加味防己黄芪汤联合大剂量甲强龙治疗急性脊髓损伤的实验及临床研究

发布时间：2018-02-26 19:33

本文关键词： 急性脊髓损伤加味防己黄芪汤甲强龙并发症　出处：《福建中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过实验及临床研究加味防己黄芪汤与大剂量甲强龙联合应用治疗急性脊髓损伤,观察其早期疗效及安全性。方法：72只雌性SD大鼠随机分为3组：MP组、联合组(加味防己黄芪汤+MP)及空白组,每组各24只。三组术后Id,3d,7d,14d进行BBB评分评估大鼠脊髓运动功能恢复情况；术后1d、3d、7d取标本行TUNE L染色观察损伤脊髓细胞凋亡情况；术后14d取标本行HE染色观察脊髓病理学改变情况。2013年05月至2014年09月,将受伤时间在8小时内的45例急性脊髓损伤患者随机分为MP组和联合组。MP组22人,给予甲强龙冲击治疗；联合组23人,在MP组的基础上口服加味防己黄芪汤浓缩液6周。于治疗前后根据ASIA标准评定脊髓神经功能情况,并观察各组并发症发生的情况。结果：大鼠BBB评分结果显示,术后三组大鼠随着时间推移脊髓神经功能评分均有所提高；术后3d、7d、14d联合组及MP组的BBB评分提高明显高于空白组(P0.05)；而联合组于术后7d、14d评分优于MP组(P0.05)。TUNEL染色结果显示：三组大鼠脊髓均可见TUNEL阳性凋亡细胞,术后3d凋亡细胞数量达到最高峰,术后7d明显减少；其中术后1d、3d、7d联合组及MP组的凋亡细胞数均少于空白组(P0.05),并且联合组于术后3d、7d少于MP组(P0.05)。HE染色结果显示：三组脊髓正常结构均有所破坏,细胞结构不完整,胶质细胞增生,空腔形成；联合组和MP组与空白组相比脊髓结构更完整,正常神经细胞保留更多,胶质细胞增生更少,形成的空腔更少；联合组与MP组相比脊髓损伤范围更小,组织结构更清晰,细胞结构更完整,偶见空腔,数量明显减少,存活神经细胞数更多,胶质细胞增生不明显。患者治疗6周后,MP组及联合组患者的脊髓神经感觉及运动功能均有明显恢复。联合组患者的感觉、运动、ASIA分级改善及并发症减少优于MP组(P0.05)。结论：1.加味防己黄芪汤与大剂量甲强龙联用能减少大鼠损伤脊髓的细胞凋亡,减轻脊髓损伤的病理改变,提高大鼠脊髓神经功能的恢复；2.加味防己黄芪汤与大剂量甲强龙联用能提高临床上患者脊髓功能恢复,同时能减少感染及电解质紊乱情况的发生。
[Abstract]:Objective: to observe the early curative effect and safety of modified Fangji Huangqi decoction combined with high dose methylenolone in the treatment of acute spinal cord injury. Methods: Seventy-two female Sprague-Dawley rats were randomly divided into 3 groups: group 1: MP. The rats in the combined group (modified Fangji Huangqi decoction) and the blank group (24 rats in each group) were evaluated with BBB score on the 3rd day after operation for 7 days and 14 days after operation, and the TUNE L staining was used to observe the apoptosis of injured spinal cord cells at 1 day, 3 days and 7 days after operation. From May 2013 to September 2014, 45 patients with acute spinal cord injury who had been injured within 8 hours were randomly divided into MP group (n = 22) and combined group (n = 22). 23 patients in the combined group were treated with modified Fangzhenhuangqi decoction for 6 weeks on the basis of MP. The neurological function of spinal cord was evaluated according to ASIA standard before and after treatment, and the complications in each group were observed. Results: the results of BBB score showed that there were no significant differences between the two groups. The neurological function scores of the spinal cord in the three groups improved with time after operation. The BBB score of the combined group and MP group was significantly higher than that of the blank group on the 3rd day after operation, and the score of the combined group was better than that of the MP group on the 7th day after operation. The results of Tunel staining showed that TUNEL positive apoptotic cells were found in the spinal cord of all the three groups, and the number of apoptotic cells reached the highest level on the 3rd day after operation. The number of apoptotic cells in the combined group and MP group was less than that in the blank group on the 1st and 3rd day after operation, and in the combined group was less than that in the MP group on the 3rd day after operation. The results of HE staining showed that the normal structure of spinal cord was damaged and the cell structure was incomplete in the three groups. The combined group and MP group had more intact spinal cord structure, more normal nerve cells, less glial cell proliferation and less cavity formation, and the combined group and MP group had smaller range of spinal cord injury than MP group. The tissue structure is clearer, the cell structure is more complete, the cavity is occasionally empty, the number is significantly reduced, and the number of surviving nerve cells is more. Glial cell proliferation was not obvious. After 6 weeks of treatment, the sensory and motor functions of spinal cord in MP group and combined group were significantly recovered. The improvement of Asia grade and the decrease of complications were better than that of MP group (P 0.05). Conclusion the combination of modified Fangji Huangqi decoction and high dose methylenolone can reduce the apoptosis of injured spinal cord cells and alleviate the pathological changes of spinal cord injury in rats. The combination of modified Fangji Huangqi decoction and high dose of methylenolone can improve the recovery of spinal cord function and reduce the incidence of infection and electrolyte disturbance. 2.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.2

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