针刺治疗外阴硬化性苔藓的临床观察及治疗前后VEGF和CD34的表达

发布时间：2018-10-30 14:19

【摘要】：目的:1)通过观察临床指标的变化,明确外阴硬化性苔藓(VLS)针刺疗法的临床效果。2)以病变组织中的血管内皮生长因子(VEGF)和原始造血细胞抗原分子(CD34)为表征指标,借助免疫组化检测手段,探究它们在VLS中的表达、意义及相关性。3)结合临床观察与免疫组化检测分析手段,进一步探究VLS的病因与病机,以及针刺疗法的机理。方法:选取符合诊断标准的VLS患者30例为试验组(针刺治疗前后形成自身对照),另选取正常对照组5例。选取试验组外阴阿是穴对患者施行针灸围刺法治疗,连续治疗3个疗程,每月连续15天为一疗程,取外阴病变组织活检行免疫组化检测,对照分析治疗前后的临床症状与体征、VEGF阳性表达值和CD34阳性表达值(即MVD值),并与正常对照组对比分析。结果:1)针刺治疗前后VLS患者病变组织的临床症状及体征指标的差异均具有统计学意义(P0.05),治疗后阴痒、阴痛、皮肤色素、弹性及皮损范围等均有大幅度改善。治愈3例,显效12例,有效13例,无效2例,总有效率达93.3%。2)治疗前:VLS患者病变组织中VEGF值较正常组织显著升高,MVD值则明显减少,差异均有统计学意义(P0.05)。VEGF的表达与CD34的表达不同步。治疗后:VEGF值较治疗前回落,MVD值则回升,差异均有统计学意义(P0.05);治疗后与对照组的差异无统计学意义(P0.05),具有可比性。结论:1)本研究证实围刺法针刺治疗外阴硬化性苔藓疗效明显,绝大多数患者各临床观察指标均有明显改善。2)患者病变组织中VEGF值升高,而MVD值降低;而针刺治疗后VEGF值明显回落,MVD值则显著回升。VEGF值与MVD值存在密切的反馈机制。反映出病变皮肤组织中局部微循环障碍可能为一个重要的致病因素。3)针刺改善了 VLS病变组织局部的微循环,调整了全身气血阴阳平衡,舒活经络,调节脏腑,促进外阴气血旺盛,祛邪扶正。4)在病变区给予针刺治疗,可能对VEGF及CD34的信号传递过程造成重要干涉,这或许是该病治疗的内在关键所在。
[Abstract]:Objective: 1) to observe the changes of clinical indexes, To determine the clinical effect of (VLS) acupuncture therapy in vulvar lichen sclerosus. 2) taking vascular endothelial growth factor (VEGF) and primitive hematopoietic cell antigen molecule (CD34) in pathological tissues as the characterization indexes, and by means of immunohistochemical method, Explore their expression, significance and correlation in VLS. 3) combined with clinical observation and immunohistochemical analysis, further explore the etiology and pathogenesis of VLS, as well as the mechanism of acupuncture therapy. Methods: 30 VLS patients who met the diagnostic criteria were selected as experimental group (self control group before and after acupuncture treatment) and 5 normal control group. The patients in the experimental group were treated with acupuncture and moxibustion at Ashi point for 3 consecutive courses of treatment, 15 days a month as a course of treatment. Biopsy of vulvar lesions was performed by immunohistochemistry, and the clinical symptoms and signs before and after treatment were compared and analyzed. VEGF positive expression value and CD34 positive expression value (MVD value) were compared with normal control group. Results: 1) the clinical symptoms and signs of VLS patients were significantly different before and after acupuncture treatment (P0.05). After treatment, yin-itch, yin-pain, skin pigment, elasticity and range of skin lesions were significantly improved. 3 cases were cured, 12 cases were effective, 13 cases were effective, 2 cases were ineffective, the total effective rate was 93.3.2) before treatment, the VEGF value in pathological tissue of VLS patients was significantly higher than that in normal tissue, and the MVD value was significantly decreased. The difference was statistically significant (P0.05) the expression of). VEGF and CD34 were not synchronized. After treatment: the VEGF value was lower than before treatment, the MVD value was increased, the difference was statistically significant (P0.05); the difference between the treatment group and the control group was not statistically significant (P0.05), which was comparable. Conclusion: 1) the therapeutic effect of peri-acupuncture on vulvar lichen sclerosus is obvious, and most of the patients have improved all the clinical indexes. 2) the VEGF value in the pathological tissue of the patients is increased, but the MVD value is decreased. However, after acupuncture treatment, the VEGF value decreased significantly, while the MVD value increased significantly. There was a close feedback mechanism between VEGF value and MVD value. 3) Acupuncture improved the local microcirculation of VLS, adjusted the balance of qi, blood, yin and yang, relaxed the meridians, regulated the viscera. Promoting the exuberance of vulva qi and blood, dispelling evil and nourishing the spirit. 4) Acupuncture treatment in the lesion area may cause important interference in the signal transduction process of VEGF and CD34, which may be the internal key of the treatment of the disease.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.3

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