本文選題：距離 + 艾灸�。� 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景類風(fēng)濕關(guān)節(jié)炎(Rheumatoid Arthritis,RA)是一種原因不明的,以關(guān)節(jié)滑膜炎癥為特征的慢性自身免疫性疾病,主要累及小關(guān)節(jié)[1]。RA會(huì)引起患者出現(xiàn)關(guān)節(jié)損傷,甚至最終導(dǎo)致殘疾,降低了患者的生活質(zhì)量,甚至可以引起心血管及其他合并癥。改善病情的抗風(fēng)濕藥物(Disease-modifying antirheumatic drugs,DMARDs)為治療 RA 的關(guān)鍵藥物,其通過(guò)減少滑膜炎癥和全身炎癥從而改善關(guān)節(jié)功能。當(dāng)關(guān)節(jié)炎不受控制或者DMARDs聯(lián)用產(chǎn)生效應(yīng)時(shí),應(yīng)使用生物制劑。但是產(chǎn)生感染、結(jié)核、腫瘤的危險(xiǎn)以及昂貴的價(jià)格令患者難以承受,從而限制了其在臨床上的使用。艾灸作為中醫(yī)外治法的重要組成部分,可以用于治療多種慢性疾病。利用艾葉燃燒而產(chǎn)生的溫通溫補(bǔ)作用及艾葉的藥物作用,經(jīng)過(guò)經(jīng)絡(luò)的調(diào)節(jié),發(fā)揮補(bǔ)益氣血陰陽(yáng),驅(qū)寒散濕的功效。艾灸能夠溫通經(jīng)絡(luò),活血化瘀,不僅對(duì)炎癥反應(yīng)局部有抗炎調(diào)節(jié)的作用,而且能夠通過(guò)調(diào)節(jié)神經(jīng)-內(nèi)分泌網(wǎng)絡(luò)系統(tǒng)而對(duì)整個(gè)機(jī)體進(jìn)行調(diào)控,從而達(dá)到治療類風(fēng)濕關(guān)節(jié)炎的目的。但是,艾灸操作大多憑借經(jīng)驗(yàn),臨床缺乏標(biāo)準(zhǔn),艾灸距離成為影響艾灸療效的重要因素之一。目的通過(guò)比較不同距離艾灸治療類風(fēng)濕關(guān)節(jié)炎的療效差異,探索治療RA最佳的艾灸距離。為艾灸在臨床的推廣與應(yīng)用提供科學(xué)依據(jù),以及指導(dǎo)未來(lái)的科學(xué)實(shí)驗(yàn)及臨床應(yīng)用。方怯(1)選用SPF級(jí)雄性SD大鼠40只,隨機(jī)抽取8只做為正常對(duì)照組,余32只全部建立膠原誘導(dǎo)性關(guān)節(jié)炎(Collagen-Induced Arthritis,CIA)大鼠模型。32只大鼠全部造模成功,按隨機(jī)數(shù)字表法進(jìn)行隨機(jī)分組,分為模型組、艾灸1cm組、艾灸2cm組、艾灸3cm組,每組8只。正常對(duì)照組和模型組不予艾灸治療,但給予相同的時(shí)間固定,每次40min。艾灸1cm組每天灸雙側(cè)"腎俞"和"足三里"穴,每天1次,每個(gè)穴位10min,共40min,保持灸條距穴位皮膚的距離維持在1cm。艾灸2cm組與艾灸3cm組分別保持灸條距離穴位皮膚為2cm、3cm,其余同艾灸1cm組。每6 d為1個(gè)療程,共干預(yù)3個(gè)療程,療程間休息1d。(2)基線比較:比較造模前各組大鼠體質(zhì)量、足趾容積。(3)觀察各組大鼠造模前、干預(yù)前、艾灸3周后的一般情況,包括被毛色澤、攝食情況、四肢活動(dòng)情況等。(4)測(cè)量并比較各組大鼠干預(yù)前、艾灸3周后的體質(zhì)量變化。(5)比較各組大鼠干預(yù)前、艾灸3周足趾容積變化。(6)根據(jù)大鼠四肢的足趾腫脹及變形程度等來(lái)評(píng)定大鼠在干預(yù)前、艾灸3周的關(guān)節(jié)炎指數(shù)(Arthritis Index,AI)得分變化,正常對(duì)照組無(wú)此項(xiàng)得分。(7)艾灸3周后,腹主動(dòng)脈采血、離心,進(jìn)行酶聯(lián)免疫吸附劑測(cè)定(Enzyme Linked ImmunosorbentAssay,ELISA),比較各組大鼠血清白細(xì)胞介素1β(IL-1β)、腫瘤壞死因子α(TNF-α)的水平。(8)艾灸3周后,收集各組大鼠一側(cè)踝關(guān)節(jié)病理組織標(biāo)本進(jìn)行病理組織形態(tài)學(xué)觀察。結(jié)果(1)基線比較:各組大鼠造模前體質(zhì)量、足趾容積無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。(2)一般情況:造模前,各組大鼠一般情況良好;造模后,模型組、艾灸各組大鼠均出現(xiàn)關(guān)節(jié)紅腫,部分大鼠出現(xiàn)注射局部皮膚潰瘍;給予艾灸治療3周后,模型組大鼠癥狀持續(xù)加重,關(guān)節(jié)腫脹明顯,不能負(fù)重,活動(dòng)受限,且部分大鼠出現(xiàn)跛行;艾灸各組大鼠飲食尚可,活動(dòng)較模型組更為活躍,關(guān)節(jié)腫脹明顯改善,但仍有輕微關(guān)節(jié)紅腫;正常對(duì)照組表現(xiàn)無(wú)異常。(3)體質(zhì)量比較:造模前,各組大鼠體質(zhì)量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),基線一致。造模后干預(yù)前,與正常對(duì)照組相比,模型組、艾灸各組體質(zhì)量增長(zhǎng)緩慢,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。艾灸各組和模型組體質(zhì)量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。艾灸3周后,正常對(duì)照組大鼠體質(zhì)量持續(xù)增長(zhǎng)明顯;與正常對(duì)照組相比,模型組大鼠體質(zhì)量增長(zhǎng)緩慢,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01);與模型組相比,艾灸3cm組體質(zhì)量增長(zhǎng)較快,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);與模型組相比,艾灸1cm組、艾灸2cm組大鼠體質(zhì)量增長(zhǎng)明顯,差異有顯著統(tǒng)計(jì)學(xué)意義(p0.01);艾灸各組之間無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。(4)足趾容積比較:艾灸干預(yù)前,與正常對(duì)照組相比,模型組和艾灸各組大鼠足趾容積增加明顯,P0.01,差異具有顯著統(tǒng)計(jì)學(xué)意義;與模型組相比,艾灸各組足趾容積無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。