本文選題：電針 + 表皮生長(zhǎng)因子受體��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本課題包括實(shí)驗(yàn)研究和臨床觀察兩個(gè)方面。臨床部分通過對(duì)比電針與常規(guī)針刺治療腦缺血的療效差異,優(yōu)化腦缺血的臨床治療手段。動(dòng)物實(shí)驗(yàn)部分通過建立小鼠腦缺血模型,探究表皮生長(zhǎng)因子受體(Epidermal Growth Factor Receptor,EGFR)在腦缺血再灌注損傷中的功能,以及電針治療缺血性腦卒中的機(jī)制與其的關(guān)聯(lián)性。方法:1.實(shí)驗(yàn)研究:將30只C57小鼠以隨機(jī)數(shù)字查表原則,分為對(duì)照組、模型組及電針治療組三個(gè)組別,每組各10只小鼠,以線栓法建立小鼠大腦中動(dòng)脈栓塞(Middle cerebral artery occlusion,MCAO)腦缺血模型,電針組于造模前及MCAO模型完成后分別予以電針刺激“水溝”、“承漿”二穴。各組實(shí)驗(yàn)小鼠在缺血再灌注24小時(shí)后斷頭、取腦,一部分直接冷凍做TTC染色,觀察小鼠大腦腦缺血體積的變化情況。另一部分分離大腦皮質(zhì),提取蛋白,以免疫印跡方法,檢測(cè)EGFR及i NOS在小鼠大腦皮質(zhì)的表達(dá)變化。2.臨床觀察:本課題研究設(shè)計(jì)一個(gè)單盲、隨機(jī)、對(duì)照性試驗(yàn)來觀察缺血性腦損傷的電針療效情況,收集武漢市中西醫(yī)結(jié)合醫(yī)院符合納入標(biāo)準(zhǔn)的病例,共收集缺血性腦卒中急性期患者60例,采用隨機(jī)對(duì)照分組,分為治療組和對(duì)照組,每組各隨機(jī)分配30例病例。治療組予以電針治療,對(duì)照組予以普通針刺治療,兩組患者每天予以電針治療1次,連續(xù)7天為一個(gè)療程,然后間隔一天后進(jìn)行再下一個(gè)療程,共治療2個(gè)療程。所有病例均于治療前后分別采用美國(guó)國(guó)立衛(wèi)生院卒中量表(NIHSS評(píng)分)(見附錄四)、改良的Barthel指數(shù)(BI)(見附錄三)進(jìn)行評(píng)估,記錄治療前后兩組間評(píng)分的變化,并將所得結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,經(jīng)統(tǒng)計(jì)學(xué)分析后確定其是否具有統(tǒng)計(jì)學(xué)意義�；A(chǔ)治療:參照《中國(guó)急性缺血性腦卒中的診治指南2010》所提及的治療方案。主要包括改善循環(huán),抗血小板凝集,控制血壓,調(diào)節(jié)血糖,降脂穩(wěn)定血管斑塊,保護(hù)及營(yíng)養(yǎng)神經(jīng),對(duì)癥治療,防治并發(fā)癥的常規(guī)藥物治療等。結(jié)果:1.動(dòng)物實(shí)驗(yàn)結(jié)果1.1Bederson評(píng)分結(jié)果對(duì)照組Bederson評(píng)分為0分,小鼠表現(xiàn)為無運(yùn)動(dòng)功能障礙;模型組進(jìn)行MCAO手術(shù)后,Bederson評(píng)分明顯上升,與對(duì)照組有顯著差異,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05);電針組電針干預(yù)后Bederson評(píng)分明顯低于模型組,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。1.2 TTC染色結(jié)果模型組小鼠腦缺血體積要顯著高于對(duì)照組,表明小鼠進(jìn)行MCAO手術(shù)后,造成了小鼠大腦中動(dòng)脈供血區(qū)的梗塞而引起了小鼠大腦缺血損傷,顯示小鼠腦缺血主要部位集中在頂葉,額葉及基底節(jié)區(qū)等區(qū)域;相比較于模型組的結(jié)果,電針組顯著縮小了小鼠大腦腦缺血的體積。1.3 EGFR及i NOS表達(dá)情況相對(duì)于對(duì)照組而言,模型組小鼠EGFR表達(dá)有所上升,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);電針組電針介入后EGFR蛋白含量較模型組相比繼續(xù)上升,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);后各組i NOS表達(dá)情況:模型組小鼠i NOS表達(dá)含量顯著上升,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);電針介入后i NOS表達(dá)含量較模型組相比有所下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);2.臨床觀察結(jié)果2.1治療后兩組NIHSS評(píng)分較治療前均有所降低,與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義(均PO.O5);治療后兩組NIHSS評(píng)分相比,差異具有統(tǒng)計(jì)學(xué)意義(PO.05)。2.2治療兩組BI較治療前均有所上升,與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義(均PO.O5);治療后兩組BI相比,差異具有統(tǒng)計(jì)學(xué)意義(PO.05)。2.3治療后,治療組臨床總有效率為93.3%,對(duì)照組臨床總有效率為83.3%。兩組有效率經(jīng)過對(duì)比,治療組療效明顯優(yōu)于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(PO.05)。結(jié)論1.電針可以降低小鼠腦缺血后Bederson評(píng)分,減小腦缺血體積,改善小鼠運(yùn)動(dòng)功能障礙及神經(jīng)功能缺損,有助于小鼠的神經(jīng)功能恢復(fù),其在腦缺血后的神經(jīng)保護(hù)功能的機(jī)制可能是電針通過改變星形膠質(zhì)細(xì)胞的分泌表型,使內(nèi)源性EGFR蛋白合成并且分泌得到促進(jìn),并能夠抑制i NOS的表達(dá),減少NO的產(chǎn)生,控制中樞神經(jīng)系統(tǒng)發(fā)生的炎性反應(yīng),保護(hù)腦神經(jīng)元。2.在予以臨床常規(guī)用藥的基礎(chǔ)上,相較于常規(guī)針刺而言,結(jié)合電針刺激治療,對(duì)缺血性中風(fēng)患者有更好的效果,緩解急性缺血性中風(fēng)患者的神經(jīng)系統(tǒng)的功能缺損程度及癥狀,改善患者的日常生活能力,可以下降缺血性中風(fēng)的致殘率、致死率。
