t=3.79, P<0.001]. Treg percentage [(4.67±1.33)% vs (6.32±1.81)%, t=4.48, P<0.001], IL-35 [(50.06±7.93) pg/ml vs (65.37±8.90) pg/ml, t=7.59, P<0.001] and FoxP3 mRNA expression (1.03±0.14 vs 1.57±0.46, t=7.78, P<0.001) was lower, while Th17 cell percentage [(1.05±0.15)% vs (0.94±0.21)%, t=2.61, P=0.011], IL-17 [(40.61±13.13) pg/ml vs (33.09±11.48) pg/ml, t=2.44, P=0.017] and RORγt mRNA expression (1.26±0.16 vs 1.03±0.13, t=6.08, P<0.001) was higher in the MG group ( P<0.05). There were no statistically significant differences of above indices between different genders, onset ages, afflicting with thymoma, or different Osserman types (all P>0.05). There were no statistically significant correlations between above indices and quantitative myasthenia gravis (QMG) score (all P>0.05). Recombinant IL-36β stimulation did not affect PBMCs proliferation in MG patients ( P=0.248), and reduced Tregs percentage [(3.05±0.66)% vs (4.18±1.07)%, t=4.23, P<0.001], IL-35 secretion [(48.12±10.93) pg/ml vs (56.96±13.73) pg/ml, t=2.36, P=0.023] and FoxP3 mRNA expression (0.99±0.17 vs 1.18±0.13, t=4.01, P<0.001), but did not affect Th17 cell percentage, IL-17 secretion or RORγt mRNA expression (all P>0.05). Recombinant IL-36β stimulation inhibited immunosuppressive activity of Tregs, which presented as enhanced cellular proliferation [(0.83±0.12)×10 5vs (0.69±0.15)×10 5, t=3.02, P=0.005] and reduced IL-35 secretion [(28.71±10.08) pg/ml vs (37.12±10.47) pg/ml, t=2.39, P=0.023]. Conclusion:Increased IL-36β contributed to the regulation of Tregs/Th17 cell balance probably through inhibition of Tregs function in MG patients.