本文選題：系統(tǒng)性紅斑狼瘡 + 中醫(yī)體質　； 參考：《廣州中醫(yī)藥大學》2016年碩士論文

【摘要】：系統(tǒng)性紅斑狼瘡(SLE)是一種累及多系統(tǒng)多器官,臨床表現(xiàn)復雜,病程遷延反復的自身免疫性疾病,其病因及發(fā)病機制非常復雜,與遺傳、免疫紊亂、環(huán)境因素、性別因素等密切相關,至今尚未完全明確�，F(xiàn)代醫(yī)學研究認為凋亡細胞清除缺陷和T、B淋巴細胞凋亡異常是SLE發(fā)病的重要原因,Fas作為介導淋巴細胞凋亡的主要膜受體,與SLE發(fā)病有關。中醫(yī)認為體質是疾病發(fā)生、發(fā)展的重要因素,體質對于揭示疾病病因有獨特的優(yōu)勢。因此把中醫(yī)體質學觀點和現(xiàn)代醫(yī)學研究成果相結合,有利于揭示SLE的發(fā)病原因,為SLE的中醫(yī)藥防治奠定更科學的理論基礎。目的：本課題通過比較虛性體質和實性體質系統(tǒng)性紅斑狼瘡患者的外周血T、B淋巴細胞Fas表達率及凋亡率,探討系統(tǒng)性紅斑狼瘡發(fā)病的中醫(yī)本質及機理,為中醫(yī)藥有效防治系統(tǒng)性紅斑狼瘡提供更科學的理論依據(jù)。方法：研究收集2015年8月至2016年2月廣州中醫(yī)藥大學第一附屬醫(yī)院風濕病科門診及住院部符合SLE分類標準的病人共46例,收集病人姓名、年齡、性別、病程等一般情況資料；按照2009年4月9日實施的《中醫(yī)體質分類與判定》標準判定體質狀況,把陽虛體質、陰虛體質、氣虛體質歸為虛性體質,氣郁體質、痰濕體質、瘀血體質、濕熱體質歸為實性體質,特稟質及平和質暫不納入虛、實性體質研究范圍；并結合患者病情進行狼瘡疾病活動指數(shù)評分(SLEDAI評分)；每一位患者抽取靜脈血,采用流式細胞術檢測T淋巴細胞Fas表達率、B淋巴細胞Fas表達率以及T、B淋巴細胞凋亡率；最后采用spss22.0統(tǒng)計軟件將以上數(shù)據(jù)作統(tǒng)計學分析,比較虛性體質和實性體質SLE患者的T、B淋巴細胞Fas表達率及凋亡率,并對T、B淋巴細胞Fas表達率及凋亡率與抗ds-DNA水平、SLE疾病活動評分進行相關性分析,得出結論。結果：1.虛性體質的SLE患者的外周血T淋巴凋亡率顯著高于實性體質SLE患者。2.SLE患者外周血T淋巴細胞Fas表達率與SLE疾病活動度、抗ds-DNA抗體水平正相關。3.活動期SLE患者外周血B淋巴細胞Fas表達率與B淋巴細胞凋亡率正相關。結論：1.本次研究發(fā)現(xiàn)虛性體質組的T淋巴細胞凋亡率較實性體質組顯著升高。目前經(jīng)大量研究證實SLE外周血T淋巴細胞凋亡率較健康人升高,反映了SLE患者存在凋亡物質清除缺陷,這與SLE發(fā)病密切相關。因而我們認為虛性體質人群較實性體質人群具有更明顯的凋亡物質清除缺陷,因而更容易患SLE。這揭示了SLE患者以虛性體質常見的原因,也和中醫(yī)認為SLE的病機是以先天稟賦不足,正氣虧虛為本的這一認識相一致,因而我們可以認為“體虛”為SLE發(fā)病之本。2.SLE患者外周血T淋巴細胞Fas表達率與SLE疾病活動度、抗ds-DNA水平正相關,因此外周血T淋巴細胞Fas表達率在評估SLE疾病活動度方面具有重要價值。3.Fas介導的細胞凋亡途徑可能是活動期SLE患者外周血B淋巴細胞凋亡的主要途徑。
[Abstract]:Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems and organs with complex clinical manifestations and repeated course of disease. Gender factors and other closely related, so far has not been completely clear. Modern medical studies suggest that the defect of apoptotic cell clearance and the abnormal apoptosis of T _ (B) B lymphocytes are the important reasons for the pathogenesis of SLE. FAS is the main membrane receptor that mediates the apoptosis of lymphocytes, which is related to the pathogenesis of SLE. TCM believes that physique is an important factor in the occurrence and development of disease, and physique has a unique advantage in revealing the etiology of disease. Therefore, combining the viewpoint of TCM physique with the research results of modern medicine is helpful to reveal the pathogenesis of SLE and to lay a more scientific theoretical foundation for the prevention and treatment of SLE by TCM. Objective: to investigate the nature and mechanism of systemic lupus erythematosus (SLE) by comparing the FAS expression rate and apoptosis rate of peripheral blood TnB lymphocytes in patients with systemic lupus erythematosus (SLE). To provide a more scientific theoretical basis for the effective prevention and treatment of systemic lupus erythematosus by traditional Chinese medicine. Methods: from August 2015 to February 2016, 46 patients in the Department of Rheumatology, Department of Rheumatology, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, who met the classification criteria of SLE, were collected and their names, age, sex