[Abstract]:Objective: this topic includes two aspects of experimental research and clinical observation. In the clinical part, the clinical therapeutic means of cerebral ischemia are optimized by comparing the therapeutic effects of electroacupuncture and conventional acupuncture in the treatment of cerebral ischemia. In the animal experiment, the Epidermal Growth Factor Receptor (EGFR) is explored by establishing the model of cerebral ischemia in mice. The function of cerebral ischemia reperfusion injury and the mechanism of electroacupuncture in the treatment of ischemic stroke. Methods: 1. experimental study: 30 C57 mice were divided into the control group, the model group and the electroacupuncture treatment group were divided into the control group, the model group and the electroacupuncture treatment group, 10 rats in each group, and the middle cerebral artery embolism (Middle C) was established by the thread emboli method. Erebral artery occlusion, MCAO) cerebral ischemia model, electroacupuncture group before and after the completion of MCAO model to stimulate the "water ditch", "pulp" two points. Each group of experimental mice after 24 hours of ischemia-reperfusion, brain, a part of the direct freezing of TTC staining, observe the cerebral ischemic volume changes in the brain of mice. Separate the cerebral cortex, extract the protein, and detect the expression of EGFR and I NOS in the cerebral cortex of mice by immunoblotting,.2. clinical observation: this subject is designed to design a single blind, random, controlled trial to observe the effect of Electroacupuncture on ischemic brain injury, and collect the cases of the integrated traditional Chinese and Western medicine hospital in Wuhan. 60 cases of acute ischemic stroke were collected and divided into treatment group and control group randomly, divided into treatment group and control group, each group was randomly assigned 30 cases. The treatment group was treated with electroacupuncture, the control group was treated with common acupuncture, the two groups were treated with electroacupuncture 1 times a day for 7 days, and then another day after the next one. A total of 2 courses were treated. All cases were treated with the National Institutes of Health Stroke Scale (NIHSS score) before and after treatment (see Appendix four), the improved Barthel index (BI) (see Appendix three), and recorded the changes of the scores between the two groups before and after the treatment, and the results were statistically analyzed and determined by statistical analysis. No statistical significance. Basic treatment: reference to the treatment guidelines referred to in the guidelines for the diagnosis and treatment of acute ischemic stroke in China 2010>, mainly including improvement of circulation, antiplatelet aggregation, control of blood pressure, regulating blood sugar, reducing fat and stabilizing vascular plaques, protecting and nourishment nerve, treating disease, preventing complications by conventional medication, and so on. Results 1. The result of 1.1Bederson score was 0 in the control group and in the control group, the Bederson score was 0, and the mice showed no motor dysfunction. After the MCAO operation in the model group, the Bederson score increased significantly, and the difference had significant difference with the control group, and the difference was statistically significant (P0.05). The Bederson score in the electroacupuncture group was significantly lower than that in the model group, and the difference was poor. The volume of cerebral ischemia in the model group of