本文關鍵詞： 刺絡瀉血 高尿酸血癥 肝功能 黃嘌呤氧化酶 腎功能 血尿酸 腺苷脫氨酶　出處：《北京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：刺絡瀉血,作為中醫(yī)傳統(tǒng)治療方法之一,古謂"啟脈"、"刺絡",是指用三棱針或者其他瀉血工具刺破人體穴位或周圍血絡,放出適量血液以達到防治疾病的目的的一種治療方法。刺絡瀉血通過刺破體表瘀阻絡脈,可以直接起到活血化瘀、疏通經(jīng)絡、祛瘀生新的功效。在臨床上,經(jīng)過長期的臨床實踐發(fā)現(xiàn)刺絡瀉血可以有效治療高尿酸血癥,降低血尿酸水平。前期做過刺絡瀉血治療高尿酸血癥的臨床研究,在此基礎上,本課題深入探討刺絡瀉血治療高尿酸血癥的療效及可能機制。本研究采用腺嘌呤聯(lián)合乙胺丁醇灌胃法建立高尿酸血癥大鼠模型,通過觀"委中"、"足三里"、"豐隆"刺絡瀉血對高尿酸血癥模型大鼠血尿酸、相關酶活性及肝腎功能的影響,以探討刺絡瀉血治療高尿酸血癥的相關機制,為臨床實踐提供更多的依據(jù)。目的本實驗采用腺嘌呤合乙胺丁醇混合溶液聯(lián)合灌胃法,以制備高尿酸血癥大鼠模型。造模成功后,刺絡瀉血組于委中穴、足三里穴及豐隆穴淺表血絡行刺絡瀉血,別嘌呤醇組根據(jù)大鼠體重標準灌胃別嘌呤醇。治療結束后,觀察大鼠血清尿酸(serum uric acid,SUA)黃嘌呤氧化酶(xanthine oxidase,XOD)、腺苷脫氨酶(adenosine deaminase,ADA)、血肌酐(serumcreatinine,Cr)、血清尿素氮(blood urea nitrogen,BUN)、谷丙轉(zhuǎn)氨酶(cer-ealthird transaminase,ALT)及谷草轉(zhuǎn)氨酶(aspartate transaminase,AST)的影響。方法將雄性SD大鼠40只,按隨機原則將大鼠分為正常組、模型組、別嘌呤醇組和刺絡瀉血組,每組各10只。造模第一階段從實驗開始,正常組根據(jù)體重標準按生理鹽水350 mg.kg-1.d-1體重標準灌胃,其他組按腺嘌呤100 mg.kg-1.d-1和乙胺丁醇250 mg.kg-1.d-1體重標準灌胃,每天1次。連續(xù)4周造模成功后,第二階段正常組按生理鹽水350 mg.kg-1.d-1體重標準灌胃,每組大鼠仍按腺嘌呤100mg.kg-4.d-1體重標準灌胃,3次/周至第8周治療結束停止,維持尿酸水平,以防止大鼠自愈。4周造模成功后,刺絡瀉血組選取大鼠雙側委中穴、足三里穴附近血絡刺血,每次出血量約0.5-0.8ml,別嘌呤醇組據(jù)大鼠體重灌胃別嘌呤醇0.03 mg.kg-1.d-1,2次/周,至第8周治療結束。治療結束后,10%水合氯醛溶液腹腔注射麻醉大鼠,取血進行檢測。采用比色法檢測SUA、Cr、XOD、ADA,脲酶法檢測BUN,丙酮酸氧化酶法檢測ALT、AST。結果1.體質(zhì)量、腎質(zhì)量、腎指數(shù):模型組、別嘌呤醇組、刺絡瀉血組大鼠的體質(zhì)量均明顯降低(P0.05);與正常組相比,大鼠腎質(zhì)量、腎指數(shù)均明顯升高;與模型組相比,別嘌呤醇組大鼠體質(zhì)量、腎質(zhì)量、腎指數(shù)均明顯升高,刺絡瀉血組腎質(zhì)量、腎指數(shù)均顯著下降(P0.05);與別嘌呤醇組相比,刺絡瀉血組腎質(zhì)量、腎指數(shù)均明顯下降(P0.05)。2.血清SUA含量:與正常組相比,模型組SUA顯著增高(P0.05),與模型組相比,別嘌呤醇組、刺絡瀉血組SUA含量顯著降低(P0.05)。3.血清XOD、ADA活性情況:與正常組相比,模型組ADA、XOD活性均顯著增高(P0.05),與模型組相比,別嘌呤醇組XOD活性顯著降低(P0.05),刺絡瀉血組XOD、ADA活性顯著降低(P0.05)。4.血清Cr、BUN含量:與正常組相比,模型組Cr、BUN含量均顯著增高(P0.05);與模型組相比,別嘌呤醇組Cr、BUN含量無明顯變化,刺絡瀉血組Cr、BUN含量降低(P0.05)。5.血清AST、ALT的變化:與正常組相比;ALT、AST活性明顯增強(P0.05),與模型組相比,別嘌呤醇組AST活性無明顯變化,ALT活性顯著增強(P0.05),刺絡瀉血組ALT、AST活性顯著降低(P0.05)。結論1.大鼠"委中"、"足三里"、"豐隆"刺絡瀉血可以降低高尿酸血癥大鼠腎指數(shù),減輕腎臟的充血、炎性反應。2.大鼠"委中"、"足三里"、"豐隆"刺絡瀉血可以有效抑制XOD及ADA活性,減少尿酸合成,降低大鼠SUA水平。3.大鼠"委中"、"足三里"、"豐隆"刺絡瀉血可以降低Cr、BUN含量及ALT、AST活性,在一定程度上可以降低尿酸對肝腎的損傷,同時也可以避免因服用降尿酸西藥對肝腎的損傷。
[Abstract]:Pricking blood, as one of the traditional Chinese medicine treatment method, called "ancient kaiclock", "pricking", refers to the use of triangular needle or other tools on the acupoints of the human body spilled blood or peripheral blood vessels, a treatment method of releasing amount of blood to achieve the purpose of disease treatment. Blood pricking through puncture the surface of blood stasis in collaterals, can be directly to blood stasis, dredge the meridians, removing stasis and promoting new effect. In clinical practice, through