發(fā)布時間：2018-10-12 14:06

【摘要】：目的 小兒厭食癥(advance of infantile)是指小兒較長時間食欲不振或食欲減退,見食不貪,甚則拒食,進食量減少,是一種慢性消化功能紊亂綜合征,是兒科常見病、多發(fā)病,1-6歲小兒多見,城市兒童發(fā)病率較高。若病程遷延不愈者,可使氣血化生乏源,抗病能力下降,罹患他癥,可導致小兒營養(yǎng)不良、貧血佝僂病及免疫力低下,出現(xiàn)反復呼吸道感染,對兒童生長發(fā)育、營養(yǎng)狀態(tài)和智力發(fā)展也有不同程度的影響。目前西醫(yī)治療效果不太理想,而中醫(yī)治療小兒厭食癥具有療效佳、不良反應少等優(yōu)勢。近年來現(xiàn)代醫(yī)學對血清瘦素與厭食癥相關性進行了相關的研究,瘦素是脂肪細胞分泌的一種蛋白激素,對食欲和能量代謝具有重要的調節(jié)作用,瘦素作用于下丘腦使POMC系統(tǒng)合成增加,引起一系列的生理反應,使食欲下降,耗能增加及交感神經興奮性增加,而當瘦素水平下降時,瘦素作用于下丘腦使神經肽Y合成,分泌增加,通過Y5受體,機體產生相應的反應,即食欲增加,副交感功能增加,耗能降低,體溫降低,從而恢復脂肪容量。從古至今針刺四縫穴對治療小兒厭食癥有較好的療效,觀察針刺四縫穴對兒童厭食癥血清瘦素的影響,探討運用該方法治療小兒厭食癥的有效性與血清瘦素水平變化的相關性,從而為其在臨床上的推廣應用奠定理論基礎。 方法 本試驗對符合條件的研究對象分為兩組：治療組(針刺四縫穴),對照組(正常兒童),按擬定的方案進行研究,其中治療組(針刺四縫穴)15例,對照組(正常兒童)15例,觀察針刺四縫穴對患兒食欲、食量及治療組治療前、后的瘦素水平與正常兒童瘦素水平比較,進行統(tǒng)計分析,進而初步探討該方法治療小兒厭食癥有效性的作用機制。 成果 ①針刺四縫穴治療脾胃氣虛型小兒厭食癥總有效率為86.7%。治療組治療前、后主要癥狀總積分比較,治療前與治療后食量、食欲積分比較差異有統(tǒng)計學意義(P0.05)： ②治療組治療前血清瘦素水平與正常小兒血清瘦素水平相比(同性別)均有統(tǒng)計學意義(女：P0.01),(男：P0.05)； ③治療組治療后血清瘦素水平與正常小兒血清瘦素水平相比(同性別)均無統(tǒng)計學意義(女：P0.01),(男：P0.05)； ④治療組治療前、后血清瘦素水平相比(同性別)均有統(tǒng)計學意義(女：P0.05),(男：P0.01)。 結論 瘦素作為一種主要由脂肪細胞分泌,具有重要生物活性的多膚類激素,在調節(jié)食欲及能量代謝過程中發(fā)揮著重要作用。針刺四縫穴能顯著改善患兒食欲、食量等主要癥狀,使體內瘦素的水平發(fā)生變化,使其接近正常兒童血清瘦素水平,從而起到控制食欲及能量消耗的作用,改善厭食癥狀。
[Abstract]:Objective (advance of infantile) is a chronic dyspeptic syndrome and is a common disease in pediatrics, which refers to children's anorexia or anorexia for a long time, which is not greedy, even refuses to eat, and reduces the amount of food consumed, so it is a kind of chronic digestive dysfunction syndrome, and it is a common disease in pediatrics. Children aged 1-6 years are more common, urban children have a higher incidence. If the course of the disease is prolonged, it can cause the deficiency of qi and blood, the decrease of disease resistance, and the development of other diseases, which may lead to malnutrition in children, anemia, rickets and low immunity, recurrent respiratory tract infection, and the growth and development of children. Nutritional status and intellectual development also have varying degrees of influence. At present, the effect of western medicine is not ideal, and Chinese medicine has the advantages of good curative effect and less adverse reactions in treating anorexia in children. In recent years, the relationship between serum leptin and anorexia has been studied in modern medicine. Leptin is a protein hormone secreted by adipocytes, which plays an important role in regulating appetite and energy metabolism. Leptin acting on the hypothalamus increased the synthesis of POMC system, caused a series of physiological responses, decreased appetite, increased energy consumption and increased sympathetic excitability. When leptin level decreased, leptin induced neuropeptide Y synthesis in hypothalamus. Through Y5 receptor, the body produces corresponding responses, that is, increased appetite, increased parasympathetic function, lower energy consumption and lower body temperature, thus restoring fat capacity. The effect of acupuncture on children's anorexia was observed, and the relationship between the effect of acupuncture on serum leptin and the changes of serum leptin level in children with anorexia was discussed, so as to observe the effect of acupuncture on children's anorexia, and to explore the relationship between the effect of acupuncture on children's anorexia and the changes of serum leptin levels. So as to lay a theoretical foundation for its clinical application. Methods the subjects in this study were divided into two groups: treatment group (acupuncture at Sijiao point) and control group (normal children). In the control group (normal children), 15 cases were treated with acupuncture on appetite, food quantity and leptin level before and after treatment, and the leptin level was compared with that of normal children. Furthermore, the mechanism of the efficacy of this method in the treatment of infantile anorexia was discussed. Results 1 the total effective rate of acupuncture at Siliang point was 86.7 in treating children anorexia of spleen and stomach qi deficiency. Before and after treatment, the total scores of major symptoms in the treatment group were compared, and the amount of food consumed before and after treatment, The difference of appetite score was statistically significant (P0.05): 2Serum leptin level in treatment group was significantly higher than that in normal children (same sex) (female: P0.01), (male: P0.05); 3There was no significant difference in serum leptin levels between the treatment group and the normal children (same sex) after treatment (female: P0.01), (: P0.05); After the serum leptin level compared with (the same sex) have statistical significance (female: P0.05), (male: P0.01). Conclusion leptin, a polypeptide hormone secreted mainly by adipocytes and having important biological activity, plays an important role in the regulation of appetite and energy metabolism. Acupuncture at Sijiao point can significantly improve the main symptoms such as appetite, food intake and so on, make the level of leptin in the body change, make it close to the level of serum leptin in normal children, thus play the role of controlling appetite and energy consumption, and improve anorexia symptoms.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R246.4

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