【摘要】：目的:1.觀察穴位埋線對葡萄膜炎患者的臨床作用;2.探討穴位埋線對實(shí)驗(yàn)性自身免疫性葡萄膜炎大鼠的治療作用。方法:1.納入40名葡萄膜炎患者,隨機(jī)分為2組(A組穴位埋線結(jié)合西醫(yī)治療,B組純西醫(yī)治療),其中A組埋線時間為每半月一次,6次一個療程。觀察分析納入的葡萄膜炎患者的一般情況以及葡萄膜炎患者;檢測A、B兩組治療前后視力變化、眼部陽性體征的變化;觀察葡萄膜炎患者中體體質(zhì)的分型、分布趨勢以及中醫(yī)體質(zhì)與葡萄膜炎患者臨床病理分類的關(guān)系,對比A、B兩組治療后體質(zhì)的變化趨勢;統(tǒng)計A、B兩組治療后生存質(zhì)量量表的變化;統(tǒng)計A、B兩組治療期間及治療后復(fù)發(fā)的時間及頻率。2.將Liwes大鼠48只,采用隨機(jī)數(shù)字表法分為對照組、模型組、穴位埋線組,每組16只。將光感受器間維生素A類結(jié)合蛋白(IRBP)、結(jié)核桿菌(TB)和完全弗氏佐劑(CFA)磷酸緩沖鹽溶液(PBS)制成乳糜液后,在雙足后墊及背部兩側(cè)皮下注射。穴位埋線組于造模后第二天進(jìn)行穴位埋線,且模型組、穴位埋線組于免疫后第9、13、18、23天采集心臟血液并分離淋巴結(jié)中T淋巴細(xì)胞,進(jìn)行流式細(xì)胞儀分析,同時對眼球進(jìn)行組織病理切片。結(jié)果:1.視力:將A、B兩組治療前后視力對比分析,其中A組視力提高均值為0.35±0.15,B組視力提高均值為0.25±0.16;將2組視力提高情況做兩獨(dú)立樣本t檢驗(yàn),得t=2.14,按α=0.05,得p=0.04㩳0.05,差異有統(tǒng)計學(xué)意義,證明A組的穴位埋線比B組視力提高值大;生存質(zhì)量:治療前后生存質(zhì)量滿意度提高A組平均值為37.5±14.24,B組平均值為13.8±22.70,t=3.94,按α=0.05,得p=0.00㩳0.05,差異有顯著統(tǒng)計學(xué)意義,可認(rèn)為患者A組在穴位埋線治療下對療效評價滿意度較B組對生存質(zhì)量滿意度高;中醫(yī)體質(zhì):A組葡萄膜炎患者偏向平和質(zhì),濕熱質(zhì)、陽虛質(zhì)、痰濕質(zhì)的患者體質(zhì)有明顯的改變。B組在治療后會出現(xiàn)濕熱質(zhì)、陽虛質(zhì)的中醫(yī)體質(zhì)患者所占比例明顯上升,同時平和質(zhì)患者的體質(zhì)也受影響,出現(xiàn)了偏頗質(zhì);兩組療效對比p=0.0050.05,A組的有效率高于B組;陽性體征:2組葡萄膜炎患者在初次就診時其臨床癥狀無明顯差別,但在治療后對于復(fù)發(fā)的葡萄膜炎患者穴位埋線組患者的陽性體征明顯比純西醫(yī)治療輕;同時A組在治療期間內(nèi)的復(fù)發(fā)率較B組低。2.造模后第6至7天大鼠眼部開始出現(xiàn)炎癥反應(yīng),第13天炎癥達(dá)高峰(模型組臨床評分為:3.42±0.58,穴位埋線組為:2.17±0.68,p=0.018,差異有統(tǒng)計學(xué)意義),之后逐漸開始消退。組織病理學(xué)結(jié)果顯示模型組在第9、13、18、23天時虹膜,睫狀體及視網(wǎng)膜炎癥均比穴位埋線組嚴(yán)重,而空白對照組眼部結(jié)構(gòu)完整,未見明顯炎癥表現(xiàn);流式細(xì)胞儀分析顯示第13天CD4+T占細(xì)胞比例最高值:模型組為85.97±1.03,穴位埋線組為:79.51±0.64,兩組比較差異有統(tǒng)計學(xué)意義(p0.001);第13天時CD8+T最低:模型組為:14.03±1.03,治療穴位埋線組為:20.49±0.64,兩組比較差異有統(tǒng)計學(xué)意義(p0.001)。結(jié)論:1.通過A、B兩組不同的對葡萄膜炎的治療方法對比,發(fā)現(xiàn)穴位埋線在視力提高、患者生存質(zhì)量提高、病情復(fù)發(fā)率、中醫(yī)體質(zhì)改變等方面均較B組未埋線治療組好。說明穴位埋線對葡萄膜炎的流行病學(xué)某些方面具有一定的作用;2.在機(jī)制研究方面眼形態(tài)學(xué)、組織病理、細(xì)胞水平等結(jié)果顯示,穴位埋線可有效減輕實(shí)驗(yàn)性自身免疫性葡萄膜炎大鼠炎癥水平,對大鼠的葡萄膜炎具有治療作用。
[Abstract]:Purpose: 1. To observe the clinical effect of acupoint catgut embedding on patients with uveitis; To explore the therapeutic effect of acupoint catgut embedding on experimental autoimmune uveitis rats. Method: 1. Forty-four patients with uveitis were randomly divided into 2 groups (group A acupuncture point embedding line combined with western medicine treatment and B group pure western medicine treatment), in which group A buried line time was once every half a month, 6 times a course of treatment. To observe the general condition of patients with uveitis included in the analysis and the patients with uveitis; to detect changes in visual acuity and signs of ocular signs before and after treatment in group A and B; and observe the classification of body constitution in patients with uveitis. The relationship between the distribution trend and the clinical and pathological classification of traditional Chinese medicine constitution and uveitis was compared with that of group A and B. The changes of survival quality scale were statistically analyzed in both groups A and B. The time and frequency of relapse after treatment and post-treatment were statistically analyzed. Forty-eight Lives rats were divided into two groups: control group, model group and acupuncture point buried line group. A chylchylous solution is prepared by combining the photoreceptors with vitamin A binding protein (IRBP), mycobacterium tuberculosis (TB) and complete Freund's adjuvant (CFA) phosphate buffered saline solution (PBS), and subcutaneous injection is carried out on both sides of the back cushion and the back of the bipedal. At the 9th, 13th, 18th and 23rd day after immunization, the T-lymphocytes in the lymph nodes were collected and analyzed by flow cytometry. Result: 1. The visual acuity of group A and B was analyzed before and after treatment. Among them, the mean value of vision in group A was 0. 