静心止动方治疗抽动障碍疗效观察及免疫相关性研究
发布时间：2019-05-07 19:42
【摘要】：目的:1.通过比照TD患儿血清中IL-6及TNF-α两种细胞因子经静心止动方治疗前及治疗后的水平变化,不同病情程度的水平变化,及与对照组的水平差异,来探究TD的发病、病情严重程度与细胞因子IL-6及TNF-α的关系,并同时探究年龄、性别对其影响。2.通过观察TD患儿血清中IL-6及TNF-α含量经静心止动方治疗3个月后的变化,结合临床抽动症状改善状况,评估静心止动方的治疗TD的疗效。揭示该方治疗TD的作用靶点,从现代医学的角度明确静心止动方治疗TD的机制,验证其"从心论治"的辨证思路。3.结合本实验结果及TD病因病机相关文献,从细胞免疫方面探讨本病的相关性。方法:本次研究对象为中国中医科学院广安门医院儿科门诊就诊的TD患儿及正常儿童,以DSM-Ⅴ为入选TD患者诊断标准,严格按照入组要求进行病例的筛选和剔除,最终保留病例组74例,对照组20例。均经静心止动方治疗3个月,采用耶鲁综合抽动严重程度量表(YGTSS)的评分以评估其治疗前后的抽动症状严重程度,参照治疗前后评分减分率评价疗效,整个疗程以患儿的肝肾功能、尿常规来保证安全性。采集所有入组儿童疗前及TD组患儿疗后静脉血2ml,于4℃下以4000rpm离心10分钟后收集上层血清于-80℃保存至检测。使用德国产DPC immulite 1000化学发光免疫分析仪,采用化学发光法检测TNF-α及IL-6水平。设备生产厂家为德国西门子公司,试剂盒为该公司原厂试剂盒,批号为0262。本课题所有实验均在中国中医科学院广安门医院检验科完成,按照试剂盒说明书严格操作。统计采用SPSS19.0统计软件进行统计学处理,计量资料以均数±标准差表示,采用成对样本t检验、独立样本t检验、非参数Mann-Whitney U检验、Spearman双变量相关性检验、非参数Kruskal-Wallis H(K)等分析方法。结果:1.74例TD患儿经静心止动方治疗3月后,按照减分率计算得出:显效19例,有效40例,无效15例,总有效率79.7%。2.TD患儿治疗前血清TNF-α水平高于对照组(P0.01),IL-6水平差异无统计学意义。TD患儿治疗后血清TNF-α水平高于对照组,IL-6水平低于对照组,差异均有统计学意义(P0.05)。3.TD组治疗后血清TNF-α水平较治疗前显著降低(P0.01),IL-6水平变化无统计学意义。4.TD患儿的性别与血清TNF-α和IL-6水平的差异无统计学意义。5.年龄越大的TD患儿YGTSS评分越低(r=-0.249,P0.05),同时血清TNF-α水平也越低(r=-0.303,P0.01);而TD患儿的年龄与IL-6水平差异无统计学意义。6.轻度、中度、重度TD患儿之间血清TNF-α水平差异具有显著统计学意义(P0.01),程度越高血清TNF-α水平越高,且与对照组比较均有统计学意义;三者IL-6水平差异无统计学意义。7.疗前、疗后YGTSS评分越高的患儿,血清TNF-α水平越高(r=0.956、0.929,P0.01;YGTSS评分与IL-6水平相关性无统计学意义。结论:1.本次研究中TD患儿以静心止动方治疗后总有效率为79.7%,治疗后所有患儿肝肾功能均未见异常。此结果再次证实导师韩斐教授"从心论治"治疗抽动障碍的治疗理论和其自拟方药"静心止动方"的有效性和安全性。2.经过实验研究,TD患儿血清TNF-α水平较正常儿童升高,经治疗后下降。IL-6水平较正常儿童差异无统计学意义,经治疗后较正常儿童下降。推测TD发病与机体免疫功能的紊乱有关。3.研究结果提示男孩较女孩更容易患有本病,且女性患儿多数病情较轻,男性患儿则相对病情较重,推测可能与男、女之间免疫及神经系统生长发育的差异相关。4.病情越重、YGTSS评分越高的TD患儿血清TNF-α水平越高,IL-6的差异无统计学意义。因此可以考虑将TNF-α水平作为判断抽动严重程度的一项参考指标。5.年龄越大的TD患儿YGTSS评分越低,血清TNF-α水平也越低;患儿年龄与血清IL-6水平差异无统计学意义。推测可能与年龄较大的患儿免疫及神经系统生长发育较完善相关。
[Abstract]:Objective:1. The incidence of TD was investigated by comparing the levels of IL-6 and TNF-1 in the serum of the patients with TD before and after treatment, the level of different conditions, and the level difference with the control group. The relationship between the severity of the disease and the levels of IL-6 and TNF-1 and the influence of age and sex were also explored. By observing the changes of IL-6 and TNF-1 content in the serum of the children with TD in 3 months after the treatment, the effect of the treatment TD of the static-heart stop was assessed in combination with the improvement of the clinical symptom. This paper reveals the target of the treatment of TD, and it is clear from the angle of modern medicine that the mechanism of the treatment of TD is clear and the dialectical thinking of the "the treatment of heart disease" is verified. The correlation of this disease was discussed from the aspects of cellular immunity in combination with the experimental results and the related literature of the pathogenesis of TD. Methods: The subject of this study was the TD and the normal children of the pediatric outpatient department of the Guangan Men's Hospital of the Chinese Academy of Chinese Medicine. The diagnosis standard of the patients with TD was determined by the DSM-V. The screening and elimination of the cases were carried out in strict accordance with the requirements of the enrollment,74 cases of the case group and 20 cases of the control group were retained. All patients were treated with the static-heart stop for 3 months, and the scores of the Yale Comprehensive Stroke Severity Scale (YGTSS) were used to assess the severity of the symptoms of the pre-and post-treatment, and the efficacy was evaluated with reference to the score reduction rate before and after the treatment. The whole course of treatment was to ensure the safety of the liver and kidney function and the urine routine of the child. All the children who were enrolled in the pre-treatment and in the TD group were collected for 2 ml of venous blood, and the upper serum was collected at-80.degree. C. for 10 minutes at 4.degree. C. for 10 minutes and then stored at-80.degree. C. for detection. The levels of TNF-1 and IL-6 were detected by the chemiluminescence method using the dpc immulite 1000 chemiluminescent immunoassay. The equipment manufacturer is the German Siemens, the kit is the original kit of the company, and the batch number is 0262. All the experiments of the subject are completed in the Laboratory of the Guangan Men's Hospital of the Chinese Academy of Chinese Medicine, and are strictly operated according to the instructions of the kit. The statistical processing was carried out using the SPSS19.0 statistical software, and the measurement