發(fā)布時(shí)間：2018-03-29 02:26

  本文選題：銀屑病　切入點(diǎn)：藥物性肝損害　出處：《南京中醫(yī)藥大學(xué)》2013年碩士論文

【摘要】：目的：銀屑病俗稱“牛皮癬”,是一種常見的、容易反復(fù)發(fā)作的慢性炎癥性皮膚病。治療中、重度銀屑病的藥物中如甲氨蝶呤、維A酸類等一線藥物的長期使用則可能會引起肝損害。本課題通過臨床觀察和實(shí)驗(yàn)研究雙環(huán)醇片對嚴(yán)重銀屑病治療中的藥物性肝損害的保護(hù)作用,從而為優(yōu)化臨床治療銀屑病方案提供線索和實(shí)驗(yàn)根據(jù)。 方法：實(shí)驗(yàn)一：按照患者就診順序?qū)⒎霞{入標(biāo)準(zhǔn)的研究對象按隨機(jī)數(shù)字表法分為2組,一組為治療組,共12例；一組為對照組,共17例。治療組在治療銀屑病期間,出現(xiàn)藥物性肝損害后口服雙環(huán)醇片(25mg,一日3次),治療至肝功能指標(biāo)恢復(fù)正常。對照組在治療期間,出現(xiàn)藥物性肝損害后連續(xù)口服甘利欣片(甘草酸二銨150mg,一日2次),治療至肝生化指標(biāo)恢復(fù)正常。觀察兩組的肝功能恢復(fù)至正常的情況。實(shí)驗(yàn)二：將40只ICR小鼠隨機(jī)分為5組,分別為A組空白對照組、B組雷公藤造模組、C組雙環(huán)醇高劑量組、D組雙環(huán)醇低劑量組、E組甘利欣對照組。A、B組給予羧甲基纖維素混懸液口服,C組、D組、E組給予相應(yīng)藥物處理5天后,第6天后4組給予雷公藤口服。24h后取血處死,解剖取肝臟,觀測血清指標(biāo)及病理情況。 結(jié)果：臨床實(shí)驗(yàn)表明雙環(huán)醇與甘利欣均有保肝降酶的作用(P0.05),雙環(huán)醇的總有效率為100%,甘利欣的總有效率為94.12%兩者療效無明顯差異(P0.05)。動物實(shí)驗(yàn)表明各組小鼠血清AST比較,模型對照組明顯大于空白對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。雙環(huán)醇高劑量組、甘利欣均小于模型對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。雙環(huán)醇低劑量與模型組相似,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。雙環(huán)醇高劑量組與甘利欣組相似,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。雙環(huán)醇低劑量組大于甘利欣組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：雙環(huán)醇能降低藥物所致的肝酶升高,減輕肝細(xì)胞的變性壞死程度,具有保肝降酶的作用。
[Abstract]:Objective: psoriasis commonly known as "psoriasis" is a common, chronic inflammatory skin disease easy to attack again. In the treatment of severe psoriasis drugs such as methotrexate, long-term use of vitamin A acid and other first-line drugs may cause liver damage. The protective effect of this issue through clinical observation and Experimental Research on Bicyclol Tablets serious psoriasis in the treatment of drug-induced liver injury, so as to optimize the clinical treatment of psoriasis solutions provide clues and experimental basis.
Methods: experiment one: according to the sequence of patients met the inclusion criteria of the study were divided into 2 groups randomly, one group was the treatment group, 12 cases; one was control group, a total of 17 cases. The treatment group in the treatment of psoriasis during the emergence of drug-induced liver injury after oral administration (25mg, Bicyclol Tablets 3 times a day), normal recovery treatment to liver function. The control group during the treatment period, the emergence of drug-induced liver injury after continuous oral tablets (diammonium glycyrrhizinate diammonium glycyrrhizinate 150mg, 2 times a day), normal recovery treatment to the liver biochemical indicators. The liver function of two groups recovered to normal. Experiment two: 40 ICR mice were randomly divided into 5 groups, group A control group, B group, C group, Tripterygium wilfordii model, bicyclol group D high dose group, low dose group of bicyclol group, E control group.A group B Diammonium Glycyrrhizinate, treated with carboxymethyl cellulose oral suspension, C group, D group E were given corresponding drugs After 5 days of treatment, after sixth days, the 4 groups were given blood from the 4 groups of Tripterygium wilfordii, and the liver was dissected and the serum indexes and pathological conditions were observed.
Results: the clinical experiment showed that bicyclol and Potenline were hepatoprotection effect of bicyclol (P0.05), the total efficiency is 100%, with the total effective rate was 94.12% in the two effects are not significantly different (P0.05). The animal experiment showed that the level of serum AST of mice in each group, model control group was significantly greater than the control group, there was statistical significant differences (P0.05). Bicyclol in high dose group, diammonium glycyrrhizinate were less than the model control group, the difference was statistically significant (P0.05). Low dose of bicyclol is similar with the model group, the difference was not statistically significant (P0.05). Bicyclol in high dose group and simvastatin group were similar, no significant difference (P0.05) double. Low dose of alcohol group than diammonium glycyrrhizinate group, the difference was statistically significant (P0.05).
Conclusion: dicyclic alcohols can reduce the increase of liver enzymes caused by drugs, reduce the degree of degeneration and necrosis of liver cells, and have the effect of protecting liver and reducing enzymes.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R758.63

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