and course of disease were collected. According to the standard of TCM constitution classification and judgment implemented on April 9, 2009, the constitution of yang deficiency, yin deficiency and qi deficiency were classified as deficiency constitution, qi depression constitution, phlegm dampness constitution, blood stasis constitution. The dampness and heat constitution is classified as the solid constitution, the special quality and the calming quality are not included in the study of deficiency, and the physical fitness is studied. The disease activity index score (SLEDAI score) is carried out according to the condition of the patient. Each patient takes the venous blood. Flow cytometry was used to detect the FAS expression rate of T lymphocytes, the FAS expression rate of B lymphocytes and the apoptosis rate of B lymphocytes. Finally, the above data were statistically analyzed by spss22.0 software. To compare the FAS expression rate and apoptosis rate between asthenia and solid constitution SLE patients, and to analyze the correlation between FAS expression rate and apoptosis rate and anti-ds-DNA level of SLE disease activity score. The result is 1: 1. The rate of T lymphoid apoptosis in SLE patients with asthenia constitution was significantly higher than that in SLE patients with solid constitution. 2. The FAS expression rate of peripheral blood T lymphocytes in SLE patients was positively correlated with disease activity and anti-ds-DNA antibody level. There was a positive correlation between FAS expression and B lymphocyte apoptosis in active SLE patients. Conclusion 1. The apoptosis rate of T lymphocytes in asthenia constitution group was significantly higher than that in solid constitution group. At present, a large number of studies have confirmed that the apoptosis rate of T lymphocytes in peripheral blood of SLE is higher than that of healthy persons, which indicates that there is a defect in the clearance of apoptotic substances in SLE patients, which is closely related to the pathogenesis of SLE. Therefore, we think that the deficiency body population has more obvious apoptotic substance clearance defect than the real physical group, so it is more likely to suffer from SLE. This reveals the common causes of asthenia in SLE patients, and is consistent with the Chinese medicine's understanding that the pathogenesis of SLE is based on the deficiency of innate endowment and deficiency of qi. Therefore, we can conclude that "body deficiency" is the origin of SLE. 2. There is a positive correlation between FAS expression rate in peripheral blood T lymphocytes and disease activity and anti-ds-DNA level in SLE patients. Therefore, the expression rate of FAS in peripheral blood T lymphocytes has important value in evaluating the disease activity of SLE. 3. FAS mediated apoptosis may be the main pathway of peripheral blood B lymphocyte apoptosis in active SLE patients.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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