【摘要】：目的通過觀察補(bǔ)陽還五湯對大鼠腓總神經(jīng)損傷后腓總神經(jīng)及脛前肌形態(tài)與功能、神經(jīng)生長因子(nerve growth factor, NGF)及mRNA表達(dá)的影響,探討補(bǔ)陽還五湯治療周圍神經(jīng)損傷導(dǎo)致運動障礙的部分機(jī)理,為臨床應(yīng)用和進(jìn)一步研究補(bǔ)陽還五湯治療周圍神經(jīng)損傷導(dǎo)致運動障礙提供客觀的理論依據(jù)。方法1.補(bǔ)陽還五湯治療周圍神經(jīng)損傷導(dǎo)致運動障礙的理論探討收集、整理中醫(yī)學(xué)有關(guān)痿證及西醫(yī)學(xué)對周圍神經(jīng)損傷的文獻(xiàn)研究,探討防治周圍神經(jīng)損傷導(dǎo)致運動障礙的研究概況并總結(jié)近年來有關(guān)補(bǔ)陽還五湯組方、配伍、單味藥及復(fù)方的現(xiàn)代藥理研究等文獻(xiàn)資料。2.補(bǔ)陽還五湯治療腓總神經(jīng)損傷導(dǎo)致運動障礙的實驗研究SPF級雄性大鼠48只,隨機(jī)分為假手術(shù)組、彌可保組(劑量為625mg/g)、模型組、補(bǔ)陽還五湯(Buyang huanwu decoction, BYHWD)高、中、低劑量組(劑量分別為25.92mg/g、12.96mg/g、6.48mg/g生藥)。建立大鼠腓總神經(jīng)夾傷模型,每日灌胃給藥。21d后測量足趾寬度,記錄展趾功能；進(jìn)行肌電圖檢測,測量肌電位衰減率；檢測脛前肌的濕重比；脛前肌HE染色,測定脛前肌肌纖維橫截面積；運用透射電鏡組織學(xué)技術(shù)觀察得出髓鞘形態(tài)與厚度；運用免疫組化法檢測大鼠NGF的分泌情況；PCR檢測腓總神經(jīng)中神經(jīng)生長因子mRNA的表達(dá),以此觀察補(bǔ)陽還五湯給藥后大鼠腓總神經(jīng)再生與功能恢復(fù)情況。結(jié)果1.周圍神經(jīng)損傷導(dǎo)致的運動障礙相當(dāng)于祖國醫(yī)學(xué)的“痿證”范疇。發(fā)病的主要病理機(jī)制之一為元氣大傷、血脈不通。病性為本虛標(biāo)實。元氣大傷為本,血脈瘀阻為標(biāo)。主要治法為補(bǔ)氣活血。補(bǔ)陽還五湯作為補(bǔ)氣活血法的代表方,治療本病,切合病機(jī)。2.展趾功能：術(shù)后第2d患側(cè)出現(xiàn)足趾蜷縮和跛行。7d后BYHWD中、高劑量組和彌可保組足趾逐漸伸展,而模型組恢復(fù)則很慢。14d后情況繼續(xù)好轉(zhuǎn)。21d后各組足趾明顯伸展,步態(tài)基本恢復(fù)正常。但是除假手術(shù)組外,其余各組患側(cè)均出現(xiàn)不同程度的運動障礙。展趾功能結(jié)果顯示,與假手術(shù)組比,模型組差異顯著(P0.01)。BYHWD高劑量組、彌可保組與模型組相比差異顯著(P0.01或P0.05)。BYHWD各組與彌可保組比較無統(tǒng)計學(xué)差異(P0.05)。3.重復(fù)神經(jīng)電刺激檢測衰減反應(yīng)：假手術(shù)組除外,其余五組組大鼠RNS均出現(xiàn)不同程度的衰減,差異顯著(P0.01)。BYHWD高劑量、彌可保組與模型組比較差異顯著(P0.01)。BYHWD高劑量與彌可保組相比不具備統(tǒng)計學(xué)差異。4.脛前肌濕重比：與假手術(shù)組相比,各組大鼠患側(cè)脛前肌的濕重比都呈現(xiàn)不同程度的降低(P0.01或P0.05)。與模型組相比,BYHWD高劑量、彌可保組均有顯著增高(P0.05),而彌可保組與BYHWD組間無統(tǒng)計學(xué)差異(P0.05)。5.脛前肌橫截面積：假手術(shù)組脛前肌橫截面形態(tài)較規(guī)則,結(jié)締組織很少。與假手術(shù)組相比,模型組肌纖維結(jié)構(gòu)紊亂、細(xì)胞間隙增寬、結(jié)締組織增生、肌纖維萎縮變性明顯。BYHWD各組和彌可保組細(xì)胞間隙增寬,肌纖維輕度萎縮變性,但形態(tài)較規(guī)則,結(jié)構(gòu)尚清晰、染色較均一,結(jié)締組織增生不明顯肌纖維橫截面積統(tǒng)計分析提示：其余五組與假手術(shù)組相比差異顯著(P0.05)。BYHWD各組與彌可保組相比無明顯差異(P0.05)。6.腓總神經(jīng)電鏡形態(tài)學(xué)觀察：假手術(shù)組軸突內(nèi)在軸突內(nèi)可見到橫斷的微管、神經(jīng)絲及軸系膜。部分髓鞘神經(jīng)橫切面形態(tài)規(guī)則,髓鞘板層結(jié)構(gòu)排列整齊、均勻,無離散現(xiàn)象。BYHWD和彌可保組髓鞘厚度改變不明顯,只有少量變性的神經(jīng)纖維髓鞘板層離散。BYHWD中、低劑量組髓鞘厚度進(jìn)一步變薄、板層離散情況更一步加重。模型組髓鞘厚度進(jìn)一步減薄,部分髓鞘板層離散非常嚴(yán)重,形成大量髓鞘球。各組大鼠脫髓鞘厚度統(tǒng)計結(jié)果可見：其它五組與假手術(shù)組相比差異顯著(P0.05),與模型組相比,BYHWD各組與彌可保組差異顯著(P0.05)。與彌可保組相比,BYHWD高劑量組差異顯著(P0.05)。7.NGF蛋白表達(dá)：假手術(shù)組、BYHWD各組和彌可保組可見較多NGF免疫反應(yīng)陽性顆粒,呈淺棕色。模型組大鼠NGF陽性顆粒數(shù)目減少,著色淺淡。假手術(shù)組與模型組比較具有統(tǒng)計學(xué)意義(P0.05)。BYHWD各組彌可保組與模型組比差異顯著(P0.01或P0.05)。8.NGF-mRNA的表達(dá)：6組的NGF-mRNA基因相對表達(dá)量比較,差異有統(tǒng)計學(xué)意義(P0.05),假手術(shù)組、彌可保組與BYHWD高、中、低劑量組NGF-mRNA基因相對表達(dá)量明顯增高,分別是模型組的4.79倍、2.16倍、3.41倍、1.83倍、1.31倍；其中BYHWD中劑量及高劑量組、彌可保組NGF-mRNA相對表達(dá)量明顯強(qiáng)于模型組(P0.05),BYHWD高劑量組NGF-mRNA相對表達(dá)量明顯強(qiáng)于彌可保組(P0.05)。結(jié)論1.補(bǔ)陽還五湯能夠有效促進(jìn)大鼠夾傷神經(jīng)及其靶器官骨骼肌形態(tài)與功能恢復(fù),對大鼠周圍神經(jīng)損傷導(dǎo)致的運動障礙有較好的防治作用。2.補(bǔ)陽還五湯對周圍神經(jīng)再生的保護(hù)作用與它對NGF蛋白和腓總神經(jīng)中NGF-mRNA的表達(dá)有關(guān)。其機(jī)理可能與該方大補(bǔ)元氣,活血化瘀的功效相聯(lián)。該方能夠有效促進(jìn)軸突和髓鞘生長來促進(jìn)周圍神經(jīng)再生,其機(jī)理有待進(jìn)一步的研究。