艾灸3周后,與正常對(duì)照組相比,模型組大鼠足趾容積增長(zhǎng)明顯,P0.01,差異具有顯著統(tǒng)計(jì)學(xué)意義;與模型組相比,艾灸各組足趾容積明顯下降,P0.01,差異具有顯著統(tǒng)計(jì)學(xué)意義;與艾灸3cm組相比,艾灸1cm組與艾灸2cm組大鼠足趾容積下降明顯,P0.01,差異具有顯著統(tǒng)計(jì)學(xué)意義。艾灸1cm組與艾灸2cm組之間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(5)關(guān)節(jié)炎癥評(píng)分比較:干預(yù)前,除正常對(duì)照組外,各組大鼠AI評(píng)分均大于4分,顯示造模成功,組間比較,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性。艾灸3周后,模型組AI評(píng)分持續(xù)增高,艾灸各組AI評(píng)分較模型組明顯下降(P0.01)。艾灸各組之間比較,AI評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(6)IL-1β水平:艾灸3周后,與正常對(duì)照組相比,模型組血清IL-1β水平明顯升高,P0.01,差異有顯著統(tǒng)計(jì)學(xué)意義。與模型組相比,艾灸各組血清IL-1β水平明顯下降,P0.01,差異有顯著統(tǒng)計(jì)學(xué)意義。與艾灸3cm組相比,艾灸1,2cm組血清IL-1β水平較明顯降低(P0.01),艾灸1cm組與艾灸2cm組之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(7)TNF-α水平:艾灸3周后,與正常對(duì)照組相比,模型組血清INF-α水平明顯升高,P0.01,差異有顯著統(tǒng)計(jì)學(xué)意義。與模型組相比,艾灸各組血清TNF-α水平明顯下降,P0.01,差異有顯著統(tǒng)計(jì)學(xué)意義。與艾灸3cm組相比,艾灸1,2cm組血清TNF-α水平較明顯降低(P0.01),艾灸1cm組與艾灸2cm組之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(8)病理HE染色:正常對(duì)照組大鼠踝關(guān)節(jié)病理HE染色未見明顯異常。模型組可見關(guān)節(jié)腔變窄,狹窄的關(guān)節(jié)腔內(nèi)可見炎細(xì)胞;炎細(xì)胞嚴(yán)重浸潤(rùn),血管翳形成;滑膜細(xì)胞腫脹且排列無(wú)序,有明顯增生,并且可見嚴(yán)重變性壞死。艾灸各組可見中度炎細(xì)胞浸潤(rùn);滑膜細(xì)胞稍有增生或中度腫脹;與模型組比較,血管翳明顯減少,表明具有明顯好轉(zhuǎn)。艾灸2cm組大鼠滑膜腫脹、炎細(xì)胞浸潤(rùn)程度較艾灸1cm組和艾灸3cm組有所改善,而艾灸1cm組與艾灸2cm組間無(wú)明顯差異。結(jié)論(1)艾灸3周治療后,與模型組相比,艾灸各組一般情況改善,足趾紅腫相對(duì)較輕,病理染色顯示滑膜變薄、炎細(xì)胞輕度浸潤(rùn)。血清IL-1β水平、TNF-α水平均低于模型組。證明艾灸在改善關(guān)節(jié)功能、調(diào)節(jié)免疫方面具有一定作用。(2)艾灸治療CIA大鼠,在艾灸距離為1～2cm時(shí),艾灸治療效果更佳。(3)從耐受性、接受度、療效等方面綜合考慮,艾灸2cm組為艾灸治療類風(fēng)濕關(guān)節(jié)炎大鼠的最佳距離。本實(shí)驗(yàn)研究結(jié)果為臨床規(guī)范化應(yīng)用艾灸治療RA提供重要的參考價(jià)值和借鑒意義。
[Abstract]:Background rheumatoid arthritis (Rheumatoid Arthritis, RA) is a chronic autoimmune disease characterized by joint synovitis. The main involvement of the small joint [1].RA can cause joint injury, even eventually lead to disability, reduce the quality of life of the patient, even cause cardiovascular and other complications. Disease-modifying antirheumatic drugs (DMARDs) is a key drug for the treatment of RA. It improves joint function by reducing synovitis and systemic inflammation. Biological agents should be used when arthritis is not controlled or DMARDs is produced. The expensive price makes the patient difficult to bear, which limits its clinical use. Moxibustion is an important part of the external treatment of traditional Chinese medicine. It can be used to treat a variety of chronic diseases. Effect. Moxibustion can warm the meridian, promote blood circulation and dissipate blood stasis, not only has the effect of inflammation and regulation of inflammation, but also can regulate the whole body by regulating the nervous endocrine network system, so as to achieve the purpose of treating rheumatoid arthritis. However, moxibustion is mostly operated by the experience, the clinical lack of standard, moxibustion distance becomes Objective one of the important factors affecting the therapeutic effect of moxibustion is to compare the difference of therapeutic effect of different distance moxibustion on the treatment of rheumatoid arthritis, explore the best distance of moxibustion for the treatment of RA, provide scientific basis for the popularization and application of Moxibustion in clinical practice, and guide the future scientific experiment and clinical application. (1) 40 male SD rats were selected. 