【摘要】：目的：通過分析脾虛氣陷型Ⅲ°脫垂性內(nèi)痔患者在補(bǔ)中益氣湯干預(yù)后的臨床表現(xiàn),初步探討補(bǔ)中益氣湯治療Ⅲ°脫垂性內(nèi)痔的臨床應(yīng)用價(jià)值。進(jìn)一步在分子生物學(xué)研究的層面上,對(duì)比脾虛氣陷型Ⅲ°脫垂性內(nèi)痔患者服用補(bǔ)中益氣湯及草木犀浸液片與單純服用草木犀浸液片后,其內(nèi)痔組織中Fibulin-5 mRNA與蛋白表達(dá)的變化差異,評(píng)估補(bǔ)中益氣湯對(duì)脾虛氣陷型Ⅲ°脫垂性內(nèi)痔的臨床療效,以期探討補(bǔ)中益氣湯治療Ⅲ°脫垂性內(nèi)痔的分子生物學(xué)的作用機(jī)制,進(jìn)一步探究脫垂性內(nèi)痔的發(fā)病機(jī)理。方法：將59例證型為脾虛氣陷的Ⅲ°脫垂性內(nèi)痔的患者依門診號(hào)順序,按隨機(jī)數(shù)字表分為3組,其中治療組(A組)20例,對(duì)照組(B組)20例,空白組(C組)19例。治療前均根據(jù)評(píng)分標(biāo)準(zhǔn)進(jìn)行評(píng)分；A組病人口服草木犀流浸液片,每次1600mg,每日3次,同時(shí)服用補(bǔ)中益氣湯,黃芪20g、人參9g、當(dāng)歸12g、陳皮9g、升麻15g、柴胡6g、白術(shù)12g、甘草6g,飯后溫服,每日一劑,每日3次,每次100m1；B組病人口服草木犀流浸液片,每次1600mg,每日3次；C組僅做空白對(duì)照,不服用任何藥物,均治療1療程(1周)。療程停止后第2天,各組患者均按照療效判斷標(biāo)準(zhǔn)及評(píng)分標(biāo)準(zhǔn)予行臨床評(píng)價(jià)、評(píng)分。通過廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院倫理委員會(huì)審批后,服從患者手術(shù)意愿,簽署知情同意書,行手術(shù)治療后,收�、蠖让摯剐詢�(nèi)痔肛墊組織標(biāo)本30例,分別來(lái)源于A、β、C組患者,各10例,重新分組為A1、B1、C1組,采用PCR. Western-blot技術(shù)從基因-蛋白層次系統(tǒng)研究比較各組患者內(nèi)痔組織中Fibulin-5 mRNA與蛋白的表達(dá)分布差異。結(jié)果：1.臨床研究中,A組與B組比較,治療后便血評(píng)分無(wú)統(tǒng)計(jì)學(xué)意義(P0.017),痔核脫出評(píng)分有統(tǒng)計(jì)學(xué)意義(P0.017)；A組與C組比較,治療后便血評(píng)分、痔核脫出評(píng)分均有統(tǒng)計(jì)學(xué)意義(P0.017)；B組與C組比較,治療后便血評(píng)分有統(tǒng)計(jì)學(xué)意義(P0.017),痔核脫出評(píng)分無(wú)統(tǒng)計(jì)學(xué)意義(P0.017)。2.臨床研究中,A組治療前后便血評(píng)分比較差異有統(tǒng)計(jì)學(xué)差異(P0.05),B組治療前后便血評(píng)分比較差異有統(tǒng)計(jì)學(xué)差異(P0.05),C組治療前后便血評(píng)分比較差異有統(tǒng)計(jì)學(xué)差異(P0.05)；A組治療前后痔核脫出評(píng)分比較差異有統(tǒng)計(jì)學(xué)差異(P0.05),B組治療前后痔核脫出評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),C組治療前后痔核脫出評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)：三組療效結(jié)果比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),A組的有效率明顯優(yōu)于B組及C組。3.實(shí)驗(yàn)研究中,三組療效結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),A1組Ⅲ°。脫垂性內(nèi)痔組織中Fibulin-5mRNA、Fibulin-5蛋白的表達(dá)多于B1組及C1組。結(jié)論：1.補(bǔ)中益氣湯治療脾虛氣陷型Ⅲ°。脫垂性內(nèi)痔內(nèi)痔得到滿意的效果,補(bǔ)中益氣湯可以明顯改善脾虛氣陷型Ⅲ度脫垂性內(nèi)痔痔核脫出癥狀,對(duì)脾虛氣陷型Ⅲ度內(nèi)痔便血癥狀改善不明顯。2.補(bǔ)中益氣湯可促進(jìn)Ⅲ°脫垂性內(nèi)痔組織中Fibulin-5蛋白及Fibulin-5mRNA的表達(dá)。3. Fibulin-5蛋白及Fibulin-5mRNA的表達(dá)水平的降低,可能是脫垂性內(nèi)痔形成的病理學(xué)機(jī)制之一。4.補(bǔ)中益氣湯治療脫垂性內(nèi)痔的機(jī)制可能是促進(jìn)Fibulin-5蛋白及Fibulin-5mRNA的表達(dá),從而促進(jìn)彈性纖維的合成與再生,抑制新生血管的生成,穩(wěn)定血管結(jié)構(gòu),促進(jìn)肛墊復(fù)位而發(fā)揮治療作用。
[Abstract]:Objective:To investigate the clinical value of Buzhong Yiqi Decoction in the treatment of prolapsed internal hemorrhoids with spleen-deficiency and qi-depression type III degree by analyzing the clinical manifestations of the patients with prolapsed internal hemorrhoids with spleen-deficiency and qi-depression type III degree after the intervention of Buzhong Yiqi Decoction. The changes of Fibulin-5 mRNA and protein expression in internal hemorrhoids of Cao Mu Xi Extract Tablets and Cao Mu Xi extract tablets were compared with those of Cao Mu Xi extract tablets. The clinical effect of Bu Zhong Yi Qi Decoction on prolapsed internal hemorrhoids with spleen deficiency and qi depression type III was evaluated in order to explore the molecular biological mechanism of Bu Zhong Yi Qi Decoction in treating prolapsed internal hemorrhoids with III degree prolapse. Methods: 59 cases of prolapsed internal hemorrhoids with spleen deficiency and qi depression were randomly divided into three groups according to the order of outpatient numbers, including 20 cases in treatment group (group A), 20 cases in control group (group B) and 19 cases in blank group (group C). Buzhong Yiqi Decoction, Astragalus 20g, Ginseng 