[Abstract]:Objective To observe the effect of Buyang Huanhui Five Decoction on the morphology and function of the peroneal nerve and the anterior tibial muscle, nerve growth factor (NGF) and the expression of mRNA after the injury of the peroneal nerve in rats, and to explore the partial mechanism of the treatment of the peripheral nerve injury caused by the tonifying Yang and the five soup, and further study the clinical application and further study of the tonifying yang five soup. The treatment of peripheral nerve injury can provide an objective theoretical basis. Method 1. the theoretical exploration of the treatment of peripheral nerve injury caused by peripheral nerve injury is collected, the literature of Chinese medicine related to flaccid syndrome and Western Medicine on peripheral nerve injury is studied, and the research situation of the prevention and treatment of peripheral nerve injury resulting in dyskinesia is discussed. In recent years, we summarize the literature of Buyang Huanhui Five Decoction, compatibility, single flavor medicine and compound medicine and other literature data,.2. Buyang Huanhui Five Decoction in the treatment of 48 SPF male rats in the treatment of general peroneal nerve injury, which are randomly divided into sham operation group, mica group (625mg/g), model group, Yang Yang five Decoction (Buyang Huanwu) Decoction, BYHWD) high, medium, low dose group (dose of 25.92mg/g, 12.96mg/g, 6.48mg/g raw medicine respectively). Establish the rat peroneal nerve clamp injury model, measure the width of the toe, record the function of the toe of the toes after the daily perfusion of the stomach for.21d, detect the electromyography, measure the decline rate of the muscle potential, detect the wet weight ratio of the tibial muscle, and determine the tibia by HE staining of the tibial muscle and determine the tibia. The transversal area of the anterior muscle fibers was observed and the morphology and thickness of the myelin sheath were observed by transmission electron microscopy, and the secretion of NGF in rats was detected by immunohistochemistry; PCR was used to detect the expression of nerve growth factor mRNA in the general peroneal nerve, so as to observe the regenerative and functional recovery of the total peroneal nerve of the rats after the five decoction. Results 1. The dyskinesia caused by peripheral nerve injury is equivalent to the category of "flaccid syndrome" in the Chinese medicine. One of the main pathological mechanisms of the disease is massive trauma, unconnected blood. The disease is a virtual