本文選題：腸易激綜合征 + 肝郁脾虛　； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:腸易激綜合征(irritable bowel syndrome,IBS)是一種以腹痛及腹部不適為主要特征同時伴有排便習慣的改變及大便性狀改變的一種慢性反復發(fā)作性胃腸道功能紊亂性腸病。腸易激綜合征給生活帶來極大的不便[81]。據(jù)報道[82]2013年IBS在歐美和北美地區(qū)的發(fā)病率增長很快,已接近20%,國內的發(fā)病率約10～15%。亞洲國家的IBS發(fā)病率也正在逐漸增長,一步步向歐美國家發(fā)病率靠攏。在IBS各種證型中,肝郁脾虛是IBS的最常見證型,也是IBS的基本病機。臨床上很多用疏肝健脾作為治療方法的。其治療機制與降低腸道的高敏感性、增加腸道的壓力閾值、調節(jié)腦腸互動功能、調節(jié)胃腸激素分泌功能、調節(jié)機體免疫系統(tǒng)、增強免疫力有著很大的關聯(lián)。目前對IBS還沒有明確的發(fā)病機制。通過臨床觀察,我們發(fā)現(xiàn)安腸止瀉方對肝郁脾虛型的IBS-D的治療有著很好的效果,希望通過本次研究能了解安腸止瀉方對肝郁脾虛型IBS-D大鼠血清及腦腸組織上相關激素VIP、5-HT是否有影響。方法:1.造模:SPF級SD大鼠50只,番瀉葉灌胃+慢性束縛+冷水刺激應激法聯(lián)合造模。造模結束后評估造模結果。2.分組:隨機的將SD大鼠分為空白組、模型組、馬來酸曲美布汀組、安腸止瀉方低、高劑量組,按照隨機數(shù)字表法分組。3.給藥:正常組及模型組均以0.9%Nacl灌胃。馬來酸曲美布汀組予以馬來酸曲美布汀0.03g/ml灌胃,體積20ml/kg,安腸止瀉方組高、低劑量組分別以1.5g/ml、0.75g/ml濃度的中藥溶液灌胃,每日2次,連續(xù)兩周。4.檢測指標:a.大鼠一般狀態(tài)的觀察。b.大鼠體重的變化。c.造模階段大鼠稀便率的變化。d.球囊擴張實驗檢測大鼠結腸疼痛敏感度。e.采用酶聯(lián)免疫法檢測血清及其腦腸組織中VIP、5-HT含量。結果:1、造模初期大鼠警惕不安、煩躁嘶叫;造模后期大鼠反抗減弱、神態(tài)疲倦、喜靜靠于鼠籠邊緣,毛色枯黃,皮毛雜亂沒有光澤。2、造模期間大鼠體重減輕。3、大鼠造模組稀便率第3天比第一天顯著升高,第7天有所降低。4、模型組腸道壓力閾值比正常組腸道壓力閾值明顯降低,腸道敏感性增高,模型組與空白組相比差異顯著(*P0.05)。造模后的大鼠經(jīng)西藥組治療后,大鼠壓力閾值有所升高,但仍低于正常組,西藥組與造模組差異明顯(#P0.05),中藥高濃度組壓力閾值較模型組也有所升高(#P0.05),中藥高濃度組與西藥組差異較小(P0.05)3、與空白組對照,模型組血清5-HT(***P0.005)、腦組織5-HT(***P0.005)、腸組織5-HT(*P0.05)含量都有明顯提高,差異顯著,模型組血清VIP(*P0.05)、腦組織VIP(*P0.05)、腸組織VIP(***P0.005)含量都有明顯提高,差異顯著。4、與模型組對照,安腸止瀉方高劑量組及西藥組血清5-HT(###P0.005)、腦組織5-HT(###P0.005)、腸組織5-HT(#0.05)含量均有不同程度的降低,安腸止瀉方及西藥組大鼠血清VIP(#P0.05)及腸組織腸組織VIP(#P0.05)顯著降低,差異明顯。結論:1、SD大鼠在番瀉葉灌胃加束縛和冷水應激刺激下可以使得內臟的敏感性增高,結腸痛閾值降低,情志刺激造成肝郁脾虛模型,聯(lián)合造模方法造成腸道功能紊亂,而腸粘膜未見病理損傷,基本符合IBS的診斷標準,證明了肝郁脾虛大鼠模型復制成功。2、安腸止瀉方能夠降低SD大鼠血清和腦腸粘膜中5-HT的含量以及血清、腸組織中VIP含量,并且能夠提高肝郁脾虛型IBS-D大鼠的內臟痛閾值,緩解IBS-D的癥狀,明確了該方的基礎實驗效應,提示了該效應與調控5-HT、VIP的變化相關。3、從結果看,安腸止瀉方高劑量組對模型組的大鼠血清和腦腸5-HT以及大鼠血清和腸組織VIP含量的降低作用與西藥馬來酸曲美布汀效果相當,而安腸止瀉方低劑量效果不明顯,所以安腸止瀉方劑量大作用效果較明顯,推測作用的效應與劑量呈依賴性的關系。
[Abstract]:Objective: irritable bowel syndrome (IBS) is a chronic recurrent gastrointestinal dysfunction enteropathy with abdominal pain and abdominal discomfort as the main characteristics accompanied by changes in the habit of defecation and changes in the stool character. The irritable bowel syndrome causes great inconvenience to life. [81]. is reported to be IBS in [82]2013 years. The incidence of the disease in Europe and America and North America has increased rapidly, and it is close to 20%. The incidence of IBS in the Asian countries is about 20%. The incidence of the Asian countries is increasing gradually. The incidence of the disease is closer to the European and American countries. In the various IBS syndromes, the liver depression and spleen deficiency are the most common syndrome of IBS, and also the basic pathogenesis of IBS. The treatment mechanism is related to reducing the Gao Min sensibility of the intestinal tract, increasing the threshold of the intestinal pressure, regulating the interaction of the brain and intestines, regulating the secretion function of the gastrointestinal hormone, regulating the immune system of the body and enhancing the immunity. At present, there is no clear pathogenesis for IBS. Through clinical observation, we found an antidiarrheal prescription. The treatment of liver qi stagnation and spleen deficiency type of IBS-D has a good effect. Through this study, we hope to understand the effect of an intestinal antidiarrheal prescription on the serum and brain tissue related hormone VIP and 5-HT in IBS-D rats with liver depression and spleen deficiency. Methods: 1. model: 50 SPF grade SD rats, combined with senna leaf perfusion and chronic restraint + cold water stimulation stress method. .2. groups were divided into two groups: the SD rats were randomly divided into the blank group, the model group, the maleic trimebutine group, the low Anchang antidiarrheal prescription, the high dose group, and the.3. administration according to the random number table method: the normal group and the model group were gavage with 0.9%Nacl. The maleic trimebutine group was treated with trimebutine maleic 0.03g/ml in the stomach, and the volume 20ml/ Kg, andchang antidiarrheal prescription