本文選題：系統(tǒng)性硬化癥 + 溫陽活血通絡法��； 參考：《湖北民族學院》2014年碩士論文

【摘要】：目的：通過臨床藥物驗證的方法觀察溫陽活血通絡法聯(lián)合醋酸潑尼松治療系統(tǒng)性硬化癥的臨床療效，并初步探討其作用機理，為臨床應用提供可靠、客觀、科學的理論依據(jù)。 方法：1.收集SSc患者臨床標本，并隨機分為溫陽活血通絡法聯(lián)合醋酸潑尼松治療組（中西藥治療組）和醋酸潑尼松治療組（西藥治療組），治療8周后，觀察其有效率、皮膚積分、關(guān)節(jié)壓痛積分及安全性評定指標；2.將SSc患者和與之匹配的健康體檢者，清晨空腹抽取上肢靜脈血2ml，提取分離外周血單個核細胞，逆轉(zhuǎn)錄cDNA，實時熒光定量聚合酶鏈（RT-PCR）技術(shù)檢測TGF-β1、CCL2/MCP-1、CCL5/RANTES在系統(tǒng)性硬化癥患者外周血單個核細胞中mRNA的表達，并與正常對照組進行比較，了解上述致病因子在SSc患者PBMC中mRNA的表達及病情發(fā)展相關(guān)性，為明確溫陽活血通絡法聯(lián)合醋酸潑尼松治療本病的作用機理奠定基礎，同時將參與臨床藥物驗證的SSc患者，通過檢測治療前后上述致病因子mRNA表達變化情況，來闡述其作用機理。 結(jié)果：1臨床觀察①參與臨床觀察的系統(tǒng)性硬化癥患者35例，中西藥治療組20例，男性3例，女性17例，平均年齡為（47.2±11.2），，西藥治療組15例，全為女性，平均年齡為（40.8±4.76），兩組患者治療前基本情況比較差異無統(tǒng)計學意義（p＞0.05）；②兩組患者治療后，其臨床療效中西藥治療組20例痊愈0(0)%，顯效3（15%），有效14（70%），無效3（15%），總有效率為85%，西藥對照組15例，痊愈0(0)%，顯效0（0），有效8例（53.3%），無效7例（46.7%），總有效率為53.3%，明顯低于中西藥治療組（85%），差異有統(tǒng)計學意義(p＜0.05)；③兩組患者治療前皮膚積分、關(guān)節(jié)壓痛積分差異無統(tǒng)計學意義（p＞0.05），治療后皮膚積分、關(guān)節(jié)積分均有一定程度降低，但中西藥組要優(yōu)于西藥治療組，且差異有統(tǒng)計意義（p＜0.05）；④兩組患者經(jīng)藥物治療后，實驗室指標檢查血沉均有明顯下降，中西藥組治療前后血沉下降差異有統(tǒng)計學意義（p＜0.05），兩組治療后血沉差異有統(tǒng)計學意義（p＜0.05）；⑤兩組患者治療后均未出現(xiàn)明顯的不良反應和毒副作用，安全性指標也均未出現(xiàn)異常。 2實驗研究結(jié)果①檢測52例SSc患者及健康體檢者PBMC中TGF-β1、MCP-1、RANTES mRNA的表達RQ值分別為（1.95±1.58）、（0.98±0.63）、（1.33±0.81），均高于健康對照組（1.10±0.54）、（0.90±0.25）、（1.04±0.34），且差異有統(tǒng)計學意義（p＜0.05）；②進一步分析其表達高低與SSc病情相關(guān)性發(fā)現(xiàn)，血沉、C反應蛋白在RQ值高的組大于RQ值低的組，且差異有統(tǒng)計學意義（p＜0.05），補體C3、C4、抗核抗體陽性率、抗Scl-70抗體陽性率、抗Jo-1抗體陽性率、肺間質(zhì)纖維化等在RQ值表達高的組大于RQ值表達低的組，但差異無統(tǒng)計學意義(p＞0.05)；③對兩組患者治療前后轉(zhuǎn)化生長因子、趨化因子差值進行比較，發(fā)現(xiàn)兩組患者治療8周后均能降低其表達，但中西藥組要優(yōu)于西藥治療組，且差異具有統(tǒng)計學意義（p＜0.05），而TGF-β1在兩組患者中治療前后差值無統(tǒng)計學意義（p＞0.05）。 結(jié)論：1溫陽活血通絡法聯(lián)合醋酸潑尼松治療系統(tǒng)性硬化癥在改善和控制皮膚硬化、關(guān)節(jié)疼痛、紅細胞沉降率等方面有一定療效，且安全性較好；2.轉(zhuǎn)化生長因子（TGF-β1）、趨化因子（MCP-1、RANTES）在SSc患者外周血單個核細胞（PBMC）中mRNA的表達上調(diào)可促進SSc的發(fā)生與進展；3溫陽活血通絡法聯(lián)合醋酸潑尼松治療SSc可能是通過抑制趨化因子（MCP-1、RANTES）的表達而起作用，其抑制MCP-1、RANTES的表達可能為其抗纖維化的機制之一。
[Abstract]:Objective: To observe the clinical efficacy of Wenyang Huoxue Tongluo method combined with prednisone acetate in the treatment of systemic sclerosis by clinical drug validation, and to explore its mechanism of action and provide a reliable, objective and scientific basis for clinical application.
