本文關(guān)鍵詞：COPD合并抑郁狀態(tài)的臨床病證分析及加味二陳湯干預(yù)效應(yīng)的實(shí)驗(yàn)研究　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： COPD 抑郁 證候 加味二陳湯 UPLC 多巴胺

【摘要】：目的：探討COPD合并抑郁的臨床現(xiàn)狀與病證特點(diǎn),研究加味二陳湯對(duì)大鼠COPD合并抑郁模型的干預(yù)效應(yīng),為COPD合并抑郁的研究提供新思路,為中醫(yī)臨床治療COPD合并抑郁提供基礎(chǔ)資料和參考。方法：1.臨床研究：采用橫斷面調(diào)查研究方法,調(diào)研自2015年6月至2016年2月在江蘇省第二中醫(yī)院、江蘇省中西醫(yī)結(jié)合醫(yī)院呼吸內(nèi)科確診為COPD的住院患者116例,排除不合格樣本后,實(shí)際納入99例進(jìn)行SDS量表問(wèn)卷調(diào)查,分析其伴有抑郁狀態(tài)患者的分布以及證型特點(diǎn)。2.實(shí)驗(yàn)研究：建立大鼠COPD以及COPD合并抑郁模型。采用氣管內(nèi)注入LPS、煙熏制作大鼠COPD模型,并復(fù)加給予隨機(jī)應(yīng)激刺激制作大鼠COPD合并抑郁模型。以加味二陳湯(二陳湯加白術(shù)、黃連、遠(yuǎn)志)分別干預(yù)大鼠COPD模型(地塞米松為對(duì)照)以及COPD合并抑郁模型(地塞米松+鹽酸氟西汀為對(duì)照),觀察該方對(duì)大鼠COPD和COPD合并抑郁模型肺病理學(xué)、氣道炎癥變化,以及對(duì)COPD合并抑郁模型的體重、行為學(xué)(開(kāi)場(chǎng)實(shí)驗(yàn))、糖水試驗(yàn)的影響,采用UPLC技術(shù)檢測(cè)各組大鼠腦海馬體中多巴胺(DA)的含量變化。結(jié)果：1.臨床調(diào)查結(jié)果(1)COPD患者的證型特點(diǎn)。COPD患者99例,男性53例,女性46例,年齡(68.14±9.04)歲,證型分布包括痰熱蘊(yùn)肺證64例、痰濁壅肺證14例、肺腎氣陰兩虛證21例。(2)COPD合并抑郁的情況分析。經(jīng)SDS量表分析,合并抑郁狀態(tài)的患者48例,占總數(shù)的48.48%。其中SDS得分0.5至0.59(輕度抑郁)的患者共14例,SDS得分0.6至0.69(中度抑郁)的患者共24例,SDS得分大于0.7(重度抑郁)的患者共10例。COPD合并抑郁狀態(tài)的48例患者中,其主證為痰熱蘊(yùn)肺者30例、占總抑郁人數(shù)比達(dá)到62%,痰濁壅肺者11例、占總抑郁人數(shù)比為23%,肺腎氣陰兩虛者7例、占總抑郁人數(shù)比為15%。2.實(shí)驗(yàn)結(jié)果(1)加味二陳湯干預(yù)大鼠COPD模型的效應(yīng)：加味二陳湯顯著改善大鼠COPD模型的肺病理,顯著減少BALF內(nèi)中性粒細(xì)胞數(shù)比例,與模型組相比有差異(P0.01-0.05)。(2)加味二陳湯干預(yù)大鼠COPD合并抑郁模型的效應(yīng)及機(jī)制：1)COPD合并抑郁模型的肺病理和BALF氣道炎癥比單純COPD組嚴(yán)重。加味二陳湯對(duì)COPD合并抑郁大鼠模型的肺病理具有改善作用,顯著減少BALF中炎細(xì)胞數(shù)比例,與模型組相比有差異(P0.01-0.05)。2)COPD合并抑郁模型組大鼠體重下降,第14、21、28天與空白對(duì)照組大鼠體重相比有極顯著統(tǒng)計(jì)學(xué)差異(P0.01)。加味二陳湯高、低劑量給藥組與COPD合并抑郁模型組比較體重上升,第14、21、28天與COPD合并抑郁模型組比較具有顯著與極顯著統(tǒng)計(jì)學(xué)意義(P0.01-0.05)。3)COPD合并抑郁模型組大鼠行為學(xué)明顯改變、糖水消耗量降低。加味二陳湯改善COPD合并抑郁模型的行為學(xué)表現(xiàn),增加其糖水消耗量,open-field實(shí)驗(yàn)顯示第14、28天COPD合并抑郁模型組與空白對(duì)照組相比有顯著統(tǒng)計(jì)學(xué)差異(P0.05);加味二陳湯高、低劑量給藥組與COPD合并抑郁模型組比較相比有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。4)UPLC檢測(cè)各組大鼠腦海馬體中多巴胺(DA)的含量,COPD合并抑郁模型組與空白對(duì)照組相比腦組織中多巴胺(DA)含量明顯降低(P0.01);加味二陳湯高、低劑量組與COPD合并抑郁模型組比較腦組織中多巴胺(DA)含量有所升高,具有顯著統(tǒng)計(jì)學(xué)差異(P0.01-0.05),但是低于COPD合并抑郁陽(yáng)性藥組(地塞米松+鹽酸氟西汀)。結(jié)論：1.本研究通過(guò)99例COPD臨床資料分析發(fā)現(xiàn),合并抑郁狀態(tài)的COPD患者占48.48%,以中度抑郁稍多。COPD合并抑郁狀態(tài)中醫(yī)證型分析,其主證為痰熱蘊(yùn)肺證占總抑郁62%、痰濁壅肺證占23%、肺腎氣陰兩虛證占15%。2.本研究通過(guò)對(duì)加味二陳湯干預(yù)COPD合并抑郁狀態(tài)的作用進(jìn)行觀察,發(fā)現(xiàn)采用氣管內(nèi)注入LPS、煙熏并隨機(jī)給予應(yīng)激刺激復(fù)制大鼠COPD合并抑郁模型,其肺部病變較COPD模型更為嚴(yán)重,同時(shí)體重、行為學(xué)、糖水消耗量、腦組織中多巴胺(DA)水平明顯改變。加味二陳湯可以改善其肺病理,明顯降低其BALF內(nèi)中性粒細(xì)胞數(shù)比例,改善其體重變化、行為學(xué)表現(xiàn)、增加其糖水消耗量,增加其腦組織中多巴胺(DA)含量。結(jié)果提示,加味二陳湯對(duì)COPD以及COPD合并抑郁狀態(tài)具有明顯的干預(yù)作用。以上研究為COPD合并抑郁狀態(tài)的臨證辨治研究,以及化痰散郁方藥加味二陳湯治療COPD合并抑郁狀態(tài)提供了基礎(chǔ)性研究資料。
