【作者】 刘聪慧；

【导师】 詹宇坚；

【作者基本信息】 广州中医药大学 ， 中医眼科学， 2005， 硕士

【摘要】 白塞氏病(Behcet’ disease BD)属中医“狐惑”之范畴,是以眼、口腔、生殖器症状为主,并伴有全身各系统受累损害的疾病。亦称白塞氏综合征,或眼-口-生殖器综合征。本病发病急骤,病因复杂,症状多样,病情变化诡异多端,且病程冗长,多因反复的视网膜血管栓塞而导致严重的视力损害,部分患者因并发新生血管性青光眼,而导致眼球萎缩。现代医学认为本病的病因复杂,机理未明,多针对症状治疗,疗效不持久。中医认为本病多本虚标实,但是有关本病的分型较为繁杂,证型不够规范,临床难以把握。近年来有关本病的研究在不断深入,以寻求其变化规律,从而指导临床的进一步研究和疾病的治疗。本研究在导师的指导下,在综述了有关本病中医证候和中、西医治疗的文献、了解国内外的研究现状的基础上,观察了本病的临床表现,初步探讨了本病的中医证候特点。 一、文献研究 通过对祖国医学对白塞氏病的研究现状的综述,认为本病的病机主要为本虚标实。但有关本病的分型较为繁杂,不够规范。现代医学认为,白塞氏病的发生与多种因素有关,治疗的方法也多样化,部分方法疗效肯定,但不持久。为了将中医证型客观化,更有利于辨证和用药,设计了本研究。 二、临床研究 目的:了解白塞氏病的中医证候特点,将证型与客观指标联系起来,分析起内在的联系,规范中医辨证分型,使中医证型客观化。 方法:对纳入本研究的48例患者,按白塞氏病临床观察表登记患者的证候信息,根据辩证论治,分为湿热蕴结型、肝肾阴虚型、脾肾阳虚型三组,结合患者的FFA检查结果及T淋巴细胞亚群的检测结果,进行临床研究分析。 结果:1、白塞氏病湿热为患,贯穿始终。48例患者中,有36例患者出现玻璃体不同程度的浑浊,占77%,27例患者表现为网膜局限性水肿,占56%。舌红者,有25例,占52%;苔黄者28例,占58.3%。此均为湿邪所致。2、证候复杂。各证型间证状及体征相互交错,如腰膝酸软,在肝肾阴虚型中,占50%,在湿热蕴结型中,占37.5%,脾肾阳虚型中亦可见此症状,占12.5%,症状的主次不同,所占比例不同。3、白塞氏病的FFA检查,典型的表现为:视网膜毛细血管扩张,通透性增加。根据累及网膜的部位不同,而表现各异。研究发现,证型的不同和视盘的荧光改变之间存在相关性。从构成比可以分析,湿热蕴结型,视盘高荧光的发生率与肝肾阴虚型、脾肾阳虚型的视盘荧光改变不同,差别有统计学意义(P<0.05)。而视网膜水肿的改变,组间无差异(P>0.05),尚不能说明各证型之间,网膜水肿的改变有差异。4、目前大多数学者认为白塞氏病的发病与免疫因素有关,认为BD是免疫性疾病,而T更多还原

【Abstract】 Behcet’s disease (BD) is a systemic disease, including many organs’ pathological changes. It includes the uveitis, oral cavity and genital orga’s ulcer, and the skin disorder. BD is also called Behcet’ s syndrome. Behcet’s disease epidsodes suddenly, and has complex etiological factors and diversif -ied symptoms; Furthermore, BD changes much more and has a tediously long course. Repeated retinal vascular embolism leads to serious damage of the sight; Neovascular glaucoma can be found in some patiences, which will lead to the atrophy of eyeball. Modern medicine think its etiopathogenesis is complex, the therapeutic effect doesn’ t last for long time; and the therapy is difficult to over-all. The nosogenesis of BD is deficiency of essence and excess of appearance in the view of the Traditional Chinese Medicine(TCM), but BD’ s classifications are so trivial and complicated and syndrome types aren’ t objective that it is hard to grasp in clinic. In recent years investigations are gradually given to this disease to found its regularity of change, which will do good to the clinical deep investigations and therapies. After we have summarized the concerned documents of the symptoms in TCM and treatments in TCM and western medicine, and on the basis of the newest study , we obverse the manifestation and discuss the characters of the symptoms in TCM . Literature reviewIt is believed BD’ s pathological mechanism in TCM is origin deficiency and superqiciality excess in main. BD’ s classifications are too much trivial and complicated and not enough objective. Morden medicine think the occurance of BD is related to many factors, and its therapies are multiple, part of which are sure to have effects of treatment on BD, but they cann’ t be taken for a long time. We design this study in order to make the syndrome types objective and do much good to syndrome differentiation and treatment.Clinical studyPurpose: Learn the characters of the symptoms in TCM, contact BD ’ s syndrome type in TCM and objective marker to analyse the internal relation between them; make the syndrome differentiation normal and the syndrome type objective .Methods:48 cases are registered according to observations table of BD about the TCM symptomes and signs and divided into there groups on the basis of the standards of diagnosis: Syndrome of Stagnation of Dampness-heat; Syndrome of Yin Deficiency of Liver and Kindney and Syndrome of Deficiency of Spleen and Kidney yang, moreover we connect the patients’ examination of Fudus Flourescein Angiography(FFA) and T lymphocyte test with the syndrome and have a clinical investigation. Result:1、Dampness-heat, which is throughout the course of the disease, is a etiological factor. There are 17 patients who have Aqueous opacity, account for 35.4 per cent of 48 patients;and 36 patients, have Vitrea opacity, account for 77 per cent;and 27 patients, have reianl edema, account for 56 per cent;and 25 patients, have reddish tongue, account for 52 per cen;and 28 patients, have yellow coating, account for 58.3 per cent. All of that explain Dampness -heat is the etiological factor. 2、 BD ’ s symptomes and signs are complex. For example we see from the study Lassitude in loin and legs is account for 50per cent in Syndrome of Yin Deficiency of Liver and Kindney, 12.5 per cent of Syndrome in Deficiency of Spleen and Kidney yang, 37. 5 per cent in Syndrome of Stagnation of Dampness-heat. Each syndrome has different proportion of symptomes and signs. 3、 The typical manifestation of FFA is fluorescein effusion of retinal blood capillary. There are different manifestations according to retinal lesion locus and the course of the disease. We draw a conclusion that the Syndrome is related to the change of the FFA examination of optic disc.We conclude on the constituent ratio that fluorescein of optic disc of Syndrome of Stagnation of Dampness-heat is stronger than that of Syndrome of Yin Deficiency of Liver and Kindney and Syndrome of Deficiency of Spleen and Kidney yang, and the difference is significant, while the fluorescein change of retinal edema isn’ t different among the three groups. 4、 Many scholars think BD’ s aetiological agent is related to factors of immunology, and think BD is a immune disease. T lymphocyte has the functions of cellar immunization and immunoregulation. We find there is a obviously different outcome of T lympho更多还原