Methods: 1. the clinical specimens of SSc patients were collected, and they were randomly divided into two groups: Warm Yang activating blood circulation method combined with prednisone acetate treatment group (Chinese and Western medicine treatment group) and prednisone acetate treatment group (Western medicine treatment group). After 8 weeks of treatment, the efficiency, skin integral, joint pressure pain score and safety assessment index were observed. 2. the matched health of patients with SSc and the health were matched. The examiners took the upper limb venous blood 2ml early in the morning, extracted the peripheral blood mononuclear cells, reverse transcriptase cDNA, real-time fluorescence quantitative polymerase chain (RT-PCR) technique to detect the expression of TGF- beta 1, CCL2/MCP-1, CCL5/RANTES in the peripheral blood mononuclear cells of patients with systemic sclerosis, and compared with the normal control group to understand the above pathogenicity. The relationship between the expression of mRNA and the development of the disease in the PBMC of SSc patients is the basis for determining the mechanism of the action of prednisone acetate with the method of Warming Yang activating blood circulation and collaterals. At the same time, the SSc patients who are involved in the clinical drug validation are examined by the changes of the mRNA table of the above pathogenic factors before and after the treatment.
Results: 1 in clinical observation, there were 35 patients with systemic sclerosis, 20 cases in Chinese and Western medicine, 3 in men and 17 in women, with the average age of (47.2 + 11.2), and 15 in the western medicine treatment group. The average age was (40.8 + 4.76). The basic situation of the two groups before treatment was not statistically significant (P > 0.05); (2) two groups After the treatment, 20 cases in the treatment group were cured by 0 (0)%, 3 (15%), 14 (70%), 3 (15%), 85% in the total, 15 in the western medicine control group, 20 in the control group. (3) there was no statistical difference between the two groups before treatment and the score of joint pressure pain was not statistically significant (P > 0.05). After treatment, the skin integral and joint integral were reduced to a certain extent, but the Chinese and Western medicine groups were superior to the western medicine treatment group, and the difference was statistically significant (P < 0.05). (4) after the drug treatment, the laboratory indexes were obvious. There was significant difference between the Chinese and Western medicine group before and after treatment (P < 0.05), and the difference in the two groups after treatment was statistically significant (P < 0.05). 5. After treatment, there were no obvious adverse reactions and side effects in the two groups, and the safety indexes were also not abnormal.
2 test results (1) the expression of TGF- beta 1, MCP-1, RANTES mRNA in 52 SSc patients and healthy subjects was (1.95 + 1.58), (0.98 + 0.63) and (1.33 + 0.81), respectively higher than that of the healthy control group (1.10 + 0.54), (0.90 + 0.25), and the difference was statistically significant (P < p). Secondly, the expression level and SSc disease were further analyzed. It was found that the group of C reactive protein in the group with high RQ value was higher than that of the low RQ value group, and the difference was statistically significant (P < 0.05), the complement C3, C4, the positive rate of anti nuclear antibody, the positive rate of anti Scl-70 antibody, the positive rate of anti Jo-1 antibody and pulmonary interstitial fibrosis were higher than the low expression of RQ value in the group of RQ (P), but the difference was not statistically significant (P) > 0.05); (3) comparing the TGF and chemokine difference between the two groups before and after treatment, it was found that the two groups were able to reduce their expression after 8 weeks of treatment, but the Chinese and Western medicine group was better than the western medicine group, and the difference was statistically significant (P < 0.05), while the difference of TGF- beta 1 was not statistically significant before and after treatment in the two groups (P > 0.05).
Conclusion: 1 the treatment of systemic sclerosis with prednisone acetate and warming yang in combination with prednisone acetate is effective in improving and controlling skin sclerosis, joint pain and erythrocyte sedimentation rate, and has good safety. 2. the expression of TGF- (MCP-1, RANTES) and mRNA expression in peripheral blood mononuclear cells (PBMC) of SSc patients Up regulation can promote the occurrence and progress of SSc; 3 the treatment of SSc with prednisone acetate and warm yang activating blood circulation method may play a role by inhibiting the expression of MCP-1 (RANTES), which inhibits the expression of MCP-1, and the expression of RANTES may be one of the mechanisms of anti fibrosis.
【學位授予單位】：湖北民族學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R744.51

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