[Abstract]:Objective: To investigate the clinical situation and syndrome characteristics of COPD with depression and intervention effect of Jiawei Decoction on rats with two COPD depression model, provide new ideas for the study of COPD patients with depression, provide basic data and reference for clinical treatment of COPD complicated with depression. Methods: 1. clinical research: This was a cross-sectional study. Research from June 2015 to February 2016 in second Chinese Medicine Hospital of Jiangsu Province, Jiangsu Province Traditional Chinese Medicine Hospital of respiratory medicine COPD was diagnosed in 116 cases, eliminate unqualified samples, the actual included 99 cases of SDS scale questionnaire, analyzed the distribution status of patients with depression and syndrome characteristics of.2.: a experimental study COPD and COPD rats with depression model. By intratracheal instillation of LPS, smoked rat models of COPD were made, and added random stress stimulation in rats given COPD combined with anti Yu Mo With the modified two type. Chen Tang (Tonga Erchen Atractylodes, Rhizoma Coptidis, Radix Polygalae) were treated COPD rats (dexamethasone as control) and COPD model with depression (dexamethasone + fluoxetine as control), observe the side of COPD and COPD in rat model of depression with lung pathological changes in airway inflammation, and the weight of patients with depression the model of COPD (open field test), behavioral effects, sugar test, using UPLC technology to detect rat hippocampus in dopamine (DA) levels were observed. Results: 1. clinical findings (1) 99 type of syndrome characteristics of.COPD patients with COPD patients, male 53 cases, female 46 cases. Age (68.14 + 9.04) years old, syndrome distribution including 64 cases of phlegm, phlegm syndrome 14 cases, lung and kidney yin deficiency syndrome in 21 cases. Two (2) of COPD with depression. The SDS scale analysis, 48 patients with depressive state, accounting for 48.48%. the SDS 0.5 to 0.59 (mild depression) with a total of 14 cases, SDS score of 0.6 to 0.69 (moderate depression) with a total of 24 cases, SDS score greater than 0.7 (severe depression) 48 cases of patients with a total of 10.COPD patients with depression in patients with 30 cases, the main symptom is heat phlegm. The total number of people with depression to reach more than 62%, 11 cases of phlegm, the total number of depression ratio was 23%, 7 cases of lung and kidney yin deficiency accounted for two, the total number of depression than for the 15%.2. experimental results (1) the effect of Jiawei Decoction intervention two COPD rat model of pulmonary pathology: modified two Decoction significantly improved the COPD model rats, significantly reduce the number of neutrophil proportion in BALF, there are differences compared with the model group (P0.01-0.05). (2) the effect and mechanism of Jiawei Decoction on rats with two COPD depression model: 1) lung pathology and BALF airway inflammation of COPD with depression model is worse than pure COPD group. "Two of COPD patients with depression Decoction Lung pathology in rat model with improved function, significantly