發(fā)布時(shí)間：2018-04-30 12:32

  本文選題：芪丹復(fù)感顆粒 + 反復(fù)呼吸道感染��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的及意義:據(jù)不完全統(tǒng)計(jì),在我國(guó)兒科門診病人中,呼吸道感染占患兒的70%左右,其中30%為反復(fù)呼吸道感染,且發(fā)病率呈居高不下之態(tài)。特別是在季節(jié)更替、氣候變化異常,或家長(zhǎng)對(duì)兒童衣物增減不及時(shí),都易讓患兒出現(xiàn)反復(fù)的感冒、發(fā)熱、咳嗽等病證,病程纏綿,每年發(fā)病幾次或十幾次,且易并發(fā)肺炎、哮喘、心肌炎、急性腎炎等嚴(yán)重疾患,更加增加患兒成年后患其他慢性呼吸系統(tǒng)疾病的可能性。對(duì)兒童無論從身體上還是心靈上都易造成嚴(yán)重?fù)p害,也令家人和親人擔(dān)憂。因此反復(fù)呼吸道感染雖然不能稱為一個(gè)獨(dú)立的疾病,但作為兒科常見的臨床現(xiàn)象,其形勢(shì)嚴(yán)峻己經(jīng)引起全社會(huì)的廣泛關(guān)注�，F(xiàn)代醫(yī)學(xué)對(duì)RRTI確切的發(fā)病原因尚未所知,研究提示RRTI的發(fā)生可能與小兒的解剖特點(diǎn)、免疫功能異常、微量元素缺乏、遺傳易感性與基因突變等因素有關(guān)。而隨著黏膜免疫系統(tǒng)研究的深入,我們發(fā)現(xiàn)RRTI患兒的體液免疫及細(xì)胞免疫功能均有不同程度的降低,尤以細(xì)胞免疫功能改變明顯,而在胃腸道黏膜集合淋巴結(jié)中抗原誘導(dǎo)的淋巴細(xì)胞會(huì)經(jīng)循環(huán)而分布到呼吸道和消化道及各處外分泌腺黏膜的淋巴組織中,使機(jī)體獲得抗體。因此肺、脾同免疫功能的關(guān)系顯得密不可分。在以往的中醫(yī)治療上,多以解表扶正為大法。王俊宏教授則突破固有的傳統(tǒng)思路,在"肺脾同調(diào)"的基礎(chǔ)上提出"久病必瘀",以益氣活血運(yùn)脾為其治療原則,更加深入探究小兒反復(fù)呼吸道感染的中醫(yī)病機(jī)。本次研究主要觀察芪丹復(fù)感顆粒就對(duì)氣虛血瘀型反復(fù)呼吸道感染患兒治療前后中醫(yī)證候的改變及T細(xì)胞亞群的影響以及制備免疫低下小鼠模型,觀察并檢測(cè)芪丹復(fù)感顆粒對(duì)免疫功能低下模型小鼠T細(xì)胞亞群的影響,同時(shí)從臨床和實(shí)驗(yàn)兩方面闡述芪丹復(fù)感顆粒對(duì)RRTI患兒免疫系統(tǒng)的改善效果。研究方法臨床研究:本研究全部病例來自2015年8月至2016年12月就診于北京中醫(yī)藥大學(xué)東直門醫(yī)院兒科門診的患兒,共計(jì)31例患兒進(jìn)入臨床試驗(yàn)。予口服芪丹復(fù)感顆粒(黃芪,白術(shù),太子參,丹參,赤芍,川考,雞內(nèi)金等),根據(jù)患兒臨床病情的不同,隨證加減,若鼻塞流涕者加辛夷、蒼耳子,痰盛加浙貝(燥邪偏盛增加川貝起潤(rùn)肺作用),咽喉腫痛加玄參、板藍(lán)根,咳嗽加炙百部、炙杷葉;濕重者加生白術(shù)、生蒼術(shù),大便干者加瓜萎、炒枳實(shí),治療3個(gè)月�？诜⻊┝恳阑純耗挲g不同而調(diào)整。急性感染者應(yīng)暫停試驗(yàn),對(duì)癥處理。3個(gè)月后進(jìn)行治療前后臨床表現(xiàn)、中醫(yī)證候積分以及血清T細(xì)胞亞群含量對(duì)比。動(dòng)物實(shí)驗(yàn):雄性昆明小鼠70只隨機(jī)分成7組,分辨為模型組、空白對(duì)照組、芪丹復(fù)感顆粒高、中、低劑量組,匹多莫德組,槐杞黃組。每組10只,對(duì)照組生理鹽水,其余各組按照50mg/kg的劑量連續(xù)注射環(huán)磷酰胺溶液3d;同時(shí)各組連續(xù)給藥10天。觀測(cè)免疫低下模型小鼠治療前后,胸腺、脾等臟器指數(shù)以及T細(xì)胞亞群免疫指標(biāo)的變化。統(tǒng)計(jì)方法:以上數(shù)據(jù)均采用Excel錄入,SPSS20.0統(tǒng)計(jì),統(tǒng)計(jì)方法為正態(tài)數(shù)據(jù)采用配對(duì)t檢驗(yàn),組間分析采用單因素方差分析及方差齊性檢驗(yàn),方差齊性數(shù)據(jù)使用Tukey和REGWQ檢驗(yàn),方差不齊數(shù)據(jù)使用Dunnett' st檢驗(yàn)。研究結(jié)果1、經(jīng)過統(tǒng)計(jì),CD3+治療前為65.77±6.70,治療后為66.27±4.42,P0.05無統(tǒng)計(jì)學(xué)意義。CD3+CD4+、CD3+CD8+、CD4+/CD8+在治療前分別為40.78±5.77、22.17±3.46、1.37±0.66,經(jīng)過治療后均呈升高分別為 45.78±3.73、25.13±4.27、1.71±0.11,均P0.05有統(tǒng)計(jì)學(xué)意義。提示芪丹復(fù)感顆粒對(duì)于RRTI患兒免疫力有提升作用。治療前后呼吸道癥狀對(duì)比可見鼻塞流涕癥狀緩解率為84%,咽痛充血緩解率為88%,咳嗽咳痰緩解率為71%,腹脹頻率緩解率為67%。治療前后鼻塞流涕癥狀積分、咽痛充血癥狀積分、咳嗽咳痰癥狀積分、腹脹頻率癥狀積分經(jīng)統(tǒng)計(jì)后P0.05,均有統(tǒng)計(jì)學(xué)意義。提示芪丹復(fù)感顆粒對(duì)于RRTI患兒鼻塞流涕、咽痛充血、咳嗽咳痰、腹脹頻率癥狀有改善作用。2、治療前后中醫(yī)癥狀積分對(duì)比得出自汗、面色少華、納呆食少、倦怠乏力、面色晦暗、眼眶色黑經(jīng)過治療后各癥狀積分均較前下降,且均P0.05有統(tǒng)計(jì)學(xué)意義。提示芪丹復(fù)感顆粒在中醫(yī)癥狀改善方面有顯著療效。3、脾/胸腺指數(shù),經(jīng)組間分析后得出,造模后的小鼠脾指數(shù)和胸腺指數(shù)明顯低于空白對(duì)照組,均P0.01,差異具有統(tǒng)計(jì)學(xué)意義,模型組同匹多莫德組、槐杞黃組及芪丹復(fù)感(高中劑量)組在脾指數(shù)及胸腺指數(shù)上均無明顯差異,均P0.05。