【作者】 李延平；

【导师】 李灿东；

【作者基本信息】 福建中医学院 ， 中西医结合临床， 2007， 博士

【摘要】 高尿酸血症是临床常见病症，中西医结合在本病的防治具有较大的优势，本课题提出了中医易患因素的概念，通过对临床和动物实验的多变量数据进行研究，取得了初步结论。1．临床研究1．1方法：选择高尿酸血症患者、健康人各130例，采用辨证要素(证素)积分的方法，结合计算机技术，对四诊资料进行分析统计，并检测尿酸、血糖、甘油三酯、胆固醇、胰岛素等指标，初步建立高尿酸血症的临床辨证分型、中医易患因素、证素分布规律、病理生理特点，同时探讨高尿酸血症患者中医证与血生化指标的相关性、高尿酸血症患者临床特征与指标的关系，为本病中西医结合诊断和证的客观化研究服务。1．2结果1．2．1高尿酸血症患者中医证型有：痰湿阻滞、阳气亏虚、阴血不足、湿热内蕴、气滞血瘀和寒凝气结，以痰湿阻滞、阳气亏虚这两种最为多见。1．2．2高尿酸血症患者中医易患因素是：当脾、肾、肝出现病变时，特别以脾为突出，容易引起高尿酸血症；同时当机体存在痰湿、阳虚的病理变化时，易患高尿酸血症，而其中又以湿最为突出。1．2．3高尿酸血症病位、病性特点：五脏中关系较为紧密的是肾，但高尿酸血症的形成是多脏腑(肝、脾)功能失调的结果；湿、阳虚是高尿酸血症的重要病理因素，而虚实夹杂是高尿酸血症的证候学特点。1．2．4高尿酸血症的病理生理学基础：高尿酸血症患者均伴有血糖、血脂的升高；痰湿阻滞型总胆固醇明显升高，且此型患者关节冷、痛症状明显，说明总胆固醇与痰关系密切。2．动物实验2．1方法：本课题采用腺嘌呤配合乙胺丁醇制备高尿酸血症模型大鼠，从湿热、痰浊、瘀血角度，分别采用不同中医治法的方药——四妙散、二陈汤、血府逐淤汤进行反证，并作相应尿酸、血糖、血脂等生化指标的检测，初步得到此种动物模型的中医证型特点。2．2结果2．2．1此法可制备出伴有肾功能损害高尿酸血症的模型大鼠。2．2．2三种中药均对高尿酸血症大鼠模型的体重、血尿酸、血脂、血糖等指标具有不同程度的影响，特别是对肾功能影响最为明显。且血府逐瘀汤作用最为显著。2．2．3此法制备高尿酸血症模型大鼠中医证型特点为血瘀。3．结论：本课题利用证素辨证积分法结合计算机统计处理，初步判断出高尿酸血症患者中医证型以痰湿阻滞、阳气亏虚最为多见；当存在脾、肾、肝、湿、阳虚的病变时，特别是脾、湿，易患高尿酸血症；五脏中与高尿酸血症关系较为紧密的是肾，而虚实夹杂是高尿酸血症的证候学特点；高尿酸血症患者均伴有血糖、血脂的升高，而总胆固醇与痰关系密切。在动物实验中，采用腺嘌呤+乙胺丁醇的方法能够复制高尿酸血症的大鼠模型，血府逐瘀汤在改善指标上作用最为显著，说明血瘀可能是此种模型主要证型特点。更多还原

【Abstract】 Hyperuricemia is the frequent disease in clinic; it would obtain well prevention and cure with the method of integrated WM- TCM. We put forward the TCM risk factors firstly, and get the elementary conclusions by studying on the variable data of clinical and animal experiment.1. Clinical study1.1 Method: Choosing hyperuricemia patients and healthy people 130 respectively, combing syndrome differentiation by syndrome element and computer technology, analysing the diagnosis informations by statistic process, detecting the uric acid, blood sugar, insulin, triglyceride, cholesterol, to build the criterion of TCM syndrom differentiation, to discuss the TCM risk factor, distributing law of syndrome element, character of the pathology. At the same time, By discussing the ralationship of the TCM syndrom differentiation and uric acid, clinical syndrom, blood index, to show the essential and foundation of hyperuricemia, and serve the diagnosis of integrated WM- TCM and objective sudy.1.2 Results:1.2.1 TCM susceptibility of hyperuricemia were: turbid sputum and retention of dampness, yang and qi deficiency, yin and blood deficiency, dampness and heat evil inside, qi stagnation and blood stasis, cold coagulate and qi stagnation. Turbid sputum and retention of dampness, yang and qi deficiency, their frequence were most.1.2.2 TCM risk factors of hyperuricemia were kidney, spleen and liver, but it’s most important factor is spleen. At the same time, retention of dampness and yang deficiency also were the important TCM risk factors, especially retention of dampness.1.2.3 The TCM pathological changes position of hyperuricemia was kidney, but the spleen and liver took the part of the process together. Dampness and yang deficiency were the important TCM pathological factors in the same. But deficiency matching excessive was the TCM symptomatology characteristic.1.2.4 The character of the pathology of hyperuricemia: hyperuricemia all attend by the increasing of blood sugar, triglyceride and cholesterol. Hyperuricemia with turbid sputum and retention of dampness were arthrodynia obviously, it showed there were the close relationship between the cholesterol and sputum.2. Animal experiment2.1 Method: Hhyperuricemia rat model was established by the adenine and ethambutol. Then the rats were cured with Simiaosan, Erchentang, Xuefuzhuyutang. After treatment, the rats were executed to examine the uric acid, blood glucose, insulin, triglyceride, cholesterol, to get the TCM syndrom differentiation of the hyperuricemia rat model.2.2 Results:2.2.1 With this method, we could build the hyperuricemia rat model with kidney damage.2.2.2 The TCM formula could react on the hyperuricemia rat model respectivly, especially in kidney function. And Xuefuzhuyutang was the best.2.2.3 With this method, we found the TCM syndrom differentiation of the hyperuricemia rat model was blood stasis.3. Conclusion: We had obtained that the ’turbid sputum and retention of dampness’ and ’yang and qi deficiency’ were the main TCM susceptibility of hyperuricemia; The important TCM risk factors were: spleen, kidney, liver, dampness and yang deficiency, especially spleen and dampness; The kidney was the closet organ with the hyperuricemia, and deficiency matching excessive was the TCM symptomatology characteristic of the hyperuricemia; TCM syndrom differentiation of the hyperuricemia rat model which established by the adenine and ethambutol was blood stasis.更多还原