本文關(guān)鍵詞： 抽動障礙 證治規(guī)律 止抽湯 作用機(jī)制 多巴胺系統(tǒng)　出處：《云南中醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：中醫(yī)藥治療抽動障礙(Tic disorders,TD)有其特色和優(yōu)勢,為客觀評價中藥復(fù)方治療TD的療效,探討證治規(guī)律及作用機(jī)制,本論文做了相關(guān)研究,全文共分為兩部分。第一部分:通過收集文獻(xiàn),加以整理而探討中藥復(fù)方治療TD的證治規(guī)律。檢索2005年至2015年關(guān)于中藥復(fù)方治療抽動障礙的臨床文獻(xiàn),符合納入要求的文獻(xiàn)共125篇。2015年的文獻(xiàn)數(shù)量最多(20篇),其次是2014年(18篇)、2013年(18篇)、2012年(15篇)。會議論文4篇,學(xué)位論文35篇,期刊論文86篇,中藥復(fù)方治療抽動障礙的樣本量共6090例。23篇文獻(xiàn)采用自身對照試驗方法,84篇文獻(xiàn)采用隨機(jī)對照試驗方法,18篇文獻(xiàn)為非隨機(jī)對照試驗研究。125篇文獻(xiàn)中,有關(guān)中藥復(fù)方的不良反應(yīng)或安全性研究的文獻(xiàn)共計15篇。結(jié)果顯示中藥復(fù)方臨床研究治療TD的數(shù)量呈逐年增加的趨勢,但臨床試驗的科學(xué)性、實驗結(jié)果的可信性以及中藥復(fù)方的安全性研究有待加強(qiáng)、提高。主要問題在于:1、臨床試驗研究未能科學(xué)的遵循隨機(jī)、盲法原則。84篇隨機(jī)對照試驗研究中,提及隨機(jī)方法的文獻(xiàn)共30篇,3篇文獻(xiàn)提到了隨機(jī)隱藏,雙盲法臨床研究文獻(xiàn)2篇。2、對中藥復(fù)方的不良反應(yīng)和安全性評價的觀察研究不夠重視。125篇臨床文獻(xiàn)中,66篇研究了具體證型,共統(tǒng)計出36種證型,頻數(shù)排名前三的證型分別為:肝風(fēng)內(nèi)動,風(fēng)痰內(nèi)擾型(8篇)、脾虛肝亢型(7篇)、肝風(fēng)亢動型(6篇)。125篇臨床文獻(xiàn)共涉及182味中藥,使用頻數(shù)超過30次的中藥為:白芍(94次)、鉤藤(86次)、天麻(56次)、僵蠶(51次)、甘草(50次)、全蝎(39次)、膽南星(39次)、龍骨(37次)、石菖蒲(36次)、柴胡(33次)、牡蠣(33次)。對182味中藥功效進(jìn)行分類,共分16類,使用頻數(shù)排名前五的為:平肝熄風(fēng)藥(330次,用藥14種)、補(bǔ)氣藥(150次,用藥12種)、補(bǔ)血藥(135次,用藥5種)、清熱藥(132次,用藥27種)、安神藥(130次,用藥16種)、化痰止咳藥(120次,用藥14種)。182味中藥主要歸經(jīng)為:肝經(jīng)(114次)、脾經(jīng)(67次)、腎經(jīng)(62次),肺經(jīng)(60次)、心經(jīng)(56次)。主要用藥的聚類分析結(jié)果:C1:茯苓、珍珠母、遠(yuǎn)志、白術(shù)、生地黃、當(dāng)歸、陳皮、蟬蛻;C2:膽南星、全蝎、龍骨、石菖蒲、牡蠣、柴胡、郁金;C3:僵蠶、甘草、天麻;C4:白芍、鉤藤。通過對證型,中藥的使用頻數(shù)、種類、歸經(jīng),主要用藥的聚類結(jié)果進(jìn)行統(tǒng)計分析討論�？偨Y(jié)出TD的病因病機(jī)特點為:本病多由臟腑功能失調(diào)所致,病位主要在肝臟,常涉及脾、腎二臟。主要的病機(jī)特點為肝風(fēng)內(nèi)動、痰熱膠結(jié)擾神成疾。平肝息風(fēng)原則是中醫(yī)治療本病的主要配伍規(guī)律,化痰、安神是遣方組藥的關(guān)鍵。肝風(fēng)內(nèi)動、風(fēng)痰內(nèi)擾,脾虛肝亢是臨床最常見證型。白芍、鉤藤、天麻、僵蠶、甘草、全蝎、膽南星、龍骨、石菖蒲、柴胡、牡蠣是臨床最常用的藥物。而聚類分析結(jié)果中的4組中藥可分別作為臨床不同證型的基礎(chǔ)方。二、觀察云南省名中醫(yī)、全國第三、五批老中醫(yī)學(xué)術(shù)思想指導(dǎo)老師劉以敏主任臨床治療抽動障礙的自擬方止抽湯對TD模型大鼠的抽動行為及紋狀體DA系統(tǒng)(DRD1、DRD2、DRD3、DAT的m RNA表達(dá)),以探討止抽湯治療該病的作用機(jī)制。方法:將56只SPF級實驗Wistar大鼠隨機(jī)分為空白組(10只)、模型組(10只)、氟哌啶醇組(18只)、止抽湯組(18只),除空白組外,其余三組用IDPN腹腔注射誘導(dǎo)出現(xiàn)TD模型后,予止抽湯及對照西藥氟哌啶醇分別予以灌胃干預(yù)治療14天,模型組予等量生理鹽水灌胃,觀察藥物對TD模型大鼠的抽動行為影響。觀察完畢后,立即快速斷頭處死各組大鼠,取出大鼠腦組織中的雙側(cè)紋狀體。用實時熒光定量PCR技術(shù)檢測大鼠腦組織紋狀體DRD1、DRD2、DRD3、DAT的m RNA表達(dá)水平。實驗結(jié)果顯示;止抽湯與氟哌啶醇均能顯著減少TD模型大鼠的抽動行為,但與氟哌啶醇比較,止抽湯能較快改善TD模型大鼠的抽動行為。止抽湯的作用機(jī)制可能與上調(diào)TD模型大鼠紋狀體DRD2、DRD3的m RNA表達(dá)量有關(guān)。
