發(fā)布時(shí)間：2018-04-16 12:41

  本文選題：抽動(dòng)穢語(yǔ)綜合征 + 臨床觀察��； 參考：《北京中醫(yī)藥大學(xué)》2012年碩士論文

【摘要】：目的： (1)連續(xù)、動(dòng)態(tài)地觀察靜心制動(dòng)方治療抽動(dòng)穢語(yǔ)綜合征的臨床療效,從不同階段的療效中分析抽動(dòng)穢語(yǔ)綜合征病情反復(fù)的原因及規(guī)律。 (2)探討抽動(dòng)穢語(yǔ)綜合征與細(xì)胞免疫、體液免疫及自身免疫的關(guān)系。方法： (1)選擇160例抽動(dòng)穢語(yǔ)綜合征患者,根據(jù)中醫(yī)辨證將其分為肝亢風(fēng)動(dòng)組、脾虛肝亢組及陰虛風(fēng)動(dòng)組,均采用靜心制動(dòng)方加減治療,療程為6個(gè)月。應(yīng)用耶魯綜合抽動(dòng)嚴(yán)重程度量表統(tǒng)計(jì)患者治療前后抽動(dòng)癥狀次數(shù)、頻率、強(qiáng)度、復(fù)雜性、干擾等評(píng)分變化；采用抽動(dòng)程度評(píng)分表觀察患者治療前后抽動(dòng)部位、程度的分?jǐn)?shù)變化；采用中醫(yī)情志睡眠評(píng)分表觀察患者治療前后中醫(yī)情志睡眠的評(píng)分變化。初診、治療3月、治療6月后各填寫(xiě)一次耶魯綜合抽動(dòng)嚴(yán)重程度量表、抽動(dòng)程度評(píng)分表、中醫(yī)情志睡眠評(píng)分表。 (2)以酶聯(lián)免疫吸附試驗(yàn)法測(cè)定抽動(dòng)穢語(yǔ)綜合征患者的TNF-α、IL-6、ANA及體液免疫(IgA、IgG、IgM),用流式細(xì)胞儀檢測(cè)T淋巴細(xì)胞亞群。結(jié)果： (1)通過(guò)靜心制動(dòng)方治療,治療3個(gè)月后、6個(gè)月后顯效率分別為15%、44%,總有效率分別達(dá)81%、89%,經(jīng)統(tǒng)計(jì)不同治療階段的顯效率、總有效率差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；治療前與治療3個(gè)月后、治療6個(gè)月后,具體部位總體抽動(dòng)癥狀評(píng)分比較均有顯著性差異(P0.05)；治療前與治療6個(gè)月后中醫(yī)情志、睡眠變化例數(shù)的比較有顯著性差異(P0.05)。 (2)不同證型顯效率、總有效率均無(wú)顯著性差異(P0.05)；治療前與治療3月后、治療6月后的抽動(dòng)癥狀總分差值,三證型比較均無(wú)顯著性差異(P0.05)；不同證型中醫(yī)情志、睡眠變化例數(shù)的比較無(wú)顯著性差異(P0.05)。 (3)抽動(dòng)穢語(yǔ)綜合征患者與本院所測(cè)正常值比較,T淋巴細(xì)胞亞群CD3+、CD8+細(xì)胞百分比均高于正常值,但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),CD4+及CD4+/CD8+比值均明顯低于正常值,皆有統(tǒng)計(jì)學(xué)意義(P0.05)；免疫球蛋白IgA、IgG、IgM均明顯低于正常值,皆有統(tǒng)計(jì)學(xué)意義(P0.05)；TNF-α與IL-6均明顯低于正常值,皆有統(tǒng)計(jì)學(xué)意義(P0.05)；30例抗核抗體ANA均為陰性。 結(jié)論： (1)導(dǎo)師的靜心制動(dòng)方在不同的治療階段療效均較顯著,使抽動(dòng)穢語(yǔ)綜合征患者在抽動(dòng)癥狀的次數(shù)、頻率、強(qiáng)度、復(fù)雜性及中醫(yī)情志睡眠等方面改善明顯；160例患者在前6個(gè)月的治療中療效迅速上升,患者總體病情無(wú)明顯反復(fù),或個(gè)別患者病情雖有反復(fù),但沒(méi)有到影響總分?jǐn)?shù)降低的程度,今后應(yīng)繼續(xù)延長(zhǎng)觀察期,或縮短觀察節(jié)段時(shí)間,或改變觀察方式,以綜合評(píng)價(jià)患者病情反復(fù)的情況；靜心制動(dòng)方治療不同證型患者的療效、總體抽動(dòng)癥狀緩解程度及中醫(yī)情志睡眠改善程度均無(wú)差別。 (2)抽動(dòng)穢語(yǔ)綜合征的發(fā)病可能與機(jī)體細(xì)胞免疫、體液免疫功能及自身免疫均有關(guān)。但應(yīng)將抽動(dòng)穢語(yǔ)綜合征患者與反復(fù)呼吸道感染患者的免疫水平進(jìn)行比較,并進(jìn)一步探討免疫因素如何影響抽動(dòng)穢語(yǔ)綜合征的發(fā)病及病變過(guò)程。
[Abstract]:Objective:1) to observe the clinical effect of Jingxinjiaofang in the treatment of Gilles de la Tourette syndrome (Gilles de la Tourette syndrome) continuously and dynamically, and analyze the cause and regularity of the repeated condition of Gilles de la Tourette syndrome from different stages of curative effect.To explore the relationship between Tourette syndrome and cellular immunity, humoral immunity and autoimmunity.Methods:1) 160 patients with Tourette syndrome were divided into three groups according to TCM syndrome differentiation: hyperactivity of liver group, spleen deficiency group, and yin deficiency group. All patients were treated with the addition and subtraction of Jing Xin Jiao Fang for 6 months.The frequency, frequency, intensity, complexity and disturbance of tic symptoms before and after treatment were evaluated by Yale comprehensive tic severity scale, and the scores of twitch position and degree before and after treatment were observed.To observe the changes of TCM emotional sleep score before and after treatment with TCM emotional sleep score table.At first visit, 3 months after treatment, 6 months after treatment, each completed Yale comprehensive tic severity scale, tic score table, TCM emotional sleep score table.