發(fā)布時(shí)間：2018-10-30 14:19

【摘要】：目的:1)通過觀察臨床指標(biāo)的變化,明確外陰硬化性苔蘚(VLS)針刺療法的臨床效果。2)以病變組織中的血管內(nèi)皮生長因子(VEGF)和原始造血細(xì)胞抗原分子(CD34)為表征指標(biāo),借助免疫組化檢測手段,探究它們在VLS中的表達(dá)、意義及相關(guān)性。3)結(jié)合臨床觀察與免疫組化檢測分析手段,進(jìn)一步探究VLS的病因與病機(jī),以及針刺療法的機(jī)理。方法:選取符合診斷標(biāo)準(zhǔn)的VLS患者30例為試驗(yàn)組(針刺治療前后形成自身對照),另選取正常對照組5例。選取試驗(yàn)組外陰阿是穴對患者施行針灸圍刺法治療,連續(xù)治療3個(gè)療程,每月連續(xù)15天為一療程,取外陰病變組織活檢行免疫組化檢測,對照分析治療前后的臨床癥狀與體征、VEGF陽性表達(dá)值和CD34陽性表達(dá)值(即MVD值),并與正常對照組對比分析。結(jié)果:1)針刺治療前后VLS患者病變組織的臨床癥狀及體征指標(biāo)的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),治療后陰癢、陰痛、皮膚色素、彈性及皮損范圍等均有大幅度改善。治愈3例,顯效12例,有效13例,無效2例,總有效率達(dá)93.3%。2)治療前:VLS患者病變組織中VEGF值較正常組織顯著升高,MVD值則明顯減少,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。VEGF的表達(dá)與CD34的表達(dá)不同步。治療后:VEGF值較治療前回落,MVD值則回升,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療后與對照組的差異無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。結(jié)論:1)本研究證實(shí)圍刺法針刺治療外陰硬化性苔蘚療效明顯,絕大多數(shù)患者各臨床觀察指標(biāo)均有明顯改善。2)患者病變組織中VEGF值升高,而MVD值降低;而針刺治療后VEGF值明顯回落,MVD值則顯著回升。VEGF值與MVD值存在密切的反饋機(jī)制。反映出病變皮膚組織中局部微循環(huán)障礙可能為一個(gè)重要的致病因素。3)針刺改善了 VLS病變組織局部的微循環(huán),調(diào)整了全身氣血陰陽平衡,舒活經(jīng)絡(luò),調(diào)節(jié)臟腑,促進(jìn)外陰氣血旺盛,祛邪扶正。4)在病變區(qū)給予針刺治療,可能對VEGF及CD34的信號傳遞過程造成重要干涉,這或許是該病治療的內(nèi)在關(guān)鍵所在。
[Abstract]:Objective: 1) to observe the changes of clinical indexes, To determine the clinical effect of (VLS) acupuncture therapy in vulvar lichen sclerosus. 2) taking vascular endothelial growth factor (VEGF) and primitive hematopoietic cell antigen molecule (CD34) in pathological tissues as the characterization indexes, and by means of immunohistochemical method, Explore their expression, significance and correlation in VLS. 3) combined with clinical observation and immunohistochemical analysis, further explore the etiology and pathogenesis of VLS, as well as the mechanism of acupuncture therapy. Methods: 30 VLS patients who met the diagnostic criteria were selected as experimental group (self control group before and after acupuncture treatment) and 5 normal control group. The patients in the experimental group were treated with acupuncture and moxibustion at Ashi point for 3 consecutive courses of treatment, 15 days a month as a course of treatment. Biopsy of vulvar lesions was performed by immunohistochemistry, and the clinical symptoms and signs before and after treatment were compared and analyzed. VEGF positive expression value and CD34 positive expression value (MVD value) were compared with normal control group. Results: 1) the clinical symptoms and signs of VLS patients were significantly different before and after acupuncture treatment (P0.05). After treatment, yin-itch, yin-pain, skin pigment, elasticity and range of skin lesions were significantly improved. 3 cases were cured, 12 cases were effective, 13 cases were effective, 2 cases were ineffective, the total effective rate was 93.3.2) before treatment, the VEGF value in pathological tissue of VLS patients was significantly higher than that in normal tissue, and the MVD value was significantly decreased. The difference was statistically significant (P0.05) the expression of). VEGF and CD34 were not synchronized. After treatment: the VEGF value was lower than before treatment, the MVD value was increased, the difference was statistically significant (P0.05); the difference between the treatment group and the control group was not statistically significant (P0.05), which was comparable. Conclusion: 1) the therapeutic effect of peri-acupuncture on vulvar lichen sclerosus is obvious, and most of the patients have improved all the clinical indexes. 2) the VEGF value in the pathological tissue of the patients is increased, but the MVD value is decreased. However, after acupuncture treatment, the VEGF value decreased significantly, while the MVD value increased significantly. There was a close feedback mechanism between VEGF value and MVD value. 3) Acupuncture improved the local microcirculation of VLS, adjusted the balance of qi, blood, yin and yang, relaxed the meridians, regulated the viscera. Promoting the exuberance of vulva qi and blood, dispelling evil and nourishing the spirit. 4) Acupuncture treatment in the lesion area may cause important interference in the signal transduction process of VEGF and CD34, which may be the internal key of the treatment of the disease.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.3

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