芪丹復(fù)感顆粒低劑量的小鼠脾指數(shù)和胸腺指數(shù)有一定的降低,各組間P0.059,差異具有統(tǒng)計(jì)學(xué)意義。T細(xì)胞亞群含量:經(jīng)統(tǒng)計(jì)后得出,CD3+T細(xì)胞占淋巴細(xì)胞比例的各組均較空白組呈升高,均P0.05。模型組與各治療組之間分別比較后無統(tǒng)計(jì)學(xué)意義,P0.05。在CD3+CD4+T細(xì)胞占T細(xì)胞比例中,各組均較空白組呈升高,均P0.05。模型組與各治療組組間比較中僅槐杞黃較要明顯低于模型組,P0.05。CD3+CD8+T細(xì)胞占T細(xì)胞比例方面,各組均較空白組呈降低,均P0.05,而模型組與各治療組間比較中,芪丹復(fù)感低劑量組要明顯低于模型組(P0.05),同時(shí)芪丹復(fù)感中劑量組要低于匹多莫德治療組(P0.05)匹多莫德組、槐杞黃和芪丹復(fù)感高劑量組與模型組間無統(tǒng)計(jì)學(xué)差異(均P0.05)。研究結(jié)論芪丹復(fù)感顆粒對(duì)于氣虛血瘀證反復(fù)呼吸道感染患兒癥狀及中醫(yī)證候有改善作用;芪丹復(fù)感顆粒(低劑量)對(duì)于免疫低下型小鼠血清T細(xì)胞亞群水平有提高作用、對(duì)小鼠免疫力增強(qiáng)。
[Abstract]:The purpose and significance of the study: according to incomplete statistics, respiratory tract infection accounts for about 70% of the children in the outpatient department of Pediatrics in China, of which 30% are recurrent respiratory infections, and the incidence is high. Fever, cough and other diseases, the course of disease is lingering, a few times a year or more than a dozen times, and it is easy to be complicated with pneumonia, asthma, myocarditis, acute nephritis and other serious diseases. It is more likely to increase the possibility of other chronic respiratory diseases in children. It is easy to cause serious damage to children, both in body and in mind, and to worry about family and relatives. Therefore, although recurrent respiratory infection can not be called an independent disease, as a common clinical phenomenon in pediatrics, the severe situation has attracted wide attention of the whole society. The exact cause of RRTI is not known by modern medicine. The study suggests that the occurrence of RRTI may be related to the anatomical characteristics of children, the abnormal immune function, and the lack of trace elements. Deficiency, genetic susceptibility is related to factors such as gene mutation. With the in-depth study of the mucosal immune system, we found that the humoral immunity and cellular immune function of children with RRTI are reduced in varying degrees, especially the cellular immune function changes obviously. The relationship between the lung, the spleen and the immune function appears to be inseparable. In the past Chinese medicine treatment, most of the traditional Chinese medicine, Professor Wang Jun Hong, broke through the inherent traditional ideas and put forward "long illness" on the basis of "lung and spleen homology". This study mainly observed the changes of TCM syndrome and the influence of T cell subsets before and after the treatment of qi deficiency and blood stasis type of recurrent respiratory infection and the preparation of the immunosuppressive mice model. The effect of Qidan compound granule on T cell subsets in immunocompromised model mice was detected and examined. At the same time, the effect of Qidan complex Granule on the immune system of