35% 0. 15, the visual acuity of group B increased from 0. 25 to 0. 16; 2 groups of visual acuity improved were tested by two independent samples t, and t = 2.14, the visual acuity was 0. 05, p = 0.004 鹵 0.05, the difference was statistically significant. It was proved that the point embedding line in group A was higher than that in group B. The quality of life: the quality of life before and after treatment increased the average value of group A was 37. 5, 14. 24, the average value of group B was 13. 8, 22. 70, t = 3.94, the difference was statistically significant. It can be considered that the satisfaction of efficacy evaluation was higher in group A than in group B at acupoint catgut embedding therapy. The constitution of traditional Chinese medicine: patients with uveitis in group A had a significant change in constitution of patients with mild, damp-heat, yang-deficiency and phlegm-dampness. In group B, there was a significant increase in the proportion of patients with dampness-heat and yang-deficiency type of Chinese medicine after treatment, while the physical constitution of the patients with mild quality was also affected. The effective rate of group A was higher than that in group B. Positive signs: There was no significant difference in the clinical symptoms of patients with uveitis in group 2 at the initial visit, but the positive signs of acupoint catgut embedding group in patients with recurrent uveitis after treatment were significantly lower than that of pure western medicine, while the recurrence rate of group A was lower than that of group B during treatment. Inflammatory reaction was started at the eyes of 6th to 7th day after molding, and the inflammation reached the peak at the 13th day (the clinical score of the model group was: 3.42. 0. 58, the acupuncture point buried line group was 2.17, 0.068, p = 0.018, the difference was statistically significant), and then gradually began to subside. Histopathological results showed that the iris, ciliary body and retina inflammation of the model group were serious at the 9th, 13th, 18th and 23rd days than the acupoint catgut group, while the eye structure of the blank control group was intact and no obvious inflammatory performance was found. The flow cytometry analysis showed that the CD4 + T in the 13th day accounts for the highest percentage of the cells: The model group was 85. 97% 1. 03, the acupoint catgut embedding group was 79. 51% 0. 64, the difference between the two groups was statistically significant (S1001.001); CD8 + T on the 13th day was the lowest: the model group was: 14.03 Mt. 1.03, and the treatment point buried line group was 20. 49% 0. 64, and the difference between the two groups was statistically significant (S1001.001). Conclusion: 1. Compared with the treatment methods of uveitis by A and B groups, the acupoint catgut embedding line was found to be better than that in group B in group B in the aspects of improvement of vision, improvement of patient's survival quality, recurrence rate of disease, change of physical constitution of traditional Chinese medicine, etc. It is pointed out that the acupoint embedding line has certain effect on the epidemiology of uveitis; The results of eye morphology, histopathology, cell level and so on in mechanism research show that acupoint catgut embedding can effectively reduce inflammation level in experimental autoimmune uveitis, and has therapeutic effect on uveitis in rats.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.82

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