静心制动方治疗抽动秽语综合征的动态疗效观察及免疫相关性研究

发布时间：2018-04-16 12:41

本文选题：抽动秽语综合征 + 临床观察　；参考：《北京中医药大学》2012年硕士论文

【摘要】：目的： (1)连续、动态地观察静心制动方治疗抽动秽语综合征的临床疗效,从不同阶段的疗效中分析抽动秽语综合征病情反复的原因及规律。 (2)探讨抽动秽语综合征与细胞免疫、体液免疫及自身免疫的关系。方法： (1)选择160例抽动秽语综合征患者,根据中医辨证将其分为肝亢风动组、脾虚肝亢组及阴虚风动组,均采用静心制动方加减治疗,疗程为6个月。应用耶鲁综合抽动严重程度量表统计患者治疗前后抽动症状次数、频率、强度、复杂性、干扰等评分变化；采用抽动程度评分表观察患者治疗前后抽动部位、程度的分数变化；采用中医情志睡眠评分表观察患者治疗前后中医情志睡眠的评分变化。初诊、治疗3月、治疗6月后各填写一次耶鲁综合抽动严重程度量表、抽动程度评分表、中医情志睡眠评分表。 (2)以酶联免疫吸附试验法测定抽动秽语综合征患者的TNF-α、IL-6、ANA及体液免疫(IgA、IgG、IgM),用流式细胞仪检测T淋巴细胞亚群。结果： (1)通过静心制动方治疗,治疗3个月后、6个月后显效率分别为15%、44%,总有效率分别达81%、89%,经统计不同治疗阶段的显效率、总有效率差异均有统计学意义(P0.05)；治疗前与治疗3个月后、治疗6个月后,具体部位总体抽动症状评分比较均有显著性差异(P0.05)；治疗前与治疗6个月后中医情志、睡眠变化例数的比较有显著性差异(P0.05)。 (2)不同证型显效率、总有效率均无显著性差异(P0.05)；治疗前与治疗3月后、治疗6月后的抽动症状总分差值,三证型比较均无显著性差异(P0.05)；不同证型中医情志、睡眠变化例数的比较无显著性差异(P0.05)。 (3)抽动秽语综合征患者与本院所测正常值比较,T淋巴细胞亚群CD3+、CD8+细胞百分比均高于正常值,但无统计学意义(P0.05),CD4+及CD4+/CD8+比值均明显低于正常值,皆有统计学意义(P0.05)；免疫球蛋白IgA、IgG、IgM均明显低于正常值,皆有统计学意义(P0.05)；TNF-α与IL-6均明显低于正常值,皆有统计学意义(P0.05)；30例抗核抗体ANA均为阴性。结论： (1)导师的静心制动方在不同的治疗阶段疗效均较显著,使抽动秽语综合征患者在抽动症状的次数、频率、强度、复杂性及中医情志睡眠等方面改善明显；160例患者在前6个月的治疗中疗效迅速上升,患者总体病情无明显反复,或个别患者病情虽有反复,但没有到影响总分数降低的程度,今后应继续延长观察期,或缩短观察节段时间,或改变观察方式,以综合评价患者病情反复的情况；静心制动方治疗不同证型患者的疗效、总体抽动症状缓解程度及中医情志睡眠改善程度均无差别。 (2)抽动秽语综合征的发病可能与机体细胞免疫、体液免疫功能及自身免疫均有关。但应将抽动秽语综合征患者与反复呼吸道感染患者的免疫水平进行比较,并进一步探讨免疫因素如何影响抽动秽语综合征的发病及病变过程。
[Abstract]:Objective:1) to observe the clinical effect of Jingxinjiaofang in the treatment of Gilles de la Tourette syndrome (Gilles de la Tourette syndrome) continuously and dynamically, and analyze the cause and regularity of the repeated condition of Gilles de la Tourette syndrome from different stages of curative effect.To explore the relationship between Tourette syndrome and cellular immunity, humoral immunity and autoimmunity.Methods:1) 160 patients with Tourette syndrome were divided into three groups according to TCM syndrome differentiation: hyperactivity of liver group, spleen deficiency group, and yin deficiency group. All patients were treated with the addition and subtraction of Jing Xin Jiao Fang for 6 months.The frequency, frequency, intensity, complexity and disturbance of tic symptoms before and after treatment were evaluated by Yale comprehensive tic severity scale, and the scores of twitch position and degree before and after treatment were observed.To observe the changes of TCM emotional sleep score before and after treatment with TCM emotional sleep score table.At first visit, 3 months after treatment, 6 months after treatment, each completed Yale comprehensive tic severity scale, tic score table, TCM emotional sleep score table.(2) TNF- 伪 IL-6 ANA and humoral immunoglobulin A (IgA) IgG MN were measured by enzyme linked immunosorbent assay (Elisa) in patients with Tourette's syndrome. The T lymphocyte subsets were detected by flow cytometry (FCM).Results:1) after 3 months of treatment and 6 months after treatment, the effective rates were 15 and 44, respectively, and the total effective rates were 81and 8989, respectively. There were statistically significant differences in the total effective rates between the two groups after 3 months of treatment and before and after 3 months of treatment.After 6 months of treatment, there were significant differences in the total tic symptom scores of specific sites (P 0.05), and there were significant differences in the number of cases of changes in mood and sleep in TCM before treatment and after 6 months of treatment (P 0.05).(2) there was no significant difference in the total effective rate between different syndromes and the total effective rate (P 0.05). There was no significant difference in the total score of tic symptoms between the three syndromes before treatment and three months after treatment, and there was no significant difference among the three syndrome types (P 0.05).There was no significant difference in the number of sleep change cases (P 0.05).(3) the percentage of CD3 / CD8 cells in T lymphocyte subsets in Gilles de la Tourette syndrome patients was higher than that in our hospital, but there was no statistical significance in the percentage of CD4 and CD4 / CD8 ratio of T lymphocyte subsets in patients with Tourette's syndrome were significantly lower than the normal values.All of them had statistical significance (P 0.05) and immunoglobulin IgA (IgA) IgG IL-6 were significantly lower than the normal value (P 0.05) and TNF- 伪 and IL-6 were significantly lower than the normal value (P 0.05). All the 30 cases of anti-nuclear antibody ANA were negative.Conclusion:1) the therapeutic effect of the tutor's sedentary braking prescription was significant in different treatment stages, which made the frequency, frequency and intensity of Tourette syndrome patients in tic symptoms.In the first six months of treatment, the curative effect of 160 patients increased rapidly, the overall state of the patient did not repeat obviously, or the individual patient's condition was repeated, but it did not affect the decrease of the total score.In the future, we should continue to prolong the observation period, or shorten the observation period, or change the observation mode so as to comprehensively evaluate the recurrent condition of the patient; the curative effect of Jingxinjiaofang in treating patients with different syndromes,There was no difference in the degree of relief of general tic symptoms and the improvement of emotional sleep in traditional Chinese medicine.2) the pathogenesis of Tourette syndrome may be related to cellular immunity, humoral immunity and autoimmunity.However, the immune level of Gilles de la Tourette syndrome and recurrent respiratory tract infection should be compared, and how the immune factors affect the pathogenesis and pathological process of Gilles de la Tourette syndrome should be further discussed.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.94

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