standard. The main treatment is tonifying qi and activating blood. The main treatment is to make up the Qi and activating blood. The five decoction is the representative of the method of Invigorating Qi and activating blood. The.2. spread function of the disease machine: the toe curling and the claudication.7d after the operation on the 2D side were found in BYHWD, the high dose group and the Michal group's toes gradually extended, while the model group resumed after the slow.14d and continued to improve after.21d, and the gait was basically restored to normal. But the other groups were different from the sham operation group. The result of the degree of motor dysfunction showed that the difference between the model group and the model group was significant (P0.01).BYHWD high dose group compared with the sham operation group, and the difference was significant (P0.01 or P0.05) compared with the model group (P0.01 or P0.05), there was no statistical difference between the group.BYHWD and the mass group (P0.05).3. repetitive nerve electrical stimulation detection attenuation response, except the sham operation group. The RNS of the five groups had different degrees of attenuation, the difference was significant (P0.01).BYHWD high dose, and the difference was significant (P0.01) with the model group (P0.01), the high dose of.BYHWD was not statistically different from that of the mass group, and the wet weight ratio of the anterior tibial muscle was not statistically different: compared with the sham operation group, the wet weight ratio of the anterior tibial muscle of the rats in each group were different degrees. Lower (P0.01 or P0.05). Compared with the model group, the high dose of BYHWD was significantly higher (P0.05), but there was no statistical difference between the group and the BYHWD group (P0.05) the transverse section of the anterior tibial muscle of the.5.: the cross section of the tibial muscle in the sham operation group was more regular and the connective tissue was very few. The widening of intercellular space, connective tissue hyperplasia, muscle fiber atrophy and degeneration obviously widened in.BYHWD and myocutaneous fibers, and slight atrophy of muscle fibers, but the shape is more regular, the structure is clear, the staining is more uniform. The statistical analysis of the unidentified muscle fiber cross section of the connective tissue shows that the other five groups are different from the sham operation group. (P0.05) there was no significant difference in (P0.05).BYHWD in the peroneal peroneal nerve of all groups (P0.05). The morphological observation of the common peroneal nerve in.6.: the transverse microtubules, the nerve fibers and the axonal membrane in the axon of the sham operation group were seen. The shape of the