8 rats were randomly selected as the normal control group, and the other 32 rats were all established with collagen induced arthritis (Collagen-Induced Arthritis, CIA) rat model. All the rats were successfully modeled. The random numbers were randomly divided into model group, moxibustion 1cm group, moxibustion 2cm group, moxibustion 3cm group, and group of moxibustion 3cm group, with 8 rats in each group. Moxibustion treatment, but given the same time fixed, each 40min. moxibustion 1cm group each day moxibustion bilateral "Shenshu" and "Zusanli" point, 1 times a day, each point 10min, a total of 40min, keep the distance between the moxibustion bar and the point skin on the 1cm. moxibustion 2cm group and moxibustion 3cm group to maintain the distance point skin for 2cm, 3cm, the rest of the moxibustion and 1cm group. Every 6 d. 1 courses of treatment, a total of 3 courses of intervention, interval of rest 1D. (2) baseline comparison: compare the mass of rats in each group before making the model and the volume of the toe. (3) observe the general condition of the moxibustion before 3 weeks of moxibustion before the intervention, including the hair color, feeding situation, and the living conditions of the limbs. (4) measure and compare the moxibustion for 3 weeks before the intervention of rats in each group. Change of body mass. (5) compare the volume changes of moxibustion for 3 weeks before intervention. (6) according to the toe swelling and deformation degree of the limbs of the rats, the scores of Arthritis Index (AI) of the moxibustion for 3 weeks before intervention were evaluated, and there was no score in the normal control group. (7) the abdominal aorta was collected and centrifuged after 3 weeks of moxibustion. Enzyme Linked ImmunosorbentAssay (ELISA) was used to compare the level of serum interleukin 1 beta (IL-1 beta) and tumor necrosis factor alpha (TNF- alpha) in all groups of rats. (8) after 3 weeks of moxibustion, pathological histological specimens of one side of the ankle joint were collected for pathological histomorphology. Results (1) baseline comparison: the model of rats in each group There was no statistical difference between the mass of the precursor and the volume of the toe (P0.05). (2) general situation: before the model, the rats in each group were in good condition. After the model, the model group and the moxibustion group all had joint redness and swelling, and some rats were injected with local skin ulcers. After the moxibustion treatment was given for 3 weeks, the symptoms of the rats in the model group continued to aggravate and joint swelling. Obviously, the weight was not heavy, the activity was limited, and some rats were limping; the rats in the moxibustion group were more active in diet, more active than the model group, and the joint swelling was obviously improved, but there