children with RRTI was discussed from two aspects of clinical and experimental. The clinical study of the study methods: all cases from August 2015 to December 2016 were from the east of Beijing University of Chinese Medicine A total of 31 children in the outpatient department of Pediatrics in the hospital of gate hospital were enrolled in the clinical trials. They were given oral Qidan Fu Kang Granules (Huang Qi, Rhizoma Atractylodes, Radix radix ginseng, radix salviae miltiorrhizae, Radix Paeoniae Radix Paeoniae, kagao, chicken inner gold etc.). Sore throat, Radix Isatidis, Radix Isatis Root, coughing with 100 parts, broiled quat leaves; wet heavy people with Atractylodes, cacoatractylodes, cacoatractylodes, cacoatractylodes, fry Fructus aurantii Immaturus for 3 months. The oral dose is adjusted according to the age of children. The patients with acute infection should suspend the experiment for.3 months after treatment, TCM syndrome score and serum T fine. Animal experiment: 70 male Kunming mice were randomly divided into 7 groups, identified as model group, blank control group, Qidan compound granule high, middle and low dose group, pidodoodo group, Huai Qi Huang group. 10 rats in each group, control group physiological saline, and the other groups were injected cyclophosphamide solution 3D continuously according to the dose of 50mg/ kg; meanwhile the groups were continuous in each group. After 10 days of administration, the changes in the index of the thymus and spleen and the immune index of T cell subsets were observed before and after the treatment of the immunocompromised model mice. The statistical methods: the above data were recorded by Excel, SPSS20.0, and the statistical method was positive for normal data by paired t test, and the analysis of the inter group analysis was carried out by single factor analysis of variance and variance homogeneity test, Fang Chaqi The data were tested with Tukey and REGWQ, and the data of variance uneven use Dunnett'st test. Results 1, the results were 65.77 + 6.70 before CD3+ treatment, 66.27 + 4.42 after treatment, P0.05 without statistical.CD3+CD4+, CD3+CD8+ and CD4+/CD8+ were 40.78 + 5.77,22.17 + 3.46,1.37 + 0.66 before treatment, and all were increased after treatment, respectively. It was 45.78 + 3.73,25.13 + 4.27,1.71 + 0.11, all P0.05 had statistical significance. It was suggested that Qidan Fu Qing granule had a promotion effect on the immunity of children with RRTI. The respiratory symptoms before and after treatment showed that the remission rate of nasal congestion was 84%, the remission rate of sore pain was 88%, the rate of cough expectoration remission was 71%, and the rate of abdominal distention frequency relieved before and after 67%. treatment. The symptom score of nasal congestion, the integral of the