(2) TNF- 偽 IL-6 ANA and humoral immunoglobulin A (IgA) IgG MN were measured by enzyme linked immunosorbent assay (Elisa) in patients with Tourette's syndrome. The T lymphocyte subsets were detected by flow cytometry (FCM).Results:1) after 3 months of treatment and 6 months after treatment, the effective rates were 15 and 44, respectively, and the total effective rates were 81and 8989, respectively. There were statistically significant differences in the total effective rates between the two groups after 3 months of treatment and before and after 3 months of treatment.After 6 months of treatment, there were significant differences in the total tic symptom scores of specific sites (P 0.05), and there were significant differences in the number of cases of changes in mood and sleep in TCM before treatment and after 6 months of treatment (P 0.05).(2) there was no significant difference in the total effective rate between different syndromes and the total effective rate (P 0.05). There was no significant difference in the total score of tic symptoms between the three syndromes before treatment and three months after treatment, and there was no significant difference among the three syndrome types (P 0.05).There was no significant difference in the number of sleep change cases (P 0.05).(3) the percentage of CD3 / CD8 cells in T lymphocyte subsets in Gilles de la Tourette syndrome patients was higher than that in our hospital, but there was no statistical significance in the percentage of CD4 and CD4 / CD8 ratio of T lymphocyte subsets in patients with Tourette's syndrome were significantly lower than the normal values.All of them had statistical significance (P 0.05) and immunoglobulin IgA (IgA) IgG IL-6 were significantly lower than the normal value (P 0.05) and TNF- 偽 and IL-6 were significantly lower than the normal value (P 0.05). All the 30 cases of anti-nuclear antibody ANA were negative.Conclusion:1) the therapeutic effect of the tutor's sedentary braking prescription was significant in different treatment stages, which made the frequency, frequency and intensity of Tourette syndrome patients in tic symptoms.In the first six months of treatment, the curative effect of 160 patients increased rapidly, the overall state of the patient did not repeat obviously, or the individual patient's condition was repeated, but it did not affect the decrease of the total score.In the future, we should continue to prolong the observation period, or shorten the observation period, or change the observation mode so as to comprehensively evaluate the recurrent condition of the patient; the curative effect of Jingxinjiaofang in treating patients with different syndromes,There was no difference in the degree of relief of general tic symptoms and the improvement of emotional sleep in traditional Chinese medicine.2) the pathogenesis of Tourette syndrome may be related to cellular immunity, humoral immunity and autoimmunity.However, the immune level of Gilles de la Tourette syndrome and recurrent respiratory tract infection should be compared, and how the immune factors affect the pathogenesis and pathological process of Gilles de la Tourette syndrome should be further discussed.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.94

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