data was expressed as the standard deviation of the mean number. The analysis methods such as the paired sample t test, the independent sample t test, the non-parametric Mann-Whitney U test, the Spearman double-variable correlation test and the non-parametric Kruskal-Wallis H (K) were used. Results: 1.74 patients with TD were treated by the static-heart stop for 3 months, and the total effective rate was 79.7%. The serum TNF-1 level in the patients with TD was higher than that in the control group (P0.01), and the level of IL-6 was not significant. The level of TNF-1 in the patients with TD was higher than that in the control group, and the level of IL-6 was lower than that in the control group (P0.05). There was no significant difference in the level of IL-6. The lower the score of YGTSS (r =-0.249, P0.05), the lower the level of serum TNF-6 (r =-0.303, P0.01). There was a significant difference in serum TNF-1 level among children with mild, moderate and severe TD (P0.01). The higher the level of serum TNF-1, the higher the level of TNF-1 in the serum, and there was no significant difference with the control group, and there was no significant difference in the level of IL-6. The higher the serum TNF-1 level in the children with higher YGTSS scores before the treatment, the higher the serum TNF-1 level (r = 0.956, 0.929, P0.01); the correlation between the YGTSS score and the IL-6 level was not statistically significant. Conclusion:1. In this study, the total effective rate was 79.7% after the treatment with the static-heart stop, and the liver and kidney function of all the children after treatment had no abnormality. The results confirm the effectiveness and safety of Professor Han Fei's "the treatment of heart disease" on the treatment theory and the "static-core stop" of the self-proposed formula. The serum TNF-1 level in the children with TD was higher than that of normal children and decreased after treatment. There was no significant difference between the level of IL-6 and normal children. It is suggested that the pathogenesis of TD is related to the disorder of the immune function of the body. The results suggested that the boy was more likely to have the disease than the girl, and most of the female patients had a mild condition, and the male child was relatively more severe, and it was presumed that the difference in the immune and nervous system development between the male and the female was related to that of the male and female. The higher the severity of the disease, the higher the serum TNF-1 level in the patients with the higher the YGTSS score, and the difference of IL-6 was not statistically significant. Therefore, the TNF-1 level can be considered as a reference index for judging the severity of the extraction. The lower the score of YGTSS, the lower the level of serum TNF-6, the lower the level of serum TNF-6, and the difference between the age of the children and the level of IL-6 in the serum. It may be related to the development of the immune and nervous system of the children with larger age.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
本文编号：2471333
[Abstract]:Objective:1. The incidence of TD was investigated by comparing the levels of IL-6 and TNF-1 in the serum of the patients with TD before and after treatment, the level of different conditions, and the level difference with the control group. The relationship between the severity of the disease and the levels of IL-6 and TNF-1 and the influence of age and sex were also explored. By observing the changes of IL-6 and TNF-1 content in the serum of the children with TD in 3 months after the treatment, the effect of the treatment TD of the static-heart stop was assessed in combination with the improvement of the clinical symptom. This paper reveals the target of the treatment of TD, and it is clear from the angle of modern medicine that the mechanism of the treatment of TD is clear and the dialectical thinking of the "the treatment of heart disease" is verified. The correlation of this disease was discussed from the aspects of cellular immunity in combination with the experimental results and the related literature of the pathogenesis of TD. Methods: The subject of this study was the TD and the normal children of the pediatric outpatient department of the Guangan Men's Hospital of the Chinese Academy of Chinese Medicine. The diagnosis standard of the patients with TD was determined by the DSM-V. The screening and elimination of the cases were carried out in strict accordance with the requirements