P0.05.1.2 TTC staining model group was significantly higher than that of the control group. It showed that after MCAO operation, the infarct of the middle cerebral artery blood supply area in mice caused the cerebral ischemia injury in mice, which showed that the main parts of cerebral ischemia in the mice were concentrated in the parietal lobe, the frontal lobe and the basal ganglia region. Compared with the model group, the expression of.1.3 EGFR and I NOS in the cerebral ischemia of mice was significantly reduced by the electroacupuncture group compared with the control group, the EGFR expression of the model mice increased, the difference was statistically significant (P0.05). The content of EGFR protein in the electroacupuncture group was higher than that in the model group after the electroacupuncture group, and the difference had the difference. Statistical significance (P0.05); the expression of I NOS in each group: the expression of I NOS in the model group was significantly increased, the difference was statistically significant (P0.05); the I NOS expression content decreased compared with the model group after the electroacupuncture intervention, and the difference was statistically significant (P0.05); 2. the two groups of clinical observation results were compared to those of the two groups after 2.1 treatment. Compared with before treatment, the difference was statistically significant (all PO.O5), and the difference between the two groups of NIHSS scores after treatment was statistically significant (PO.05) the two groups of BI were higher than before the treatment, and the difference was statistically significant compared with that before the treatment (PO.O5); the difference was statistically significant (PO.05).2.3 treatment compared to the two groups of BI after treatment. After treatment, the total effective rate of the treatment group was 93.3%, the total effective rate of the control group was 83.3%. two, the curative effect was compared, the curative effect of the treatment group was obviously superior to the control group, the difference was statistically significant (PO.05). Conclusion 1. electroacupuncture can reduce the Bederson score of the mice after cerebral ischemia, reduce the volume of cerebellar ischemia, and improve the motor dysfunction and nerve in mice. Functional defect can help the recovery of neural function in mice. The mechanism of neuroprotective function after cerebral ischemia may be that electroacupuncture can promote the synthesis and secretion of endogenous EGFR protein by changing the secretory phenotype of astrocytes, and can inhibit the expression of I NOS, reduce the production of NO, and control the inflammation of the central nervous system. On the basis of clinical routine medication, the protection of brain neuron.2. is better than conventional acupuncture combined with electroacupuncture. It has a better effect on patients with ischemic stroke, relieving the degree of function defect and symptoms of the nervous system in patients with acute ischemic stroke, improving the daily living ability of the patients, and reducing the ischemic stroke. The rate of disability and death rate of stroke.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 田亮;杜小正;王金海;孫潤(rùn)潔;張振昶;袁博;張星華;李興蘭;張婷卓;;手針與電針治療急性缺血性腦卒中偏癱的對(duì)比研究[J];中國(guó)針灸;2016年11期