9g, Angelica Sinensis 12g, Orange Peel 9g, Cimicifu 15g, Chaihu 6g, Atractylodes macrocephala 12g, Glycyrrhiza 6g, Warm-taking after meals, one dose a day, three times a day, 100m1 each time; Patients in group B took orally Cao Mu Xiliu extract tablets, 1600mg each time, three times a day; Patients in group C only took blank control, without any drugs, all treated 1 time. Course of treatment (1 week). On the second day after stopping the course of treatment, all the patients in each group were evaluated according to the criteria of curative effect and score. After approval by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, the patients were subjected to surgical wishes, signed informed consent, and after surgical treatment, the anal pad tissue specimens of third degree prolapsed hemorrhoids were collected. The expression of Fibulin-5 mRNA and protein in the hemorrhoid tissues of each group was systematically studied by PCR-Western-blot. Results: 1. There was no significant difference between group A and group B in the clinical study (P 0.01). 017, hemorrhoids protrusion score was statistically significant (P 0.017); A group compared with C group, after treatment stool blood score, hemorrhoids protrusion score were statistically significant (P 0.017); B group compared with C group, after treatment stool blood score was statistically significant (P 0.017), hemorrhoids protrusion score was not statistically significant (P 0.017). 2. There were significant differences in the scores of stool blood before and after treatment in group B (P 0.05). There were significant differences in the scores of stool blood before and after treatment in group C (P 0.05). There were significant differences in the scores of hemorrhoids prolapse before and after treatment in group A (P 0.05). There was no significant difference in the scores of hemorrhoids prolapse before and after treatment in group B (P 0.05). There was no significant difference in the score of hemorrhoids prolapse before and after treatment in group C (P 0.05). There was a significant difference in the curative effect among the three groups (P 0.05). The effective rate of group A was significantly better than that of group B and group C. 3. In the experimental study, there was a significant difference in the curative effect among the three groups (P 0.05). The prolapsed internal hemorrhoids tissue in group A1 (III degree) Conclusion: 1. Buzhong Yiqi Decoction has a satisfactory effect on the treatment of prolapsed internal hemorrhoids of spleen-deficiency-qi-depression type III. Buzhong Yiqi Decoction can obviously improve the symptoms of prolapsed internal hemorrhoids of spleen-deficiency-qi-depression type III. The improvement of the symptoms of prolapsed internal hemorrhoids of spleen-deficiency-qi-depression type III is not clear. 2. Buzhong Yiqi Decoction can promote the expression of Fibulin-5 protein and Fibulin-5mRNA in the tissues of prolapsed internal hemorrhoids. 3. The decrease of Fibulin-5 protein and Fibulin-5mRNA expression may be one of the pathological mechanisms of prolapsed internal hemorrhoids. 4. Buzhong Yiqi Decoction may promote the expression of Fibulin-5 protein and Fibul-5mRNA in prolapsed internal hemorrhoids. The expression of in-5mRNA promotes the synthesis and regeneration of elastic fibers, inhibits angiogenesis, stabilizes vascular structure and promotes anal pad reduction.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R266

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