of the enrollment,74 cases of the case group and 20 cases of the control group were retained. All patients were treated with the static-heart stop for 3 months, and the scores of the Yale Comprehensive Stroke Severity Scale (YGTSS) were used to assess the severity of the symptoms of the pre-and post-treatment, and the efficacy was evaluated with reference to the score reduction rate before and after the treatment. The whole course of treatment was to ensure the safety of the liver and kidney function and the urine routine of the child. All the children who were enrolled in the pre-treatment and in the TD group were collected for 2 ml of venous blood, and the upper serum was collected at-80.degree. C. for 10 minutes at 4.degree. C. for 10 minutes and then stored at-80.degree. C. for detection. The levels of TNF-1 and IL-6 were detected by the chemiluminescence method using the dpc immulite 1000 chemiluminescent immunoassay. The equipment manufacturer is the German Siemens, the kit is the original kit of the company, and the batch number is 0262. All the experiments of the subject are completed in the Laboratory of the Guangan Men's Hospital of the Chinese Academy of Chinese Medicine, and are strictly operated according to the instructions of the kit. The statistical processing was carried out using the SPSS19.0 statistical software, and the measurement data was expressed as the standard deviation of the mean number. The analysis methods such as the paired sample t test, the independent sample t test, the non-parametric Mann-Whitney U test, the Spearman double-variable correlation test and the non-parametric Kruskal-Wallis H (K) were used. Results: 1.74 patients with TD were treated by the static-heart stop for 3 months, and the total effective rate was 79.7%. The serum TNF-1 level in the patients with TD was higher than that in the control group (P0.01), and the level of IL-6 was not significant. The level of TNF-1 in the patients with TD was higher than that in the control group, and the level of IL-6 was lower than that in the control group (P0.05). There was no significant difference in the level of IL-6. The lower the score of YGTSS (r =-0.249, P0.05), the lower the level of serum TNF-6 (r =-0.303, P0.01). There was a significant difference in serum TNF-1 level among children with mild, moderate and severe TD (P0.01). The higher the level of serum TNF-1, the higher the level of TNF-1 in the serum, and there was no significant difference with the control group, and there was no significant difference in the level of IL-6. The higher the serum TNF-1 level in the children with higher YGTSS scores before the treatment, the higher the serum TNF-1 level (r = 0.956, 0.929, P0.01); the correlation between the YGTSS score and the IL-6 level was not statistically significant. Conclusion:1. In this study, the total effective rate was 79.7% after the treatment with the static-heart stop, and the liver and kidney function of all the children after treatment had no abnormality. The results confirm the effectiveness and safety of Professor Han Fei's "the treatment of heart disease" on the treatment theory and the "static-core stop" of the self-proposed formula. The serum TNF-1 level in the children with TD was higher than that of normal children and decreased after treatment. There was no significant difference between the level of IL-6 and normal children. It is suggested that the pathogenesis of TD is related to the disorder of the immune function of the body. The results suggested that the boy was more likely to have the disease than the girl, and most of the female patients had a mild condition, and the male child was relatively more severe, and it was presumed that the difference in the immune and nervous system development between the male and the female was related to that of the male and female. The higher the severity of the disease, the higher the serum TNF-1 level in the patients with the higher the YGTSS score, and the difference of IL-6 was not statistically significant. Therefore, the TNF-1 level can be considered as a reference index for judging the severity of the extraction. The lower the score of YGTSS, the lower the level of serum TNF-6, the lower the level of serum TNF-6, and the difference between the age of the children and the level of IL-6 in the serum. It may be related to the development of the immune and nervous system of the children with larger age.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
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