symptoms of sore pain, the integral of cough and expectoration, the integral of the symptoms of abdominal distention were statistically significant after the statistical P0.05. It suggested that the Qidan Fu Qing granule had the effect of improving the symptoms of nasal congestion, sore throat, coughing and phlegm and abdominal distention in children with RRTI. The symptoms of abdominal distension were improved by.2, and the scores of TCM symptoms before and after the treatment were compared from before and after the treatment. There was a significant effect on the symptom improvement of traditional Chinese medicine.3, the spleen / thymus index, after the analysis of the spleen / thymus index, the spleen index and thymus index of the mice after the model were obtained, and the spleen index and thymus index after the model were obtained. Obviously lower than the blank control group, all P0.01, the difference was statistically significant. There was no significant difference between the model group and the Pi do Maude group, the Huai Qi Huang group and the Qidan complex (high school dose) group in the spleen index and the thymus index. The spleen index and thymus index of the mice in the low dose of P0.05. Qidan complex granules were reduced, and the difference was P0.059 in each group. The content of.T cell subgroup was statistically significant: after statistics, it was found that the proportion of CD3+T cells in the proportion of lymphocytes was higher than that in the blank group, and there was no statistical significance between the P0.05. model group and the treatment groups. P0.05. was higher in the proportion of T cells in CD3+CD4+T cells than in the blank group, all P0.05. model groups and each treatment group were treated with each treatment. Compared with the model group, the ratio of P0.05.CD3+CD8+T cells to T cells was lower than that in the blank group, which was lower than that of the model group. In the comparison between the model group and the treatment group, the low dose group of Qidan complex was significantly lower than that of the model group (P0.05), and the dose group in the Qidan complex was lower than the Pi do Maude treatment group. Group (P0.05) pidodo group, Huai Qi Huang and Qidan complex high dose group had no statistical difference between the model group and the model group (P0.05). Conclusion Qidan complex granule could improve the symptoms and TCM Syndromes of children with recurrent respiratory infection of qi deficiency and blood stasis syndrome, and Qidan complex granule (low dose) was used in the subgroup of serum T cells in immunocompromised mice. It has an enhanced effect and enhances immunity in mice.

【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】：2017
【分類號(hào)】：R272

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