transverse section of the myelin sheath was regular, and the myelin lamellar structure was arranged neatly and evenly, without the discrete phenomenon of.BYHWD and the mass group. Medullary sheath thickness changes were not obvious. Only a small amount of denatured nerve fiber myelin lamina dispersed.BYHWD, the myelin thickness was further thinner in the low dose group, and the lamellar dispersion was further aggravated. The medullary sheath thickness of the model group was further thinned and the medullary sheaths were dispersed very seriously and formed a large number of myelin spheres. The demyelination thickness statistics of rats in each group were statistical results. The difference between the other five groups was significantly different from the sham group (P0.05). Compared with the model group, the difference between the BYHWD and the mass groups was significant (P0.05). Compared with the mass group, the BYHWD high dose group was significantly different (P0.05).7.NGF protein expression: the sham operation group, the BYHWD groups and the mass groups showed more NGF immunoreactive particles, which were light brown. The number of NGF positive particles in the model group was reduced and the coloring was light. The comparison of the sham operation group and the model group was statistically significant (P0.05) the difference was significant (P0.01 or P0.05).8.NGF-mRNA in each group of.BYHWD groups (P0.01 or P0.05) in each group: the relative expression of NGF-mRNA gene in the 6 groups was statistically significant (P0.05), sham operation group, and mass The relative expression of NGF-mRNA gene in the group and BYHWD high, middle and low dose group was significantly higher, which was 4.79 times, 2.16 times, 3.41 times, 1.83 times, 1.31 times, respectively. The relative expression of NGF-mRNA in BYHWD and high dose groups was significantly stronger than that in the model group (P0.05), and the relative expression of NGF-mRNA in the BYHWD high dose group was obviously stronger than that of the mass group. Conclusion (P0.05). Conclusion 1. Buyang Huanhui Five Decoction can effectively promote the recovery of skeletal muscle morphology and function of the injured nerve and its target organs, and has a good preventive effect on the dyskinesia caused by peripheral nerve injury in rats. The protective effect of.2. Buyang huanfive Decoction on peripheral nerve regeneration and its expression of NGF-mRNA in NGF protein and peroneal nerve. The mechanism may be associated with the effect of this prescription, which can promote the growth of the axon and myelin sheath to promote the regeneration of the peripheral nerve. The mechanism needs further study.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 牛忠英;周圍神經(jīng)損傷診治失誤18例分析[J];中醫(yī)正骨;2002年06期

