本文選題：針刺 + 慢性心力衰竭　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過研究針刺對慢性心力衰竭兔模型的影響,探討針刺治療慢性心力衰竭(chronic heart failure,CHF)可能的機制,為臨床進一步開展和推廣慢性心力衰竭的針刺治療提供更加可靠的前期基礎(chǔ)和依據(jù)。方法:將28只雄性新西蘭大白兔按照隨機數(shù)字表分為正常對照組(7只)、CHF模型組(7只)、貝那普利組(7只)和針刺治療組(7只)。正常對照組和CHF模型組予以蒸餾水灌胃;貝那普利組予以鹽酸貝那普利(3mg/kg/d)灌胃3個月;針刺治療組予以針刺治療和等量蒸餾水灌胃。評估實驗前后實驗兔的生理狀況、血生化指標、超聲心動圖指標和心肌病理形態(tài)。干預(yù)前后,采用ELISA試劑盒測量實驗兔血漿B型鈉尿肽(B type natfiuretic peptide,BNP)、腎素(renin,REN)、血管緊張素II(angiotensinII,Ang II)、醛固酮(aldosterone,ALD)、去甲腎上腺素(norepinephrine,NE)水平,采用超聲心動圖測量左室舒張末期內(nèi)徑(left ventricular end diastolic diameter,LVEDD)、左室收縮末期內(nèi)徑(left ventricular end systolic diameter,LVESD)、左室射血分數(shù)(left ventricular ejection fraction,LVEF);干預(yù)后,采用光鏡觀察心肌病理形態(tài)變化。結(jié)果:(1)造模后,CHF模型組、貝那普利組和針刺治療組實驗兔的體重[(1.84±0.10)kg、(1.90±0.09)kg、(1.81±0.08)kg比(2.03±0.08)kg,P0.05]比正常對照組減輕,心率加快[(233.86±5.52)次/分、(234.43±4.24)次/分、(235.29±5.62)次/分比(164.86±4.10)次/分,P0.05],血漿BNP[(1940.20±87.84)pg/ml、(1905.62±109.83)pg/ml、(2012.88±89.59)pg/ml比(1408.99±119.48)pg/ml,p0.05]、ren[(259.71±14.81)pg/ml、(253.75±11.06)pg/ml、(257.61±8.88)pg/ml比(183.31±22.25)pg/ml,p0.05]、ang-Ⅱ[(461.19±38.10)pg/ml、(455.20±28.30)pg/ml、(463.39±20.23)pg/ml比(311.38±13.40)pg/ml,p0.05]、ald[(487.86±73.01)pg/ml、(445.30±17.08)pg/ml、(457.21±21.14)pg/ml比(339.29±25.73)pg/ml,p0.05]、ne[(414.16±13.56)pg/ml、(408.01±22.11)pg/ml、(400.30±14.18)pg/ml比(305.66±13.49)pg/ml,p0.05]水平升高,lvef[(56.57±2.82)%、(56.29±2.69)%、(56.43±3.60)%比(77.00±2.83)%,p0.05]下降,lvedd[(13.49±0.44)mm、(13.60±0.40)mm、(13.58±0.36)mm比(10.51±0.46)mm,p0.05]、lvesd[(8.74±0.66)mm、(8.75±0.51)mm、(8.4±0.63)mm比(6.80±0.28)mm,p0.05]增加,差異有統(tǒng)計學(xué)意義,提示造模成功。(2)在干預(yù)終點,與正常對照組相比,貝那普利組和針刺治療組的各觀察指標均無明顯差異,而chf模型組的體重[(2.64±0.09)kg比(3.14±0.08)kg、(3.08±0.08)kg、(3.06±0.09)kg,p0.05]較正常對照組、貝那普利組和針刺治療組減輕,心率[(236.57±3.78)次/分比(174.00±4.28)次/分、(182.57±9.78)次/分、(181.29±8.08)次/分,p0.05]和血bnp[(1836.91±92.54)pg/ml比(1414.07±88.84)pg/ml、(1386.76±69.38)pg/ml、(1453.16±69.58)pg/ml,p0.05]、ren[(255.49±11.97)pg/ml比(182.00±17.49)pg/ml、(186.72±6.31)pg/ml、(189.27±10.41)pg/ml,p0.05]、ang-Ⅱ[(477.85±15.44)pg/ml比(315.12±35.11)pg/ml、(325.75±15.73)pg/ml、(323.87±15.08)pg/ml,p0.05]、ald[(484.66±47.6)pg/ml比(332.55±24.97)pg/ml、(328.14±19.00)pg/ml、(329.95±17.13)pg/ml,p0.05]、ne[(406.42±16.23)pg/ml比(335.84±16.22)pg/ml、(324.10±13.56)pg/ml、(327.06±20.38)pg/ml,p0.05]水平升高,LVEDD[(13.62±0.41)mm比(12.17±0.34)mm、(12.38±0.54)mm、(12.45±0.32)mm,P0.05]、LVESD[(11.40±0.41)mm比(9.97±0.30)mm、(10.35±0.57)mm、(10.26±0.18)mm,P0.05]增加,LVEF降低[(55.43±2.64)%比(77.43±2.76)%、(65.71±2.29)%、(67.00±2.58)%,P0.05]。(3)病理形態(tài)學(xué)改變上顯示,正常對照組心肌未見明顯的異常改變,而CHF模型組、貝那普利組和針刺治療組的實驗兔心肌均可見不同程度的損傷性改變,主要包括心肌細胞排列稀疏、紊亂,細胞水腫、壞死,心肌細胞核固縮、濃縮、裂解,橫紋不清,心肌纖維組織增生,炎細胞浸潤等。其程度由低到高為:貝那普利組、針刺治療組和CHF模型組。結(jié)論:(1)針刺能降低慢性心力衰竭兔模型血漿BNP水平;(2)針刺能有效抑制慢性心力衰竭兔模型的腎素-血管緊張素-醛固酮系統(tǒng)(renin-angiotensin-aldosterone system,RAAS)和兒茶酚胺系統(tǒng)的激活,降低血漿REN、Ang-Ⅱ、ALD、NE水平;(3)針刺能改善慢性心力衰竭兔模型的心功能;(4)針刺可能對慢性心力衰竭兔模型的心肌重塑進程有改善作用。
[Abstract]:Objective: To explore the possible mechanism of acupuncture treatment for chronic heart failure (chronic heart failure, CHF) by studying the effect of acupuncture on the rabbit model of chronic heart failure, so as to provide a more reliable basis and basis for the further development and promotion of acupuncture treatment for chronic heart failure. Methods: 28 new Zealand white rabbits were used as a basis. The random number table was divided into the normal control group (7), the CHF model group (7), the Benner Pury group (7) and the acupuncture treatment group (7). The normal control group and the CHF model group were given the distilled water, and the Benner Pury group was treated with Benner Pury (3mg/kg/d) for 3 months; the acupuncture treatment group was treated with acupuncture and the same amount of distilled water was given to the stomach. Experimental rabbit's physiological status, blood biochemical index, echocardiography