不同黄芪剂量的补中益气汤对脾虚气陷型内痔组织Fibulin-3蛋白表达影响的研究

发布时间：2018-12-12 03:42

【摘要】：目的：通过观察不同黄芪剂量补中益气汤治疗脾虚气陷型内痔的临床疗效,比较分析其干预后内痔组织fibulin-3蛋白表达的差异,研究补中益气汤对脾虚气陷型内痔组织中fibulin-3蛋白表达的影响,为益气提升法治疗脾虚气陷型内痔提供理论依据,并为临床使用补中益气汤治疗脾虚气陷型内痔的最佳黄芪剂量提供依据。方法：1.临床研究：选取脾虚气陷型内痔患者66例,按随机分组法分为实验组1(34例,黄芪20g)、实验组2(32例,黄芪50g),对其的症状进行评分,分别以不同剂量黄芪的补中益气汤进行干预,观察其干预前后评分变化。2.实验研究：选取完成临床研究并符合实验纳入标准的20例脾虚气陷型内痔患者(实验组1、实验组2各10例),并随机纳入10例脾虚气陷型内痔患者作为对照组。采用免疫蛋白印迹法(Western blot)检测内痔组织中Fibulin-3蛋白的表达,并对不同组内痔组织的fibulin-3蛋白表达进行比较分析。结果：1.黄芪小剂量组补中益气汤对改善脾虚气陷型内痔的便血、肛门坠胀、脱垂等的评分具有良好的效果,对肛门坠胀、脱垂、总体评分改善具有统计学意义,但对便血的改善无统计学意义。2.黄芪大剂量组补中益气汤对改善脾虚气陷型内痔的便血、肛门坠胀、脱垂等的评分具有良好的效果,对便血、肛门坠胀、脱垂、总体评分改善均具有统计学意义。3.不同黄芪剂量补中益气汤对改善脾虚气陷型内痔的便血、肛门坠胀、脱垂的单项评分比较无明显差异,但对内痔症状总体评分的改善查体具有统计学意义,大剂量黄芪对改善内痔症状更有优势。4.大剂量黄芪组对脾虚气陷型内痔的治愈率明显高于小剂量黄芪组,但差异无统计学意义。5.补中益气汤干预后,脾虚气陷型内痔组织中fibulin-3蛋白表达明显高于未干预组,且差异有统计学意义。6.加大补中益气汤中黄芪剂量,脾虚气陷型内痔组织中Fibulin-3蛋白表达有所升高,但差异无统计学意义。结论：1.补中益气汤对脾虚气陷型内痔具有良好的治疗效果,加大黄芪剂量可提高临床疗效,但差异不显著。2. Fibulin-3蛋白表达水平的降低可能使肛垫的支持结构弹性能力下降,从而导致内痔的发生。3.补中益气汤干预组痔组织中的Fibulin-3蛋白含量明显高于对照组,补中益气汤对脾虚气陷型内痔组织中Fibulin-3蛋白的表达具有促进作用。4.加大黄芪剂量,可进一步促进Fibulin-3蛋白表达,但差异无统计学意义。5.补中益气汤可上调脾虚气陷型内痔组织中Fibulin-3蛋白的表达,从而降低MMPs活性,减缓肛垫组织弹性纤维水解,加强肛垫平滑肌固定肛垫的作用,从而缓解脾虚气陷型内痔的临床症状。
[Abstract]:Objective: to observe the clinical effect of Buzhong Yiqi decoction (BYQD) in treating internal hemorrhoids with spleen deficiency and qi depression, and to compare and analyze the difference of fibulin-3 protein expression in internal hemorrhoids after intervention. To study the effect of Buzhong Yiqi decoction on the expression of fibulin-3 protein in internal hemorrhoids with spleen deficiency and qi depression, and to provide a theoretical basis for the treatment of internal hemorrhoids with spleen deficiency and qi depression by promoting qi. It also provides the basis for clinical application of Buzhong Yiqi decoction in the treatment of spleen deficiency qi depression type of internal hemorrhoids with the best dose of Astragalus. Method 1: 1. Clinical study: 66 cases of internal hemorrhoids with spleen deficiency and qi depression were randomly divided into experimental group 1 (34 cases, astragalus 20g), experimental group 2 (32 cases, astragalus 50g). Different doses of Huangqi Buzhong Yiqi decoction were used to observe the change of score before and after intervention. 2. Experimental study: 20 cases of internal hemorrhoids with spleen deficiency and qi depression (experimental group 1, experimental group 2, 10 cases each) and 10 cases of spleen deficiency type internal hemorrhoids were randomly selected as control group. The expression of Fibulin-3 protein in internal hemorrhoids was detected by Western blot (Western blot), and the expression of fibulin-3 protein in different groups of internal hemorrhoids was compared. Results: 1. The small dose group of Astragalus membranaceus has a good effect on improving the scores of hematochezia, anal bloating and prolapse of internal hemorrhoids with spleen deficiency and qi depression, and has statistical significance for the improvement of anal bloating, prolapse and overall score. However, there was no statistical significance in improving hematochezia. 2. 2. The high dose group of Astragalus membranaceus has a good effect on improving the scores of blood loss, anal bloating and prolapse of internal hemorrhoids due to spleen deficiency and qi depression, and has statistical significance for the improvement of blood stool, anal bloating, prolapse and total score improvement. There was no significant difference in the single score of different Huangqi Buzhong Yiqi decoction in improving the hematochezia, anal distension and prolapse of internal hemorrhoids, but there was statistical significance in improving the overall score of internal hemorrhoids. High dose of Astragalus membranaceus has more advantages in improving the symptoms of internal hemorrhoids. 4. 4. The cure rate of high dose Astragalus membranaceus group was significantly higher than that of small dose Astragalus group, but the difference was not statistically significant. After intervention of Buzhong Yiqi decoction, the expression of fibulin-3 protein in internal hemorrhoids with spleen deficiency and qi depression was significantly higher than that in non-intervention group, and the difference was statistically significant. Increasing the dose of Astragalus membranaceus in Buzhong Yiqi decoction and increasing the expression of Fibulin-3 protein in internal hemorrhoids with spleen deficiency and qi depression, the difference was not statistically significant. Conclusion: 1. Buzhong Yiqi decoction has a good therapeutic effect on internal hemorrhoids with spleen deficiency and qi depression. Increasing the dose of Astragalus can improve the clinical efficacy, but the difference is not significant. 2. The decrease of Fibulin-3 protein expression level may decrease the elasticity of supporting structure of anal pad, and lead to the occurrence of internal hemorrhoids. The content of Fibulin-3 protein in hemorrhoid tissue of BZYQD intervention group was significantly higher than that of control group. Buzhong Yiqi decoction promoted the expression of Fibulin-3 protein in internal hemorrhoid tissue of spleen deficiency qi depression type. 4. Increasing the dose of Astragalus could further promote the expression of Fibulin-3 protein, but the difference was not statistically significant. Buzhong Yiqi decoction can upregulate the expression of Fibulin-3 protein in internal hemorrhoids with spleen deficiency, decrease the activity of MMPs, slow down the elastic fiber hydrolysis of anal cushion tissue, and strengthen the effect of anal cushion smooth muscle fixation on anal pad. In order to alleviate the spleen deficiency qi depression type of internal hemorrhoids clinical symptoms.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R266

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