reduce the number of inflammatory cells in BALF ratio, there are differences compared with the model group (P0.01-0.05).2) COPD depression model rats body weight decreased at 14,21,28 days and the rats weight in blank control group had significant difference compared with two (P0.01). Chen Tanggao, low dose group and COPD combined with depression model group weight increased, 14,21,28 days and COPD with depression model group compared with significant and very significant (P0.01-0.05).3) COPD depression model rats behavior change, sugar consumption decreased. Two improved COPD manifestations Jiawei decoction combined with depression and the behavior of the model study, increase the consumption of sucrose, open-field test showed that there were significant differences in 14,28 days COPD depression model group compared with the control group (P0.05); modified Erchen decoction high and low dose group COPD combined with depression model group compared with significant difference (P0.05).4) UPLC dopamine in rat hippocampus were detected in the body of the content of dopamine (DA), brain tissue compared to COPD patients with depression model group and blank control group (DA) were significantly decreased (P0.01); in two Chen Tanggao, dopamine in brain tissue compared with depression group and COPD model group, low dose (DA) content increased, the difference was statistically significant (P0.01-0.05), but lower than that of COPD with depression positive drug group (dexamethasone + fluoxetine). Conclusion: 1. the clinical data of 99 cases of COPD analysis showed that depression in patients with COPD accounted for 48.48%. With slightly more moderate depression.COPD depression in TCM analysis, the main symptom is phlegm depression accounted for 62%, phlegm syndrome accounted for 23%, two lung kidney yin deficiency accounted for 15%.2. based on the modified Chen Tanggan two To observe the state of COPD with pre depression effect, found by intratracheal instillation of LPS, and smoked were given stress stimulation in rats with COPD depression model, the lung disease is more serious than the COPD model at the same time, weight, behavior, sugar consumption, brain dopamine (DA) levels were significantly changed. Modified two decoction can improve the pulmonary pathology, significantly reduced the number of neutrophils in the proportion of BALF, the changes of body weight, behavior, increase the sugar consumption, increase of dopamine in the brain (DA) content. The results showed that two modified decoction has obvious intervention effect on COPD and COPD complicated with depression study on clinical treatment. The above research of depression is COPD, and the state of Yu phlegm loose recipe two Decoction in treatment of COPD complicated with depression provides the basic research data.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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