2 汪瑞東,武從顯,汪愛群;綜合治療慢性周圍神經(jīng)損傷[J];河南醫(yī)藥信息;2003年02期

3 顧玉東;提高周圍神經(jīng)損傷的診治水平[J];中華創(chuàng)傷骨科雜志;2003年01期

4 李志勇,楊象民,王樹榮;中藥治療周圍神經(jīng)損傷的研究進(jìn)展[J];時珍國醫(yī)國藥;2004年03期

5 顧玉東;周圍神經(jīng)損傷診治的幾個基本問題[J];醫(yī)學(xué)臨床研究;2004年05期

6 李文軍,顧玉東;周圍神經(jīng)損傷后手部感覺恢復(fù)的研究進(jìn)展[J];復(fù)旦學(xué)報(醫(yī)學(xué)版);2004年05期

7 鄭林豐;易西南;;周圍神經(jīng)損傷的再生與修復(fù)的哲學(xué)啟示[J];創(chuàng)傷外科雜志;2006年01期

8 劉小林;;我國周圍神經(jīng)損傷修復(fù)研究現(xiàn)狀與趨勢[J];中國修復(fù)重建外科雜志;2008年09期

9 顏華;張惠佳;;中藥治療周圍神經(jīng)損傷的研究進(jìn)展[J];中醫(yī)藥導(dǎo)報;2008年08期

10 劉恒;曹瑞治;;血管內(nèi)皮生長因子與周圍神經(jīng)損傷[J];廣東醫(yī)學(xué);2009年07期

相關(guān)會議論文 前10條

1 楊佩君;蔣斌;王美芬;陳凱敏;;四肢周圍神經(jīng)損傷的康復(fù)[A];中國康復(fù)醫(yī)學(xué)會第四屆會員代表大會暨第三屆中國康復(fù)醫(yī)學(xué)學(xué)術(shù)大會論文匯編[C];2001年

2 李卓東;蘇佳燦;曹烈虎;張春才;;地震中周圍神經(jīng)損傷的野戰(zhàn)診治體會[A];第十六屆全國中西醫(yī)結(jié)合骨傷科學(xué)術(shù)研討會暨中西醫(yī)結(jié)合手法治療骨傷科疾病新進(jìn)展學(xué)習(xí)班論文匯編[C];2008年

3 張曉杰;;周圍神經(jīng)損傷的護(hù)理[A];吉林省護(hù)理學(xué)會外科學(xué)護(hù)理分會第十五次學(xué)術(shù)會議論文匯編[C];2011年

4 姜加權(quán);陳金華;;豬周圍神經(jīng)損傷影像技術(shù)探討[A];2010中華醫(yī)學(xué)會影像技術(shù)分會第十八次全國學(xué)術(shù)大會論文集[C];2010年

5 傅炳峨;黃耀添;胡蘊(yùn)玉;殷琦;;晚期周圍神經(jīng)損傷的退變與再生實驗和臨床研究[A];西部大開發(fā) 科教先行與可持續(xù)發(fā)展——中國科協(xié)2000年學(xué)術(shù)年會文集[C];2000年

6 陳銀海;賴蘊(yùn)珠;姚紅華;;周圍神經(jīng)損傷的強(qiáng)度時間曲線分析[A];中國康復(fù)醫(yī)學(xué)會第四屆會員代表大會暨第三屆中國康復(fù)醫(yī)學(xué)學(xué)術(shù)大會論文匯編[C];2001年

7 周豐慧;;周圍神經(jīng)損傷的康復(fù)治療[A];中國康復(fù)醫(yī)學(xué)會第四屆會員代表大會暨第三屆中國康復(fù)醫(yī)學(xué)學(xué)術(shù)大會論文匯編[C];2001年

8 陳銀海;賴蘊(yùn)珠;姚紅華;;周圍神經(jīng)損傷的強(qiáng)度時間曲線分析[A];中國康復(fù)醫(yī)學(xué)會第三次康復(fù)治療學(xué)術(shù)大會論文匯編[C];2002年

