穴位埋线对葡萄膜炎患者的临床作用及免疫机制的研究
发布时间：2018-11-01 16:17
【摘要】：目的:1.观察穴位埋线对葡萄膜炎患者的临床作用;2.探讨穴位埋线对实验性自身免疫性葡萄膜炎大鼠的治疗作用。方法:1.纳入40名葡萄膜炎患者,随机分为2组(A组穴位埋线结合西医治疗,B组纯西医治疗),其中A组埋线时间为每半月一次,6次一个疗程。观察分析纳入的葡萄膜炎患者的一般情况以及葡萄膜炎患者;检测A、B两组治疗前后视力变化、眼部阳性体征的变化;观察葡萄膜炎患者中体体质的分型、分布趋势以及中医体质与葡萄膜炎患者临床病理分类的关系,对比A、B两组治疗后体质的变化趋势;统计A、B两组治疗后生存质量量表的变化;统计A、B两组治疗期间及治疗后复发的时间及频率。2.将Liwes大鼠48只,采用随机数字表法分为对照组、模型组、穴位埋线组,每组16只。将光感受器间维生素A类结合蛋白(IRBP)、结核杆菌(TB)和完全弗氏佐剂(CFA)磷酸缓冲盐溶液(PBS)制成乳糜液后,在双足后垫及背部两侧皮下注射。穴位埋线组于造模后第二天进行穴位埋线,且模型组、穴位埋线组于免疫后第9、13、18、23天采集心脏血液并分离淋巴结中T淋巴细胞,进行流式细胞仪分析,同时对眼球进行组织病理切片。结果:1.视力:将A、B两组治疗前后视力对比分析,其中A组视力提高均值为0.35±0.15,B组视力提高均值为0.25±0.16;将2组视力提高情况做两独立样本t检验,得t=2.14,按α=0.05,得p=0.04㩳0.05,差异有统计学意义,证明A组的穴位埋线比B组视力提高值大;生存质量:治疗前后生存质量满意度提高A组平均值为37.5±14.24,B组平均值为13.8±22.70,t=3.94,按α=0.05,得p=0.00㩳0.05,差异有显著统计学意义,可认为患者A组在穴位埋线治疗下对疗效评价满意度较B组对生存质量满意度高;中医体质:A组葡萄膜炎患者偏向平和质,湿热质、阳虚质、痰湿质的患者体质有明显的改变。B组在治疗后会出现湿热质、阳虚质的中医体质患者所占比例明显上升,同时平和质患者的体质也受影响,出现了偏颇质;两组疗效对比p=0.0050.05,A组的有效率高于B组;阳性体征:2组葡萄膜炎患者在初次就诊时其临床症状无明显差别,但在治疗后对于复发的葡萄膜炎患者穴位埋线组患者的阳性体征明显比纯西医治疗轻;同时A组在治疗期间内的复发率较B组低。2.造模后第6至7天大鼠眼部开始出现炎症反应,第13天炎症达高峰(模型组临床评分为:3.42±0.58,穴位埋线组为:2.17±0.68,p=0.018,差异有统计学意义),之后逐渐开始消退。组织病理学结果显示模型组在第9、13、18、23天时虹膜,睫状体及视网膜炎症均比穴位埋线组严重,而空白对照组眼部结构完整,未见明显炎症表现;流式细胞仪分析显示第13天CD4+T占细胞比例最高值:模型组为85.97±1.03,穴位埋线组为:79.51±0.64,两组比较差异有统计学意义(p0.001);第13天时CD8+T最低:模型组为:14.03±1.03,治疗穴位埋线组为:20.49±0.64,两组比较差异有统计学意义(p0.001)。结论:1.通过A、B两组不同的对葡萄膜炎的治疗方法对比,发现穴位埋线在视力提高、患者生存质量提高、病情复发率、中医体质改变等方面均较B组未埋线治疗组好。说明穴位埋线对葡萄膜炎的流行病学某些方面具有一定的作用;2.在机制研究方面眼形态学、组织病理、细胞水平等结果显示,穴位埋线可有效减轻实验性自身免疫性葡萄膜炎大鼠炎症水平,对大鼠的葡萄膜炎具有治疗作用。
[Abstract]:Purpose: 1. To observe the clinical effect of acupoint catgut embedding on patients with uveitis; To explore the therapeutic effect of acupoint catgut embedding on experimental autoimmune uveitis rats. Method: 1. Forty-four patients with uveitis were randomly divided into 2 groups (group A acupuncture point embedding line combined with western medicine treatment and B group pure western medicine treatment), in which group A buried line time was once every half a month, 6 times a course of treatment. To observe the general condition of patients with uveitis included in the analysis and the patients with uveitis; to detect changes in visual acuity and signs of ocular signs before and after treatment in group A and B; and observe the classification of body constitution in patients with uveitis. The relationship between the distribution trend and the clinical and pathological classification of traditional Chinese medicine constitution and uveitis was compared with that of group A and B. The changes of survival quality scale were statistically analyzed in both groups A and B. The time and frequency of relapse after treatment and post-treatment were statistically analyzed. Forty-eight Lives rats were divided into two groups: control group, model group and acupuncture point buried line group. A chylchylous solution is prepared by combining the photoreceptors with vitamin A binding protein (IRBP), mycobacterium tuberculosis (TB) and complete Freund's adjuvant (CFA) phosphate buffered saline solution (PBS), and subcutaneous injection is carried out on both sides of the back cushion and the back of the bipedal. At the 9th, 13th, 18th and 23rd day after immunization, the T-lymphocytes in the lymph nodes were collected and analyzed by flow cytometry. Result: 1. The visual acuity of group A and B was analyzed before and after treatment. Among them, the mean value of vision in group A was 0. 35% 0. 15, the visual acuity of group B increased from 0. 25 to 0. 16; 2 groups of visual acuity improved were tested by two independent samples t, and t = 2.14, the visual acuity was 0. 05, p = 0.004 卤 0.05, the difference was statistically significant. It was proved that the point embedding line in group A was higher than that in group B. The quality of life: the quality of life before and after treatment increased the average value of group A was 37. 5, 14. 24, the average value of group B was 13. 8, 22. 