COPD合并抑郁状态的临床病证分析及加味二陈汤干预效应的实验研究

发布时间：2018-01-08 21:19

本文关键词：COPD合并抑郁状态的临床病证分析及加味二陈汤干预效应的实验研究　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

更多相关文章： COPD 抑郁证候 加味二陈汤 UPLC 多巴胺

【摘要】：目的：探讨COPD合并抑郁的临床现状与病证特点,研究加味二陈汤对大鼠COPD合并抑郁模型的干预效应,为COPD合并抑郁的研究提供新思路,为中医临床治疗COPD合并抑郁提供基础资料和参考。方法：1.临床研究：采用横断面调查研究方法,调研自2015年6月至2016年2月在江苏省第二中医院、江苏省中西医结合医院呼吸内科确诊为COPD的住院患者116例,排除不合格样本后,实际纳入99例进行SDS量表问卷调查,分析其伴有抑郁状态患者的分布以及证型特点。2.实验研究：建立大鼠COPD以及COPD合并抑郁模型。采用气管内注入LPS、烟熏制作大鼠COPD模型,并复加给予随机应激刺激制作大鼠COPD合并抑郁模型。以加味二陈汤(二陈汤加白术、黄连、远志)分别干预大鼠COPD模型(地塞米松为对照)以及COPD合并抑郁模型(地塞米松+盐酸氟西汀为对照),观察该方对大鼠COPD和COPD合并抑郁模型肺病理学、气道炎症变化,以及对COPD合并抑郁模型的体重、行为学(开场实验)、糖水试验的影响,采用UPLC技术检测各组大鼠脑海马体中多巴胺(DA)的含量变化。结果：1.临床调查结果(1)COPD患者的证型特点。COPD患者99例,男性53例,女性46例,年龄(68.14±9.04)岁,证型分布包括痰热蕴肺证64例、痰浊壅肺证14例、肺肾气阴两虚证21例。(2)COPD合并抑郁的情况分析。经SDS量表分析,合并抑郁状态的患者48例,占总数的48.48%。其中SDS得分0.5至0.59(轻度抑郁)的患者共14例,SDS得分0.6至0.69(中度抑郁)的患者共24例,SDS得分大于0.7(重度抑郁)的患者共10例。COPD合并抑郁状态的48例患者中,其主证为痰热蕴肺者30例、占总抑郁人数比达到62%,痰浊壅肺者11例、占总抑郁人数比为23%,肺肾气阴两虚者7例、占总抑郁人数比为15%。2.实验结果(1)加味二陈汤干预大鼠COPD模型的效应：加味二陈汤显著改善大鼠COPD模型的肺病理,显著减少BALF内中性粒细胞数比例,与模型组相比有差异(P0.01-0.05)。(2)加味二陈汤干预大鼠COPD合并抑郁模型的效应及机制：1)COPD合并抑郁模型的肺病理和BALF气道炎症比单纯COPD组严重。加味二陈汤对COPD合并抑郁大鼠模型的肺病理具有改善作用,显著减少BALF中炎细胞数比例,与模型组相比有差异(P0.01-0.05)。2)COPD合并抑郁模型组大鼠体重下降,第14、21、28天与空白对照组大鼠体重相比有极显著统计学差异(P0.01)。加味二陈汤高、低剂量给药组与COPD合并抑郁模型组比较体重上升,第14、21、28天与COPD合并抑郁模型组比较具有显著与极显著统计学意义(P0.01-0.05)。3)COPD合并抑郁模型组大鼠行为学明显改变、糖水消耗量降低。加味二陈汤改善COPD合并抑郁模型的行为学表现,增加其糖水消耗量,open-field实验显示第14、28天COPD合并抑郁模型组与空白对照组相比有显著统计学差异(P0.05);加味二陈汤高、低剂量给药组与COPD合并抑郁模型组比较相比有显著统计学差异(P0.05)。4)UPLC检测各组大鼠脑海马体中多巴胺(DA)的含量,COPD合并抑郁模型组与空白对照组相比脑组织中多巴胺(DA)含量明显降低(P0.01);加味二陈汤高、低剂量组与COPD合并抑郁模型组比较脑组织中多巴胺(DA)含量有所升高,具有显著统计学差异(P0.01-0.05),但是低于COPD合并抑郁阳性药组(地塞米松+盐酸氟西汀)。结论：1.本研究通过99例COPD临床资料分析发现,合并抑郁状态的COPD患者占48.48%,以中度抑郁稍多。COPD合并抑郁状态中医证型分析,其主证为痰热蕴肺证占总抑郁62%、痰浊壅肺证占23%、肺肾气阴两虚证占15%。2.本研究通过对加味二陈汤干预COPD合并抑郁状态的作用进行观察,发现采用气管内注入LPS、烟熏并随机给予应激刺激复制大鼠COPD合并抑郁模型,其肺部病变较COPD模型更为严重,同时体重、行为学、糖水消耗量、脑组织中多巴胺(DA)水平明显改变。加味二陈汤可以改善其肺病理,明显降低其BALF内中性粒细胞数比例,改善其体重变化、行为学表现、增加其糖水消耗量,增加其脑组织中多巴胺(DA)含量。结果提示,加味二陈汤对COPD以及COPD合并抑郁状态具有明显的干预作用。以上研究为COPD合并抑郁状态的临证辨治研究,以及化痰散郁方药加味二陈汤治疗COPD合并抑郁状态提供了基础性研究资料。
[Abstract]:Objective: To investigate the clinical situation and syndrome characteristics of COPD with depression and intervention effect of Jiawei Decoction on rats with two COPD depression model, provide new ideas for the study of COPD patients with depression, provide basic data and reference for clinical treatment of COPD complicated with depression. Methods: 1. clinical research: This was a cross-sectional study. Research from June 2015 to February 2016 in second Chinese Medicine Hospital of Jiangsu Province, Jiangsu Province Traditional Chinese Medicine Hospital of respiratory medicine COPD was diagnosed in 116 cases, eliminate unqualified samples, the actual included 99 cases of SDS scale questionnaire, analyzed the distribution status of patients with depression and syndrome characteristics of.2.: a experimental study COPD and COPD rats with depression model. By intratracheal instillation of LPS, smoked rat models of COPD were made, and added random stress stimulation in rats given COPD combined with anti Yu Mo With the modified two type. Chen Tang (Tonga Erchen Atractylodes, Rhizoma Coptidis, Radix Polygalae) were treated COPD rats (dexamethasone as control) and COPD model with depression (dexamethasone + fluoxetine as control), observe the side of COPD and COPD in rat model of depression with lung pathological changes in airway inflammation, and the weight of patients with depression the model of COPD (open field test), behavioral effects, sugar test, using UPLC technology to detect rat hippocampus in dopamine (DA) levels were observed. Results: 1. clinical findings (1) 99 type of syndrome characteristics of.COPD patients with COPD patients, male 53 cases, female 46 cases. Age (68.14 + 9.04) years old, syndrome distribution including 64 cases of phlegm, phlegm syndrome 14 cases, lung and kidney yin deficiency syndrome in 21 cases. Two (2) of COPD with depression. The SDS scale analysis, 48 patients with depressive state, accounting for 48.48%. the SDS 0.5 to 0.59 (mild