was still slight joint swelling and swelling in the normal control group. (3) the body mass comparison: before the model, the body mass difference was not statistically significant (P0.05), baseline a Before the model intervention, compared with the normal control group, the body mass of the model group and moxibustion had a significant statistical significance (P0.01). There was no significant difference between moxibustion and model group body mass (P0.05). After 3 weeks of moxibustion, the body mass of the normal control group continued to increase obviously; compared with the normal control group, the model group was compared with the normal control group. The body mass of rats increased slowly, the difference was significant (P0.01). Compared with the model group, the body mass of moxibustion 3cm group increased rapidly, and the difference was statistically significant (P0.05). Compared with the model group, the body mass of moxibustion 1cm group and moxibustion 2cm group increased significantly (P0.01), and there was no statistical difference between moxibustion groups (P0.01); there was no statistical difference between moxibustion groups. (P0.05). (4) comparison of toe volume: before moxibustion, the volume of toe in model group and moxibustion group increased significantly compared with that of moxibustion group, P0.01, the difference had significant statistical significance. Compared with model group, there was no statistical difference between moxibustion and moxibustion in each group (P0.05). After moxibustion, moxibustion was compared with the normal control group, after 3 weeks, the model was compared with the normal control group. The volume growth of the toes in the group of rats was significantly increased, P0.01, the difference had significant statistical significance. Compared with the model group, the volume of the toe of moxibustion was significantly decreased, P0.01, the difference had significant statistical significance. Compared with the moxibustion 3cm group, the volume of the toe of Moxibustion 1cm group and moxibustion 2cm group decreased significantly, and the difference was significant statistically significant. Moxibustion 1cm was significant. There was no statistical difference between group and moxibustion 2cm group (P0.05). (5) comparison of arthritis score: before intervention, except normal control group, the AI score of rats in each group was more than 4 points, which showed that the model was successful, the difference between groups, P0.05, the difference was not statistically significant. After 3 weeks of moxibustion, the AI score of the model group continued to increase, and the AI score of moxibustion groups was more than that of the model group. There was no significant difference (P0.01). There was no significant difference in AI score between groups of Moxibustion (P0.05). (6) IL-1 beta level: after 3 weeks of moxibustion, the level of serum IL-1 beta in the model group was significantly higher than that of the normal control group, and the difference was statistically significant. Compared with the model group, the level