long-term clinical practice found that blood pricking therapy can effectively reduce hyperuricemia, serum uric acid level. Early clinical research done pricking blood therapy, high urine acidemia, on the basis of on this topic, in-depth study of curative effect of pricking blood therapy of hyperuricemia and its possible mechanism. This study uses adenine and ethambutol to establish hyperuricemia rat model by intragastric administration, through the concept of "Wei", "Zusanli", "Fenglong" pricking blood of high blood uric acid A rat model with blood uric acid, related enzyme activity and liver function, the mechanism of pricking blood therapy of hyperuricemia, provide more evidence for clinical practice. The purpose of this experiment using adenine and ethambutol mixed solution combined gavage method, rat models with high uricemia. Successful model after pricking blood group in Weizhong, Zusanli and Fenglong superficial blood vessels to assassinate the winding spilled blood allopurinol group, according to the standard weight of rats with allopurinol. After the treatment, observation of serum uric acid in rats (serum uric acid SUA (xanthine) oxidase, xanthine oxidase XOD (adenosine deaminase), adenosine deaminase, ADA), serum creatinine (serumcreatinine, Cr), blood urea nitrogen (blood urea, nitrogen, BUN), alanine aminotransferase (cer-ealthird transaminase ALT) and aspartate aminotransferase (aspartate transaminase, AST). The effects of the method 40 male SD rats were randomly divide the rats into normal group, model group, allopurinol group and pricking blood group, 10 rats in each group. The first stage of modeling from the beginning of the experiment, the normal group according to the standard according to the weight of saline 350 mg.kg-1.d-1 weight standard intragastric administration, other groups by adenine 100 mg.kg-1.d-1 and 250 mg.kg-1.d-1 standard weight of ethambutol orally, 1 times a day. After 4 weeks, the second groups according to the stages of normal saline 350 mg.kg-1.d-1 weight gavage, the rats in each group according to the 100mg.kg-4.d-1 standard weight of adenine orally, 3 times / week to eighth weeks after the treatment stopped, maintain uric acid level in order to prevent the rat self-healing.4 weeks after the modeling, pricking blood group selected rats with bilateral Zusanli Point Weizhong blood pricking blood near, every time the amount of bleeding was about 0.5-0.8ml, allopurinol group according to the body weight of rats intragastric administration of allopurinol in 0.03 mg.kg-1.d-1,2 嬈，

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