补肾精、益天癸中药在经断前后诸症中作用机制的研究

发布时间：2018-10-31 15:28

【摘要】：经断前后诸症是指妇人经断之年,因肾精虚衰、天癸枯竭而出现的一系列症状,其临床表现主要为：经水不调(经期或提前或推后、量或多或少、色质或粘稠鲜红或清稀暗淡)、烘热汗出、心悸失眠、烦躁易怒等。现代医学称其称为围绝经期综合征(perimenopausal syndrome, MPS),认为此病与女性激素水平降低有关,激素替代疗法是其主要的治疗方法。激素替代疗法虽然在临床上有一定的疗效,却伴有许多副作用,如出血、子宫内膜癌等,故而应用受到限制。中药因在临床治疗经断前后诸症中呈现出良好的疗效,进入人们的眼线,备受关注。本文研究补肾精、益天癸中药治疗经断前后诸症作用机制。系统整理中医药学文献为其提供立论依据；从传统中医药学理论、现代药学研究等领域阐述其作用机制；并从运用指征、配伍特色等方面探讨其临床运用规律。综合古代医籍文献、现代临床报道及现代药理实验及中医药学理论等研究表明：肾精虚衰、天癸枯竭是经断前后诸症发病的根本原因,肾虚累及心肝脾是其重要的病理传变,治法上补肾精、益天癸,兼顾他脏。补肾精、益天癸中药在药性方面,性寒凉能滋阴、温可益阳、平无偏忌,甘味补虚,主入肾经,趋向下焦、质润主静的特点是治疗妇人经断前后诸症的药学基础；补而益精,补而滋阴,补而温阳,补而平衡是治疗妇人经断前后诸症的主要作用机理。从临床运用规律研究表明：经水不调,烘热盗汗或心悸失眠或烦躁易怒是妇人经断前后诸症的临床运用指征；动静结合、阴阳平补、兼顾脾胃是治疗妇人经断前后诸症药物配伍特色。通过对宁心红杞胶囊(补肾精、益天癸代表复方中药)的药理作用机制研究表明：宁心红杞胶囊通过抗卵泡颗粒细胞(granulosa cells, GC)凋亡,延缓卵巢功能衰退,从而治疗经断前后诸症。为阐释宁心红杞胶囊抗GC凋亡的作用机制,本研究在体外原代培养的GC氯化镉致凋亡损伤模型上,进行了实验研究。采用MTT比色法,测定给药前后大鼠GC增殖率的变化；采用放射免疫分析法,检测大鼠GC培养液中雌二醇(estradiol, E2)、孕酮(progesterone, P)分泌量,观察宁心红杞胶囊对女性激素分泌能力的影响；采用酶联免疫吸附实验法,检测培养液中Bcl-2、Bax及Caspase-3蛋白表达,观察宁心红杞胶囊对大鼠GC凋亡相关因子的影响。结果表明：宁心红杞胶囊可促进大鼠GC增殖,提高E2、P分泌量,上调抑凋亡因子Bcl-2蛋白表达、下调促凋亡因子Bax和Caspase-3蛋白表达。结论：宁心红杞胶囊能够促进GC的增殖,提高GC女性激素分泌能力,调节GC凋亡相关因子,从而抗GC凋亡,进而改善卵巢功能,治疗经断前后诸症。本文研究的成果,阐释了补肾精、益天癸中药治疗经断前后诸症的作用机制,为临床治疗经断前后诸症提供了科学依裾。
[Abstract]:The symptoms before and after menstruation are a series of symptoms that occur in women due to deficiency of kidney essence and exhaustion of Tiangui in the year of menstrual failure. Their clinical manifestations are mainly as follows: no regulation of water (menstrual period, early or delayed, more or less), Color or thick red or dark), drying hot sweat, palpitations insomnia, irritability, etc. Modern medicine calls it perimenopausal syndrome (perimenopausal syndrome, MPS), which is mainly treated by hormone replacement therapy, which is associated with lower hormone levels in women. Although hormone replacement therapy has a certain clinical efficacy, it has many side effects, such as bleeding, endometrial carcinoma and so on, so its application is restricted. Traditional Chinese medicine has attracted much attention because of its good curative effect in clinical treatment before and after meridian break. This paper studies the mechanism of tonifying kidney essence and Yitiangui traditional Chinese medicine in treating symptoms before and after meridian break. Systematic collation of traditional Chinese medicine literature to provide theoretical basis, from the traditional Chinese medicine theory, modern pharmaceutical research and other fields of its action mechanism, and from the use of indications, compatibility characteristics and other aspects of its clinical application. According to the literature of ancient medical literature, modern clinical reports, modern pharmacological experiments and the theory of traditional Chinese medicine, it is shown that deficiency of kidney essence and exhaustion of Tiangui are the fundamental causes of the disease, and kidney deficiency involving heart, liver and spleen is an important pathological transmission. On the treatment of kidney essence, Yi Tiangui, taking into account his dirty. Tonifying kidney essence, Yitiangui traditional Chinese medicine in the aspect of medicine, sexual cold can nourish yin, warm can benefit yang, flat no bias bogey, sweet taste tonify deficiency, main enter kidney meridian, tend to lower coke, quality moisten the characteristic of body static is the pharmacological foundation of treating the disease before and after the woman's meridian break; The main mechanism of treating women's syndrome before and after menstruation is to supplement and nourish essence, nourish yin, replenish and warm yang, and supplement and balance. The study of clinical application law shows that the symptoms of women before and after transection are as follows: unregulation of water, burning heat, night sweating, palpitations, insomnia or irritability and irritability; Combination of static and dynamic, yin-yang flat tonifying, taking into account the spleen-stomach is the treatment of women before and after the break of the symptoms of drugs compatibility characteristics. The pharmacological mechanism of Ningxin Hongqi capsule (tonifying kidney essence and Yitiangui compound Chinese medicine) was studied. The results showed that Ningxin Hongqi capsule delayed the decline of ovarian function by inhibiting the apoptosis of follicular granulosa cells (granulosa cells, GC). In order to treat before and after meridian break of the disease. In order to elucidate the anti-apoptosis mechanism of Ningxin Hongqi capsule (NXH), an experimental study was carried out on the model of apoptosis induced by cadmium chloride of GC in vitro. MTT colorimetric assay was used to determine the proliferation rate of GC in rats before and after administration. Radioimmunoassay (RIA) was used to detect the secretion of estradiol, E2 and progesterone (progesterone, P) in rat GC culture medium and to observe the effect of Ningxin Hongqi capsule on female hormone secretion. Enzyme linked immunosorbent assay (Elisa) was used to detect the expression of Bcl-2,Bax and Caspase-3 protein in culture medium and to observe the effect of Ningxin Hongqi capsule on apoptosis related factors of GC in rats. The results showed that Ningxin Hongqi capsule could promote the proliferation of rat GC, increase the secretion of E2P, up-regulate the expression of Bcl-2, and down-regulate the expression of Bax and Caspase-3. Conclusion: Ningxin Hongqi capsule can promote the proliferation of GC, improve the hormone secretion ability of GC women, regulate the apoptosis related factors of GC, so as to resist the apoptosis of GC, and then improve the ovarian function. The results of this study explain the mechanism of tonifying kidney essence and Yitiangui traditional Chinese medicine in treating the symptoms before and after meridian break, and provide a scientific basis for clinical treatment of the symptoms before and after meridian break.
【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】：R271.116

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