2 繆培;張通;米海霞;;基于線栓法大鼠大腦中動(dòng)脈閉塞的局灶性腦缺血模型的比較研究[J];中國(guó)康復(fù)理論與實(shí)踐;2016年10期

3 田亮;王金海;孫潤(rùn)潔;張星華;袁博;杜小正;;頭針治療缺血性中風(fēng)的機(jī)制研究進(jìn)展[J];針刺研究;2016年01期

4 張?jiān)迄i;;淺析針灸治療對(duì)改善腦卒中偏癱患者神經(jīng)功能障礙的臨床有效性[J];世界最新醫(yī)學(xué)信息文摘;2015年89期

5 譚凱文;陳薇;;活血化瘀法治療缺血性中風(fēng)的拓展與探討[J];中西醫(yī)結(jié)合心腦血管病雜志;2015年09期

6 朱才豐;潘洪萍;賀成功;;蔡圣朝主任醫(yī)師針灸治療癡呆學(xué)術(shù)思想探析[J];遼寧中醫(yī)藥大學(xué)學(xué)報(bào);2015年08期

7 付淵博;孫敬青;宣雅波;劉慧林;鄒憶懷;王新志;王麟鵬;;基于GEE模型評(píng)價(jià)中醫(yī)綜合方案對(duì)缺血性中風(fēng)患者神經(jīng)功能損傷的臨床觀察[J];中華中醫(yī)藥雜志;2015年03期

8 史敏;;針灸對(duì)腦缺血保護(hù)作用機(jī)制綜述[J];內(nèi)蒙古中醫(yī)藥;2014年23期

9 蔡斐;谷文龍;石學(xué)敏;;“醒腦開竅”針法治療腦梗死后失語的臨床療效觀察[J];天津中醫(yī)藥;2014年05期

10 顧鴻;聶英杰;馮曉燕;;針灸特定穴位的理論與臨床[J];亞太傳統(tǒng)醫(yī)藥;2013年04期

相關(guān)博士學(xué)位論文 前6條

1 劉競(jìng)雄（Liu Ching-Hsiung）;急性缺血性腦中風(fēng)的針刺療效評(píng)估：一隨機(jī)、對(duì)照研究[D];廣州中醫(yī)藥大學(xué);2014年

2 羅振釗;Annexin-1促進(jìn)小膠質(zhì)細(xì)胞M2型轉(zhuǎn)換保護(hù)缺血損傷神經(jīng)元的機(jī)制研究[D];華中科技大學(xué);2013年

3 馮曉東;電針神庭、百會(huì)對(duì)腦卒中后認(rèn)知障礙的臨床及機(jī)制研究[D];福建中醫(yī)藥大學(xué);2013年

4 楊琴;抑制表皮生長(zhǎng)因子信號(hào)通路對(duì)腦缺血再灌注損傷的神經(jīng)保護(hù)作用及其分子機(jī)制的研究[D];華中科技大學(xué);2011年

5 賈超;靳三針療法治療腦梗塞偏癱的規(guī)范化研究[D];廣州中醫(yī)藥大學(xué);2009年

6 田舜蓮;NGF/TrkA對(duì)大鼠海馬TRPM7的調(diào)節(jié)作用[D];華中科技大學(xué);2007年

相關(guān)碩士學(xué)位論文 前9條

1 李雨蔓;針灸治療腦梗死的臨床研究進(jìn)展[D];北京中醫(yī)藥大學(xué);2016年

2 郗亞薇;“賀氏三通法”治療缺血性腦卒中的臨床觀察[D];北京中醫(yī)藥大學(xué);2014年

3 區(qū)穎儀;透穴針刺法為主治療早期缺血性中風(fēng)的臨床觀察[D];南方醫(yī)科大學(xué);2014年

4 陳麗平;百會(huì)、水溝穴不同時(shí)程電針預(yù)處理對(duì)腦缺血再灌注大鼠血腦屏障MMP-9、VEGF的影響[D];浙江中醫(yī)藥大學(xué);2013年

5 王皓琳;針?biāo)幗Y(jié)合治療急性腦梗死的臨床觀察[D];南京中醫(yī)藥大學(xué);2013年

6 邢甲進(jìn);頭針治療急性缺血性中風(fēng)的臨床和實(shí)驗(yàn)研究[D];湖北中醫(yī)藥大學(xué);2011年

7 郭志慧;星形膠質(zhì)細(xì)胞活化與表皮生長(zhǎng)因子受體表達(dá)的相關(guān)性研究[D];南華大學(xué);2011年

8 陽期望;針刺“四海之腧”為主治療急性缺血性中風(fēng)臨床觀察[D];南方醫(yī)科大學(xué);2011年

9 謝心;頭電針對(duì)缺血性腦血管病療效影響的臨床觀察[D];南京中醫(yī)藥大學(xué);2005年

，

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