中药复方治疗抽动障碍的证治规律及止抽汤作用机制研究

发布时间：2018-02-26 21:47

  本文关键词： 抽动障碍 证治规律 止抽汤 作用机制 多巴胺系统　出处：《云南中医学院》2017年硕士论文　论文类型：学位论文

【摘要】：中医药治疗抽动障碍(Tic disorders,TD)有其特色和优势,为客观评价中药复方治疗TD的疗效,探讨证治规律及作用机制,本论文做了相关研究,全文共分为两部分。第一部分:通过收集文献,加以整理而探讨中药复方治疗TD的证治规律。检索2005年至2015年关于中药复方治疗抽动障碍的临床文献,符合纳入要求的文献共125篇。2015年的文献数量最多(20篇),其次是2014年(18篇)、2013年(18篇)、2012年(15篇)。会议论文4篇,学位论文35篇,期刊论文86篇,中药复方治疗抽动障碍的样本量共6090例。23篇文献采用自身对照试验方法,84篇文献采用随机对照试验方法,18篇文献为非随机对照试验研究。125篇文献中,有关中药复方的不良反应或安全性研究的文献共计15篇。结果显示中药复方临床研究治疗TD的数量呈逐年增加的趋势,但临床试验的科学性、实验结果的可信性以及中药复方的安全性研究有待加强、提高。主要问题在于:1、临床试验研究未能科学的遵循随机、盲法原则。84篇随机对照试验研究中,提及随机方法的文献共30篇,3篇文献提到了随机隐藏,双盲法临床研究文献2篇。2、对中药复方的不良反应和安全性评价的观察研究不够重视。125篇临床文献中,66篇研究了具体证型,共统计出36种证型,频数排名前三的证型分别为:肝风内动,风痰内扰型(8篇)、脾虚肝亢型(7篇)、肝风亢动型(6篇)。125篇临床文献共涉及182味中药,使用频数超过30次的中药为:白芍(94次)、钩藤(86次)、天麻(56次)、僵蚕(51次)、甘草(50次)、全蝎(39次)、胆南星(39次)、龙骨(37次)、石菖蒲(36次)、柴胡(33次)、牡蛎(33次)。对182味中药功效进行分类,共分16类,使用频数排名前五的为:平肝熄风药(330次,用药14种)、补气药(150次,用药12种)、补血药(135次,用药5种)、清热药(132次,用药27种)、安神药(130次,用药16种)、化痰止咳药(120次,用药14种)。182味中药主要归经为:肝经(114次)、脾经(67次)、肾经(62次),肺经(60次)、心经(56次)。主要用药的聚类分析结果:C1:茯苓、珍珠母、远志、白术、生地黄、当归、陈皮、蝉蜕;C2:胆南星、全蝎、龙骨、石菖蒲、牡蛎、柴胡、郁金;C3:僵蚕、甘草、天麻;C4:白芍、钩藤。通过对证型,中药的使用频数、种类、归经,主要用药的聚类结果进行统计分析讨论。总结出TD的病因病机特点为:本病多由脏腑功能失调所致,病位主要在肝脏,常涉及脾、肾二脏。主要的病机特点为肝风内动、痰热胶结扰神成疾。平肝息风原则是中医治疗本病的主要配伍规律,化痰、安神是遣方组药的关键。肝风内动、风痰内扰,脾虚肝亢是临床最常见证型。白芍、钩藤、天麻、僵蚕、甘草、全蝎、胆南星、龙骨、石菖蒲、柴胡、牡蛎是临床最常用的药物。而聚类分析结果中的4组中药可分别作为临床不同证型的基础方。二、观察云南省名中医、全国第三、五批老中医学术思想指导老师刘以敏主任临床治疗抽动障碍的自拟方止抽汤对TD模型大鼠的抽动行为及纹状体DA系统(DRD1、DRD2、DRD3、DAT的m RNA表达),以探讨止抽汤治疗该病的作用机制。方法:将56只SPF级实验Wistar大鼠随机分为空白组(10只)、模型组(10只)、氟哌啶醇组(18只)、止抽汤组(18只),除空白组外,其余三组用IDPN腹腔注射诱导出现TD模型后,予止抽汤及对照西药氟哌啶醇分别予以灌胃干预治疗14天,模型组予等量生理盐水灌胃,观察药物对TD模型大鼠的抽动行为影响。观察完毕后,立即快速断头处死各组大鼠,取出大鼠脑组织中的双侧纹状体。用实时荧光定量PCR技术检测大鼠脑组织纹状体DRD1、DRD2、DRD3、DAT的m RNA表达水平。实验结果显示;止抽汤与氟哌啶醇均能显著减少TD模型大鼠的抽动行为,但与氟哌啶醇比较,止抽汤能较快改善TD模型大鼠的抽动行为。止抽汤的作用机制可能与上调TD模型大鼠纹状体DRD2、DRD3的m RNA表达量有关。
[Abstract]:Chinese medicine for the treatment of tic disorders (Tic, disorders, TD) has its own characteristics and advantages, to objectively assess the curative effect of traditional Chinese medicine in the treatment of TD, to explore the diagnosis and treatment regularity and mechanism, this paper has done the related research, this paper is divided into two parts. The first part: through literature collection, sorting out and explore the traditional Chinese medicine in the treatment of TD the treatment of the law. From 2005 to 2015 on the clinical literature retrieval of traditional Chinese medicine in the treatment of tic disorder compound, accord with the requirements of the 125 papers in.2015 document number (20), followed by the 2014 (18), 2013 (18), 2012 (15). 4 conference papers, degree 35 papers, 86 papers in journals, sample of Chinese herbal compound in the treatment of tic disorder with self-control method and a total of 6090 cases of.23 articles, 84 articles with randomized controlled trial method, 18 articles were non randomized controlled trials of.125 documents, the The compound drug adverse reactions or safety of the 15 articles altogether. The results showed that the number of compound Chinese medicine clinical research on the treatment of TD is increasing year by year, but the science of clinical trials, the experimental results of the credibility and safety of compound Chinese medicine research should be strengthened and improved. The main problem is: 1, clinical trials have failed to follow the scientific principles of.84 randomized, blinded randomized controlled trial study, mentioned stochastic methods 30 papers, 3 papers mentioned were hidden, double-blind clinical research literature 2.2, observation of compound Chinese medicine adverse reaction and safety evaluation of insufficient.125 clinical literatures. The 66 study specific syndromes, the total statistics of 36 card type, the frequency of the top three syndromes were: endogenous liver wind, wind phlegm disturbance type (8), spleen deficiency and liver hyperactivity, hyperactivity of liver (7) type (6).125 clinical literatures 鍏辨秹鍙，

本文编号：1539801