9 陳海嘯;;周圍神經(jīng)損傷修復(fù)研究進(jìn)展[A];2005年浙江省骨科學(xué)術(shù)會議論文匯編[C];2005年

10 張曉茹;;肌電生物反饋治療周圍神經(jīng)損傷11例[A];肢體傷殘康復(fù)與護(hù)理學(xué)術(shù)論文集[C];1995年

相關(guān)重要報紙文章 前8條

1 山東青島 戴源;周圍神經(jīng)損傷早期的康復(fù)[N];上海中醫(yī)藥報;2012年

2 張中橋;晚期周圍神經(jīng)損傷有修復(fù)價值[N];中國醫(yī)藥報;2002年

3 北京大學(xué)第一醫(yī)院兒科副教授 姜玉武;周圍神經(jīng)損傷須及時綜合治療[N];健康報;2008年

4 上海長海醫(yī)院康復(fù)醫(yī)學(xué)科 翟金萍;周圍神經(jīng)損傷的生物反饋療法[N];上海中醫(yī)藥報;2012年

5 整理 馬善治 劉渝松;右前臂周圍神經(jīng)損傷案[N];中國中醫(yī)藥報;2013年

6 本報記者 朱國旺;使羊周圍神經(jīng)再生8.5厘米[N];中國醫(yī)藥報;2002年

7 劉道安;電針對周圍神經(jīng)損傷修復(fù)有促進(jìn)作用[N];中國醫(yī)藥報;2005年

8 通訊員 張獻(xiàn)懷;神經(jīng)斷了可以移植修復(fù)[N];中國消費者報;2004年

相關(guān)博士學(xué)位論文 前10條

1 劉海飛;神經(jīng)寄養(yǎng)修復(fù)周圍神經(jīng)損傷的療效和分子機(jī)制研究[D];復(fù)旦大學(xué);2014年

2 蔣文莉;低強(qiáng)度脈沖超聲促進(jìn)周圍神經(jīng)損傷后再生的實驗研究[D];中國人民解放軍醫(yī)學(xué)院;2016年

3 何純青;地震后周圍神經(jīng)損傷的分類分級診治及晚期手術(shù)治療研究[D];中國人民解放軍醫(yī)學(xué)院;2014年

4 張偉;組織工程化人工神經(jīng)修復(fù)長節(jié)段周圍神經(jīng)損傷的實驗研究[D];第二軍醫(yī)大學(xué);2011年

5 佟帥;針刺治療周圍神經(jīng)損傷機(jī)理的實驗研究[D];黑龍江中醫(yī)藥大學(xué);2002年

6 楊光;骨髓間充質(zhì)干細(xì)胞修復(fù)大鼠周圍神經(jīng)損傷的實驗研究[D];吉林大學(xué);2007年

7 李桂石;大鼠周圍神經(jīng)損傷后脊髓前角運動神經(jīng)元變化的動態(tài)觀察[D];天津醫(yī)科大學(xué);2013年

8 孫鴻斌;Ca～（2+）對周圍神經(jīng)損傷后運動神經(jīng)元作用的實驗研究[D];吉林大學(xué);2004年

9 杜旭;電針對周圍神經(jīng)損傷大鼠神經(jīng)生長導(dǎo)向因子的影響研究[D];成都中醫(yī)藥大學(xué);2012年

10 殷琦;周圍神經(jīng)損傷后神經(jīng)、肌肉運動終板退變及再生的臨床、實驗研究[D];第四軍醫(yī)大學(xué);1991年

相關(guān)碩士學(xué)位論文 前10條

1 寇文冠;新鮮羊膜對周圍神經(jīng)損傷修復(fù)影響的實驗研究[D];河北醫(yī)科大學(xué);2015年

2 徐成毅;不同長度聚乳酸膜小間隙縫合修復(fù)周圍神經(jīng)損傷的實驗研究[D];南方醫(yī)科大學(xué);2016年

3 張賽;補(bǔ)陽還五湯防治周圍神經(jīng)損傷導(dǎo)致運動障礙的機(jī)理研究[D];南京中醫(yī)藥大學(xué);2016年

4 王冠;三種物理方法促進(jìn)兔周圍神經(jīng)損傷后修復(fù)的對比研究[D];吉林大學(xué);2010年

5 何純青;5.12汶川地震所致周圍神經(jīng)損傷的調(diào)查與治療研究[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2011年

6 高楊;微波對實驗性大鼠周圍神經(jīng)損傷后功能恢復(fù)的影響[D];大連醫(yī)科大學(xué);2011年

7 劉燕榮;鼠神經(jīng)生長因子治療周圍神經(jīng)損傷的系統(tǒng)評價[D];山西醫(yī)科大學(xué);2013年

8 李洪梅;針康法治療上肢周圍神經(jīng)損傷的臨床觀察[D];黑龍江中醫(yī)藥大學(xué);2012年

9 徐錦芳;天然細(xì)胞生長調(diào)控因子對周圍神經(jīng)損傷后再生和修復(fù)的實驗研究[D];浙江大學(xué);2002年

10 申琳;周圍神經(jīng)損傷后脊髓前角運動神經(jīng)元形態(tài)和超微結(jié)構(gòu)變化[D];天津醫(yī)科大學(xué);2011年

，

本文編號：2147704