發(fā)布時間：2018-04-27 18:41

  本文選題：腹瀉型腸易激綜合征 + 疏肝健脾方��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：第一部分臨床研究目的:運用疏肝健脾方干預(yù)肝郁脾虛證腹瀉型腸易激綜合征,觀察治干預(yù)前后腹痛、腹瀉等癥狀的變化情況,評價疏肝健脾方治療肝郁脾虛證腹瀉型腸易激綜合征的臨床療效。方法:選擇符合納入標(biāo)準(zhǔn)的肝郁脾虛證腹瀉型腸易激綜合征患者48例,隨機分為疏肝健脾方治療組24例、西藥匹維溴銨對照組24例。治療組采用疏肝健脾方(柴胡12 g、白芍20 g、陳皮10 g、炒白術(shù)15 g、防風(fēng)10 g、炮姜5 g、炙甘草10 g)干預(yù),選用農(nóng)本方制劑,每日1劑,200ml,2次/日,沖服。對照組口服匹維溴銨,每次0.2 g,一天三次。兩組均以連續(xù)用藥4周為一個療程。比較兩組干預(yù)前后癥狀總積分、各臨床癥狀積分及干預(yù)后總療效,作出綜合評定。結(jié)果:總體臨床療效方面:治療組24例中,臨床痊愈5例,顯效12例,有效4例,無效3例,總有效率為87.5%;對照組24例中,臨床痊愈6例,顯效9例,有效5例,無效4例,總有效率為83.3%,兩組的總體臨床療效相當(dāng)(P0.05)。兩組干預(yù)前后總積分比較均有顯著性差異(P0.05),提示治療組與對照組對改善臨床癥狀均有明顯作用。干預(yù)后治療組與對照組比較癥狀總積分有顯著性差異,說明治療組對臨床癥狀的改善優(yōu)于對照組。治療組對緩解腹痛程度、腹痛頻率的療效優(yōu)于對照組(P0.05);對改善腹瀉及大便形狀與對照組的療效相當(dāng)(P0.05)。結(jié)論:疏肝健脾方治療肝郁脾虛證IBS-D能改善其臨床癥狀,從臨床角度驗證了疏肝健脾方是治療肝郁脾虛證IBS-D的有效方劑。第二部分實驗研究目的:觀察疏肝健脾方對大鼠結(jié)腸黏膜肥大細(xì)胞及PKA、TRPV1、CGRP表達(dá)的影響。方法:將48只雄性SD大鼠按體重隨機分為模型組、正常組、低劑量組、中劑量組、高劑量組和對照組。正常組除外,其余各組均采用束縛應(yīng)激結(jié)合辣素灌胃,按照藥物/體重0.5mg/kg的劑量灌胃,2次/周,連續(xù)2周,制備IBS模型。從第3周末起,低劑量組、中劑量組及高劑量組分別按3.1g/kg·d,6.2g/kg·d,12.4g/kg·d劑量給予疏肝健脾方中藥;對照組予匹維溴銨水溶液15mg/kg·d;模型組予等劑量生理鹽水,正常組予同步飼養(yǎng)。大鼠灌胃給藥體積為4ml/100g,連續(xù)灌胃2周。第5周末,處死所有大鼠,截取回盲瓣下2cm至肛門上1.5cm的全部結(jié)腸,行HE染色及肥大細(xì)胞染色,進(jìn)行相關(guān)病理檢測;運用于熒光定量PCR和Western-blot技術(shù)檢測PKA、TRPV1及CGRP的表達(dá)。結(jié)果:模型組肥大細(xì)胞表達(dá)比正常組明顯增多,差異有統(tǒng)計學(xué)意義(P0.05)。低劑量組、中劑量組、高劑量組肥大細(xì)胞呈逐漸減少趨勢,與模型組比較,差異有統(tǒng)計學(xué)意義(P0.05)。說明IBS-D大鼠存在肥大細(xì)胞高表達(dá)水平,疏肝健脾方具有穩(wěn)定或降低肥大細(xì)胞表達(dá)的效用。熒光定量PCR和Western-blot技術(shù)檢測結(jié)果顯示,模型組大鼠結(jié)腸組織PKA、TRPV1、CGRP基因和蛋白表達(dá)明顯高于正常組,差異均有統(tǒng)計學(xué)意義(P0.05)。干預(yù)后,與模型組相比,高劑量組、對照組PKA、TRPV1、CGRP基因和蛋白表達(dá)以及中劑量組CGRP基因表達(dá)均呈下降趨勢,差異有統(tǒng)計學(xué)意義(P0.05)。而低劑量、中劑量組PKA、TRPV1及低劑量組CGRP基因表達(dá)與模型組比較,差異均無統(tǒng)計學(xué)意義(P0.05)。低劑量、中劑量組PKA、TRPV1及CGRP蛋白表達(dá)與模型組比較,差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:疏肝健脾方治療腹瀉型腸易激綜合征的機制可能與下調(diào)PKA表達(dá),介導(dǎo)TRPV1敏化,減少CGRP釋放有關(guān)。
[Abstract]:The first part of clinical study objective: To observe the diarrhea type irritable bowel syndrome of liver qi stagnation and spleen deficiency syndrome, observe the changes of abdominal pain, diarrhea and other symptoms before and after treatment, and evaluate the clinical effect of the treatment of diarrhea type irritable bowel syndrome of stagnation of liver qi and spleen deficiency syndrome. Methods: choose the liver qi stagnation and spleen deficiency syndrome in accordance with the standard. 48 patients with diarrhea irritable bowel syndrome were randomly divided into 24 cases of Shugan Jianpi Fang treatment group and 24 cases of Western medicine pippium bromide control group. The treatment group was treated with Shugan Jianpi Recipe (Radix Bupleuri 12 g, Radix Paeoniae Radix Paeoniae 20 g, orange peel 10 g, stir frying Baizhu 15 g, anti wind 10 g, ginger 5 g, Radix Glycyrrhiza 10 g) and selected agricultural herbs, 1, 200ml, 2 times / day, and control group. 0.2 g each time, three times a day. Two groups were treated with continuous medication for 4 weeks. The total score of symptoms before and after the intervention of the two groups, the integral of clinical symptoms and the total effect after intervention were evaluated comprehensively. Results: in the total clinical efficacy, 5 cases were cured in 24 cases, 12 cases were cured, 4 cases were effective, 3 cases were invalid and total effective. Among the 24 cases in the control group, 6 cases were cured, 9 cases were markedly effective, 5 cases were effective and 4 cases were invalid, the total effective rate was 83.3%, the total clinical effect of two groups was equal (P0.05). The total integral before and after the intervention of the two groups had significant difference (P0.05), suggesting that the treatment group and the control group had obvious effect on the improvement of clinical symptoms. The treatment group and the