發(fā)布時(shí)間：2018-11-22 11:04

【摘要】：目的：主要通過(guò)觀察干眼患者的治療前后自覺(jué)癥狀、淚膜破裂時(shí)間、淚液分泌及角膜熒光素鈉染色、結(jié)膜印跡細(xì)胞學(xué)等檢查,評(píng)價(jià)逍生散顆粒劑之臨床療效,探討其對(duì)杯狀細(xì)胞的影響,同時(shí)進(jìn)一步結(jié)合動(dòng)物模型以進(jìn)行更加深入驗(yàn)證及探討。方法：1.符合納入標(biāo)準(zhǔn)30例干眼患者(共60只眼),隨機(jī)分入A、B兩組。其中A組對(duì)照組,使用玻璃酸鈉滴眼液。B組中藥組：使用逍生散顆粒劑。玻璃酸鈉滴眼液為日本參天株式會(huì)社生產(chǎn),每次一滴,每天三次。逍生散藥物主要成分為：柴胡、白芍、當(dāng)歸、黨參、五味子、麥冬等。每日兩次,每次一袋,溫水沖服。觀察并記錄患者治療前及治療后第1、2、3、4周之自覺(jué)癥狀、淚液分泌、淚膜破裂時(shí)間、熒光素鈉染色、結(jié)膜印跡細(xì)胞學(xué)檢查。2.將180只健康C57BL/6小鼠,雌性5周,體重20-25g,小鼠隨機(jī)分6組：分別為正常對(duì)照、模型對(duì)照、生理鹽水、低劑量藥物、中劑量藥物、高劑量藥物六組,每組30只。每天于小鼠后肢根部,皮下注射氫溴酸東莨菪堿造成干眼模型。造模成功后于造模前、造模后、治療后第1周、第2周、第3周、第4周,測(cè)定其淚膜破裂時(shí)間、淚液分泌量、角膜染色、結(jié)膜杯狀細(xì)胞數(shù)量等情況。結(jié)果：1.觀察到治療組患者在自覺(jué)癥狀、淚膜破裂時(shí)間、淚液分泌及角膜熒光染色、杯狀細(xì)胞數(shù)量及等級(jí)方面具有較為明顯的改善,均具有統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)照組對(duì)于自覺(jué)癥狀、角膜熒光染色、杯狀細(xì)胞數(shù)量之方面有改善作用,具有統(tǒng)計(jì)學(xué)意義(p0.05),而在淚液分泌、淚膜破裂時(shí)間、杯狀細(xì)胞之等級(jí)方面雖有所改善,但不具有統(tǒng)計(jì)學(xué)意義(p0.05)。治療后將治療組及對(duì)照組在自覺(jué)癥狀、淚膜破裂時(shí)間、淚液分泌、角膜熒光染色、杯狀細(xì)胞數(shù)量及等級(jí)方面進(jìn)行比較,有所改善且具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.造模后B、C、D、 E、F五組在淚液分泌、淚膜破裂時(shí)間、杯狀細(xì)胞數(shù)量方面均有明顯下降,角膜熒光染色具有明顯增加,與造模前有差異(p0.05),A組與造模前無(wú)明顯改變,無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。治療后E、F組在淚液分泌、淚膜破裂時(shí)間、杯狀細(xì)胞數(shù)量方面均有明顯改善,具有統(tǒng)計(jì)學(xué)意義。D組在淚膜破裂時(shí)間有所延長(zhǎng),角膜熒光染色分?jǐn)?shù)有所下降,具有統(tǒng)計(jì)學(xué)意義(p0.05),而在淚液分泌及杯狀細(xì)胞數(shù)量方面雖有所增加,但不具有統(tǒng)計(jì)學(xué)意義(p0.05)。A、B、C組在治療后與造模后有所改變,不具有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論：逍生散顆粒劑可明顯改善患者的自覺(jué)癥狀,同時(shí)增加淚液分泌量,延長(zhǎng)淚膜破裂時(shí)間,提高淚膜穩(wěn)定性,減少杯狀細(xì)胞凋亡,減輕眼表?yè)p傷等作用。作用機(jī)制可能通過(guò)免疫調(diào)節(jié),降低或抑制炎性反應(yīng)強(qiáng)度,減少促炎細(xì)胞因子釋放,防止杯狀細(xì)胞之凋亡以發(fā)揮其藥理作用,從而達(dá)到治療干眼之目的.
[Abstract]:Objective: to evaluate the clinical efficacy of Xiao Sheng San granule by observing the conscious symptoms, tear film rupture time, tear secretion, corneal fluorescein sodium staining and conjunctival imprinting cytology before and after treatment. To study the effect of goblet cells on the goblet cells, and further combine animal models for further verification and discussion. Method 1: 1. Thirty patients (60 eyes) with dry eye according to the inclusion criteria were randomly divided into two groups. Group A was treated with sodium hyaluronate eye drops and group B was treated with Xiao Sheng San granules. Sodium hyaluronate eye drops are produced by Japan Shentian Co., Ltd., one drop at a time, three times a day. The main ingredients of Xiao Sheng San are: Bupleurum, Radix Paeoniae Alba, Angelica sinensis, Codonopsis pilosula, Schisandra chinensis, Ophiopogon. Take a bag twice a day with warm water. The conscious symptoms, tear secretion, lacrimal film rupture time, fluorescein sodium staining, conjunctival blotting cytology were observed and recorded before and after treatment. 2. 180 healthy C57BL/6 mice were randomly divided into 6 groups: normal control, model control, normal saline, low dose drug, middle dose drug and high dose drug group. A dry eye model was established by subcutaneous injection of scopolamine hydrobromide into the roots of the hind limbs of mice. The time of lacrimal film rupture, the amount of tear secretion, corneal staining and the number of conjunctival goblet cells were measured at the first week, the second week, the third week and the fourth week after the establishment of the model. Results: 1. It was observed that the patients in the treatment group had significant improvement in conscious symptoms, tear film rupture time, tear secretion and corneal fluorescence staining, the number and grade of goblet cells (p0.05). In the control group, the symptoms, corneal fluorescence staining and the number of goblet cells were significantly improved (p0.05), while the tear secretion, tear film rupture time, and the grade of goblet cells were improved. But not statistically significant (p0.05). After treatment, the treatment group and the control group in the conscious symptoms, tear film rupture time, tear secretion, corneal fluorescence staining, the number and grade of goblet cells were improved, with statistical significance (p0.05). 2. The tear secretion, tear film rupture time and the number of goblet cells were significantly decreased, and the corneal fluorescence staining was significantly increased (p0.05). There was no significant difference between group A and model (p 0.05). After treatment, the tear secretion, tear film rupture time and the number of goblet cells were significantly improved in group D. Group D prolonged the time of tear film rupture and decreased the fluorescent staining fraction of cornea. There was statistical significance (p0.05), but there was no significant difference in tear secretion and goblet cell count (p0.05). There was no statistical significance (p0.05). Conclusion: Xiao Sheng San granule can obviously improve the conscious symptoms, increase the amount of tear secretion, prolong the time of tear film rupture, improve the stability of tear film, reduce the apoptosis of goblet cells and alleviate the injury of ocular surface. The mechanism may be through immune regulation, reduce or inhibit the intensity of inflammatory response, reduce the release of pro-inflammatory cytokines, prevent goblet cell apoptosis to play its pharmacological role, so as to achieve the purpose of treating dry eye.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R276.7

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