index and myocardial pathological form. Before and after intervention, ELISA kit was used to measure B type natriuretic peptide (B type natfiuretic peptide, BNP), renin (renin, REN), angiotensin II (angiotensinII, Ang), aldosterone, norepinephrine. Ine, NE) level, using echocardiography to measure left ventricular end diastolic diameter (left ventricular end diastolic diameter, LVEDD), left ventricular end systolic diameter (left ventricular end systolic), left ventricular ejection fraction (left ventricular ejection fraction). Results: (1) after the model, the body weight of the rabbits in the CHF model group, benazepril group and the acupuncture treatment group were (1.84 + 0.10) kg, (1.90 + 0.09) kg, (1.81 + 0.08) kg ratio (2.03 + 0.08) kg, P0.05] compared with the normal control group, and the heart rate was faster [(233.86 + 5.52) / sub, (234.43 + 4.24) / sub, (234.43 + 0.09) / sub / fraction, P0.05], and plasma BNP[( 1940.20 + 87.84) pg/ml, (1905.62 + 109.83) pg/ml, (2012.88 + 89.59) pg/ml ratio (1408.99 + 119.48) pg/ml, p0.05], ren[(259.71 + 14.81) pg/ml, (253.75 + 11.06) pg/ml, p0.05] pg/ml, p0.05]. (487.86 + 73.01) pg/ml, (445.30 + 17.08) pg/ml, (457.21 + 21.14) pg/ml ratio (339.29 + 25.73) pg/ml, p0.05], ne[(414.16 + 13.56) pg/ml, (408.01 + 22.11) pg/ml, (400.30 + 22.11) pg/ml, p0.05] level, lvef[ ) mm, (13.60 + 0.40) mm, (13.58 + 0.36) mm ratio (10.51 + 0.46) mm, p0.05], lvesd[(8.74 + 0.66) mm, (8.75 + 0.51) mm, (8.4 + 0.63) mm ratio (6.80 + 13.58) mm, p0.05] increased, the difference was statistically significant, indicating the success of the model, compared with the normal control group, the observation of benazepril group and the acupuncture treatment group had no significant differences, The weight of the CHF model group was (2.64 + 0.09) kg ratio (3.14 + 0.08) kg, (3.08 + 0.08) kg, (3.06 + 0.09) kg, p0.05] compared with the normal control group, and the benazepril group and the acupuncture treatment group were relieved, heart rate [(236.57 + 3.78) / sub / fraction (174 + 4.28) / sub, (182.57 +) secondary / sub, p0.05] and bnp[(0.08) pg/ml ratio. (88.84) pg/ml, (1386.76 + 69.38) pg/ml, (1453.16 + 69.58) pg/ml, p0.05], ren[(255.49 + 11.97) pg/ml ratio (182 + 17.49) pg/ml, (186.72 + 6.31) pg/ml, p0.05], ang- II. Pg/ml, (328.14 + 19) pg/ml, (329.95 + 17.13) pg/ml, p0.05], ne[(406.42 + 16.23) pg/ml ratio (335.84 + 16.22) pg/ml, (324.10 + 13.56) pg/ml, (327.06 + 20.38) pg/ml, p0.05] level rising, LVEDD[mm ratios. (10.26 + 0.18) mm, P0.05] increased, LVEF decreased [(55.43 + 2.64)%, 77.43 + 2.76)%, (65.71 + 2.29)%, (67 + 2.58)%, and P0.05]. (3) pathological changes showed that no obvious abnormal changes were found in the normal control group, while the myocardium in the CHF model group, the bainpril group and the acupuncture treatment group showed varying degrees of damage change in the experimental rabbit myocardium. Mainly including sparse, disorder, edema, necrosis, myocardial cell nuclear condensation, concentration, lysis, transverses, myocardial fibrosis, inflammatory cell infiltration and so on. The degree from low to high is: Benner Pury, acupuncture treatment group and CHF model group. (1) acupuncture can reduce plasma BNP level in rabbit model of chronic heart failure; (2) Acupuncture can effectively inhibit the activation of the renin angiotensin aldosterone system (renin-angiotensin-aldosterone system, RAAS) and catecholamine system in the rabbit model of chronic heart failure, and reduce the plasma REN, Ang- II, ALD, NE level; (3) acupuncture can improve the cardiac function of the rabbit model of chronic heart failure; (4) acupuncture may be on the rabbits with chronic heart failure. The model can improve the remodeling process of myocardium.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R245;R-332

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