group high, low dose group with 1.5g/ml, 0.75g/ml concentration of traditional Chinese medicine solution, 2 times a day, two weeks of continuous.4. detection index: the general state of A. rats, the changes of.B. rats' weight changes.C. model stage of rat dilute rate.D. balloon dilatation test of colon pain sensitivity.E. using enzyme linked immunosorbent assay The contents of VIP and 5-HT in serum and its brain tissue were detected. Results: 1, at the early stage of the model rats, the rats were vigilant and irritable, and the rats were tired and tired. The rats were quiet on the edge of the squirrel cage, the color of the hair was yellow, the fur was unshiny.2, the weight of the rats was reduced by.3, and the rate of dilute stool in the rat model was significantly higher than the first day in the rat model. The threshold of intestinal pressure in the model group was significantly lower than that of the normal group, and the intestinal sensitivity of the model group was significantly higher than that of the blank group (*P0.05). The pressure threshold of the rats after the model group was increased after the treatment of the western medicine group, but it was still lower than the normal group, and the difference between the western medicine group and the model group was obvious (#P0.05). The pressure threshold of high concentration group of Chinese medicine was also higher than that of the model group (#P0.05). The difference between the high concentration group and the western medicine group was smaller (P0.05) 3. Compared with the blank group, the serum 5-HT (***P0.005), the 5-HT (***P0.005) of the brain tissue and the 5-HT (*P0.05) in the intestinal tissue were obviously improved, and the difference was significant. The serum VIP (*P0.05) and VIP (*P0.05) of the brain tissue were found in the model group. The contents of VIP (***P0.005) in intestinal tissue were significantly improved, and the difference was significant.4. Compared with the model group, the high dose group and the serum 5-HT (###P0.005), the 5-HT (###P0.005) of the brain tissue and the 5-HT (#0.05) content of the intestinal tissue were reduced in different degrees, and the serum VIP (#P0.05) and intestinal tissue of the intestinal tissue in the group of intestinal antidiarrheal and Western medicine group were decreased. 0.05) significantly decrease, the difference is obvious. Conclusion: 1, SD rats can increase the sensibility of the viscera, reduce the threshold of colonic pain and cause the model of liver depression and spleen deficiency under the irritation of shackle and cold water under the irritation of senna leaf and the irritation of shackles and cold water, and the combined modeling method can cause intestinal dysfunction, but no pathological damage in the intestinal mucosa is found, which basically meets the diagnostic criteria of IBS. It was proved that the model of liver qi stagnation and spleen deficiency rat model was successful.2, and an intestinal antidiarrheal recipe could reduce the content of 5-HT in the serum and the intestinal mucosa of SD rats and the content of VIP in the intestinal tissue, and could improve the visceral pain threshold of the IBS-D rats with liver depression and spleen deficiency, alleviate the symptoms of IBS-D, and confirm the basic experimental effect of this recipe, and suggest the effect and the effect of this effect. The changes of 5-HT and VIP were related to.3. From the results, the effect of the high dose group of Anchang antidiarrheal prescription on the serum and brain intestinal 5-HT in the model group and the VIP content in the serum and intestinal tissues of the model group was equal to the western medicine of trimebutine, while the low dose effect of Anchang antidiarrheal prescription was not obvious, so the effect of Anchang antidiarrheal prescription was more effective than that of Anchang antidiarrheal prescription Obviously, the effect of speculation is dependent on dose.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R285.5

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