[Abstract]:Chinese medicine for the treatment of tic disorders (Tic, disorders, TD) has its own characteristics and advantages, to objectively assess the curative effect of traditional Chinese medicine in the treatment of TD, to explore the diagnosis and treatment regularity and mechanism, this paper has done the related research, this paper is divided into two parts. The first part: through literature collection, sorting out and explore the traditional Chinese medicine in the treatment of TD the treatment of the law. From 2005 to 2015 on the clinical literature retrieval of traditional Chinese medicine in the treatment of tic disorder compound, accord with the requirements of the 125 papers in.2015 document number (20), followed by the 2014 (18), 2013 (18), 2012 (15). 4 conference papers, degree 35 papers, 86 papers in journals, sample of Chinese herbal compound in the treatment of tic disorder with self-control method and a total of 6090 cases of.23 articles, 84 articles with randomized controlled trial method, 18 articles were non randomized controlled trials of.125 documents, the The compound drug adverse reactions or safety of the 15 articles altogether. The results showed that the number of compound Chinese medicine clinical research on the treatment of TD is increasing year by year, but the science of clinical trials, the experimental results of the credibility and safety of compound Chinese medicine research should be strengthened and improved. The main problem is: 1, clinical trials have failed to follow the scientific principles of.84 randomized, blinded randomized controlled trial study, mentioned stochastic methods 30 papers, 3 papers mentioned were hidden, double-blind clinical research literature 2.2, observation of compound Chinese medicine adverse reaction and safety evaluation of insufficient.125 clinical literatures. The 66 study specific syndromes, the total statistics of 36 card type, the frequency of the top three syndromes were: endogenous liver wind, wind phlegm disturbance type (8), spleen deficiency and liver hyperactivity, hyperactivity of liver (7) type (6).125 clinical literatures 鍏辨秹鍙，

本文編號：1539801