depression) with a total of 14 cases, SDS score of 0.6 to 0.69 (moderate depression) with a total of 24 cases, SDS score greater than 0.7 (severe depression) 48 cases of patients with a total of 10.COPD patients with depression in patients with 30 cases, the main symptom is heat phlegm. The total number of people with depression to reach more than 62%, 11 cases of phlegm, the total number of depression ratio was 23%, 7 cases of lung and kidney yin deficiency accounted for two, the total number of depression than for the 15%.2. experimental results (1) the effect of Jiawei Decoction intervention two COPD rat model of pulmonary pathology: modified two Decoction significantly improved the COPD model rats, significantly reduce the number of neutrophil proportion in BALF, there are differences compared with the model group (P0.01-0.05). (2) the effect and mechanism of Jiawei Decoction on rats with two COPD depression model: 1) lung pathology and BALF airway inflammation of COPD with depression model is worse than pure COPD group. "Two of COPD patients with depression Decoction Lung pathology in rat model with improved function, significantly reduce the number of inflammatory cells in BALF ratio, there are differences compared with the model group (P0.01-0.05).2) COPD depression model rats body weight decreased at 14,21,28 days and the rats weight in blank control group had significant difference compared with two (P0.01). Chen Tanggao, low dose group and COPD combined with depression model group weight increased, 14,21,28 days and COPD with depression model group compared with significant and very significant (P0.01-0.05).3) COPD depression model rats behavior change, sugar consumption decreased. Two improved COPD manifestations Jiawei decoction combined with depression and the behavior of the model study, increase the consumption of sucrose, open-field test showed that there were significant differences in 14,28 days COPD depression model group compared with the control group (P0.05); modified Erchen decoction high and low dose group COPD combined with depression model group compared with significant difference (P0.05).4) UPLC dopamine in rat hippocampus were detected in the body of the content of dopamine (DA), brain tissue compared to COPD patients with depression model group and blank control group (DA) were significantly decreased (P0.01); in two Chen Tanggao, dopamine in brain tissue compared with depression group and COPD model group, low dose (DA) content increased, the difference was statistically significant (P0.01-0.05), but lower than that of COPD with depression positive drug group (dexamethasone + fluoxetine). Conclusion: 1. the clinical data of 99 cases of COPD analysis showed that depression in patients with COPD accounted for 48.48%. With slightly more moderate depression.COPD depression in TCM analysis, the main symptom is phlegm depression accounted for 62%, phlegm syndrome accounted for 23%, two lung kidney yin deficiency accounted for 15%.2. based on the modified Chen Tanggan two To observe the state of COPD with pre depression effect, found by intratracheal instillation of LPS, and smoked were given stress stimulation in rats with COPD depression model, the lung disease is more serious than the COPD model at the same time, weight, behavior, sugar consumption, brain dopamine (DA) levels were significantly changed. Modified two decoction can improve the pulmonary pathology, significantly reduced the number of neutrophils in the proportion of BALF, the changes of body weight, behavior, increase the sugar consumption, increase of dopamine in the brain (DA) content. The results showed that two modified decoction has obvious intervention effect on COPD and COPD complicated with depression study on clinical treatment. The above research of depression is COPD, and the state of Yu phlegm loose recipe two Decoction in treatment of COPD complicated with depression provides the basic research data.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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