of serum IL-1 beta in moxibustion groups decreased significantly, and P0.01, the difference was significant. Statistical significance. Compared with the moxibustion 3cm group, the serum IL-1 beta level of moxibustion 1,2cm group was significantly lower (P0.01), the difference between moxibustion 1cm group and moxibustion 2cm group was not statistically significant (P0.05). (7) the level of TNF- A: after 3 weeks of moxibustion, the level of serum INF- alpha in the model group was significantly higher than that in the normal control group, and the difference of P0.01, with significant statistical significance, was significant. Compared with the moxibustion group, the serum TNF- alpha level was significantly decreased, P0.01, the difference was significant statistically significant. Compared with the moxibustion 3cm group, the serum TNF- alpha level of the moxibustion 1,2cm group was significantly lower (P0.01), the difference between the moxibustion 1cm group and the moxibustion 2cm group was not statistically significant (P0.05). (8) pathological HE staining: pathological HE staining of the ankle joint in the normal control group. No obvious abnormality was found in the model group. Inflammatory cells were seen in the joint cavity; inflammatory cells were seriously infiltrated and pannus formed; the synovial cells were swollen and disordered, with obvious hyperplasia and severe degeneration and necrosis. The moxibustion groups showed moderate inflammatory cells in each group; the synovial cells were slightly proliferated or moderately swelled; and the model group was a model group. Compared with the moxibustion 2cm group, the synovial swelling of the moxibustion group was obviously better than that of moxibustion 1cm group and moxibustion 3cm group, but there was no significant difference between moxibustion 1cm group and moxibustion 2cm group. Conclusion (1) after moxibustion for 3 weeks, the moxibustion was compared with the model group, the general condition of moxibustion was improved and the toes red and swelling were relatively more than that of the model group. Light, pathological staining showed that the synovial membrane was thinner and the inflammatory cells were slightly infiltrated. The level of serum IL-1 beta and TNF- alpha water were lower than the model group. It was proved that moxibustion had a certain role in improving the function of joint and regulating immunity. (2) moxibustion was used to treat CIA rats with moxibustion at the distance of 1 to 2cm, and the effect of moxibustion was better. (3) from tolerance, acceptability and curative effect. Comprehensive consideration, moxibustion 2cm group is the best distance of moxibustion for the treatment of rheumatoid arthritis rats. The results of this study provide important reference value and reference value for the clinical standardization of the application of moxibustion for the treatment of RA.
【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】：2017
【分類號(hào)】：R245

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相關(guān)期刊論文 前10條

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