control group had a significant effect on the clinical symptoms. The treatment group and the control group were treated with the control group and the control. The curative effect of the treatment group was better than the control group. The curative effect of the treatment group on the degree of abdominal pain and the frequency of abdominal pain was better than that of the control group (P0.05); the effect of improving the shape of diarrhea and stool with the control group was equal (P0.05). Conclusion: the IBS-D of the liver qi and spleen deficiency prescription in the treatment of liver depression and spleen deficiency can improve it. Clinical symptoms, from the clinical point of view that the Shugan Jianpi prescription is an effective prescription for the treatment of liver depression and spleen deficiency syndrome IBS-D. The second part of the experimental study: To observe the effect of Shugan Jianpi Recipe on the expression of mast cells and PKA, TRPV1, and CGRP in the colon mucosa of rats. Methods: 48 male SD rats were randomly divided into model group, normal group, low dose group, In the middle dose group, the high dose group and the control group, except the normal group, the other groups were combined with the binding stress combined with the gavage of the stomach. The dose of 0.5mg/kg was given to the stomach, 2 times per week for 2 weeks, and the IBS model was prepared. From the third weekend, the low dose group, the middle dose group and the high dose group were given 3.1g/kg. D, 6.2g/kg. D, 12.4g/kg. D dosage, respectively. The control group was treated with 15mg/kg D in the control group. The model group was given equal dose of normal saline, and the normal group was fed with the normal group. The rats were given 4ml/100g for 2 weeks. The rats were sacrificed at the fifth weekend. All the rats were killed and the whole colon of 2cm to 1.5cm on the anus was intercepted, and HE staining and mast cell staining were performed. The expression of PKA, TRPV1 and CGRP was detected by fluorescence quantitative PCR and Western-blot. Results: the expression of mast cells in the model group was significantly higher than that in the normal group, and the difference was statistically significant (P0.05). The mast cells in the low dose group, middle dose group and high dose group decreased gradually, and the difference was statistically significant compared with the model group. Meaning (P0.05). It shows that the hyperexpression level of mast cells in IBS-D rats is high, and the prescription of soothing the liver and invigorating spleen can stabilize or reduce the expression of mast cells. The results of fluorescence quantitative PCR and Western-blot techniques show that the expression of PKA, TRPV1, CGRP gene and protein in the colon tissue of the model group is significantly higher than that in the normal group, the difference is statistically significant (P0.05). Compared with the model group, the PKA, TRPV1, CGRP gene and protein expression of the control group and the expression of CGRP gene in the middle dose group showed a decreasing trend compared with the model group, and the difference was statistically significant (P0.05). The low dose group, PKA, TRPV1 and low dose group CGRP gene tables were compared with the model group, and the difference was not statistically significant (P0.05). The expression of PKA, TRPV1 and CGRP protein in the medium dose group was compared with the model group, and the difference was not statistically significant (P0.05). Conclusion: the mechanism of the treatment of diarrhea type irritable bowel syndrome by Shugan Jianpi Recipe may be related to the downregulation of PKA expression, the mediating TRPV1 sensitization and reducing the release of CGRP.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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