70, t = 3.94, the difference was statistically significant. It can be considered that the satisfaction of efficacy evaluation was higher in group A than in group B at acupoint catgut embedding therapy. The constitution of traditional Chinese medicine: patients with uveitis in group A had a significant change in constitution of patients with mild, damp-heat, yang-deficiency and phlegm-dampness. In group B, there was a significant increase in the proportion of patients with dampness-heat and yang-deficiency type of Chinese medicine after treatment, while the physical constitution of the patients with mild quality was also affected. The effective rate of group A was higher than that in group B. Positive signs: There was no significant difference in the clinical symptoms of patients with uveitis in group 2 at the initial visit, but the positive signs of acupoint catgut embedding group in patients with recurrent uveitis after treatment were significantly lower than that of pure western medicine, while the recurrence rate of group A was lower than that of group B during treatment. Inflammatory reaction was started at the eyes of 6th to 7th day after molding, and the inflammation reached the peak at the 13th day (the clinical score of the model group was: 3.42. 0. 58, the acupuncture point buried line group was 2.17, 0.068, p = 0.018, the difference was statistically significant), and then gradually began to subside. Histopathological results showed that the iris, ciliary body and retina inflammation of the model group were serious at the 9th, 13th, 18th and 23rd days than the acupoint catgut group, while the eye structure of the blank control group was intact and no obvious inflammatory performance was found. The flow cytometry analysis showed that the CD4 + T in the 13th day accounts for the highest percentage of the cells: The model group was 85. 97% 1. 03, the acupoint catgut embedding group was 79. 51% 0. 64, the difference between the two groups was statistically significant (S1001.001); CD8 + T on the 13th day was the lowest: the model group was: 14.03 Mt. 1.03, and the treatment point buried line group was 20. 49% 0. 64, and the difference between the two groups was statistically significant (S1001.001). Conclusion: 1. Compared with the treatment methods of uveitis by A and B groups, the acupoint catgut embedding line was found to be better than that in group B in group B in the aspects of improvement of vision, improvement of patient's survival quality, recurrence rate of disease, change of physical constitution of traditional Chinese medicine, etc. It is pointed out that the acupoint embedding line has certain effect on the epidemiology of uveitis; The results of eye morphology, histopathology, cell level and so on in mechanism research show that acupoint catgut embedding can effectively reduce inflammation level in experimental autoimmune uveitis, and has therapeutic effect on uveitis in rats.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.82
[Abstract]:Purpose: 1. To observe the clinical effect of acupoint catgut embedding on patients with uveitis; To explore the therapeutic effect of acupoint catgut embedding on experimental autoimmune uveitis rats. Method: 1. Forty-four patients with uveitis were randomly divided into 2 groups (group A acupuncture point embedding line combined with western medicine treatment and B group pure western medicine treatment), in which group A buried line time was once every half a month, 6 times a course of treatment. To observe the general condition of patients with uveitis included in the analysis and the patients with uveitis; to detect changes in visual acuity and signs of ocular signs before and after treatment in group A and B; and observe the classification of body constitution in patients with uveitis. The relationship between the distribution trend and the clinical and pathological classification of traditional Chinese medicine constitution and uveitis was compared with that of group A and B. The changes of survival quality scale were statistically analyzed in both groups A and B. The time and frequency of relapse after treatment and post-treatment were statistically analyzed. Forty-eight Lives rats were divided into two groups: control group, model group and acupuncture point buried line group. A chylchylous solution is prepared by combining the photoreceptors with vitamin A binding protein (IRBP), mycobacterium tuberculosis (TB) and complete Freund's adjuvant (CFA) phosphate buffered saline solution (PBS), and subcutaneous injection is carried out on both sides of the back cushion and the back of the bipedal. At the 9th, 13th, 18th and 23rd day after immunization, the T-lymphocytes in the lymph nodes were collected and analyzed by flow cytometry. Result: 1. The visual acuity of group A and B was analyzed before and after treatment. Among them, the mean value of vision in group A was 0. 35% 0. 15, the visual acuity of group B increased from 0. 25 to 0. 16; 2 groups of visual acuity improved were tested by two independent samples t, and t = 2.14, the visual acuity was 0. 05, p = 0.004 卤 0.05, the difference was statistically significant. It was proved that the point embedding line in group A was higher than that in group B. The quality of life: the quality of life before and after treatment increased the average value of group A was 37. 5, 14. 24, the average value of group B was 13. 8, 22. 70, t = 3.94, the difference was statistically significant. It can be considered that the satisfaction of efficacy evaluation was higher in group A than in group B at acupoint catgut embedding therapy. The constitution of traditional Chinese medicine: patients with uveitis in group A had a significant change in constitution of patients with mild, damp-heat, yang-deficiency and phlegm-dampness. In group B, there was a significant increase in the proportion of patients with dampness-heat and yang-deficiency type of Chinese medicine after treatment, while the physical constitution of the patients with mild quality was also affected. The effective rate of group A was higher than that in group B. Positive signs: There was no significant difference in the clinical symptoms of patients with uveitis in group 2 at the initial visit, but the positive signs of acupoint catgut embedding group in patients with recurrent uveitis after treatment were significantly lower than that of pure western medicine, while the recurrence rate of group A was lower than that of group B during treatment. Inflammatory reaction was started at the eyes of 6th to 7th day after molding, and the inflammation reached the peak at the 13th day (the clinical score of the model group was: 3.42. 0. 58, the acupuncture point buried line group was 2.17, 0.068, p = 0.018, the difference was statistically significant), and then gradually began to subside. Histopathological results showed that the iris, ciliary body and retina inflammation of the model group were serious at the 9th, 13th, 18th and 23rd days than the acupoint catgut group, while the eye structure of the blank control group was intact and no obvious inflammatory performance was found. The flow cytometry analysis showed that the CD4 + T in the 13th day accounts for the highest percentage of the cells: The model group was 85. 97% 1. 03, the acupoint catgut embedding group was 79. 51% 0. 64, the difference between the two groups was statistically significant (S1001.001); CD8 + T on the 13th day was the lowest: the model group was: 14.03 Mt. 1.03, and the treatment point buried line group was 20. 49% 0. 64, and the difference between the two groups was statistically significant (S1001.001). Conclusion: 1. Compared with the treatment methods of uveitis by A and B groups, the acupoint catgut embedding line was found to be better than that in group B in group B in the aspects of improvement of vision, improvement of patient's survival quality, recurrence rate of disease, change of physical constitution of traditional Chinese medicine, etc. It is pointed out that the acupoint embedding line has certain effect on the epidemiology of uveitis; The results of eye morphology, histopathology, cell level and so on in mechanism research show that acupoint catgut embedding can effectively reduce inflammation level in experimental autoimmune uveitis, and has therapeutic effect on uveitis in rats.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.82
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