【作者】 王云峰；

【导师】 徐进康；

【作者基本信息】 南京中医药大学 ， 中医学， 2011， 硕士

【摘要】 目的观察益气养阴润肠法治疗便秘伴结肠黑变病(melanosis coli, MC)的临床疗效,以探求一种新的中医治疗方法,希望能提高临床疗效,同时运用动物实验进一步研究该方法对肠道动力,以及对MC本身的影响效果。方法临床部分：按纳入标准纳入便秘伴MC的患者45例。治疗组15例口服益气养阴润肠汤剂,对照A组15例服用福松粉剂,对照B组15例作为观察组,服用大黄碳酸氢钠片,疗程为2个月。观察三个组用药前后证候及其便秘情况的变化,治疗前后两次使用氢呼气试验测定口盲肠传输时间(OCTT),并复查肠镜,行组织学评分。实验部分：肠动力实验,小鼠40只,随机分为益气养阴润肠法高、中、低剂量组,正常组,阳性组。按各组灌胃,7天后处死,测碳末推进率。药物对豚鼠MC的影响实验,取豚鼠48只,随机分出8只作为正常组,余40只造豚鼠MC模型,30天后将模型随机分为5组,即模型组,福松组,益气养阴润肠法高剂量组、中剂量组、低剂量组,按各组灌胃,30天后处死,行组织学评分和病理组织学检查。结果临床部分：1治疗组中医证候疗效优于对照A组、对照B组(p<0.05)；2治疗组、对照A组、对照B组对便秘疗效均显著,比较无统计学差异；3对照B组内镜下无疗效,治疗组与对照A组间内镜下疗效显著,比较无统计学差异。4治疗组口盲肠传输时间改善优于对照A组(p<0.05)、对照B组(p<0.01)。实验部分：阳性组、益气养阴润肠法各剂量组的碳末推进率均明显提高,与正常组比较,有统计学显著性差异(P<0.01)；2组织学评分,与模型组比较,福松组对MC的改善最明显,在统计学上有显著性差异(P<0.01),益气养阴润肠法汤剂各剂量组对豚鼠结肠黑变病有肉眼改善,但统计学上无显著性差异(P>0.05)；3病理组织学上,除正常组外各组距回盲部0、10cm的结肠粘膜固有层内均有不同程度吞噬棕褐色色素颗粒的巨噬细胞存在,高剂量组、福松组(+),中剂量组(++),模型组、低剂量组(+++)；4各组黑色素染色阳性面积,与模型组比较,福松组、中剂量组、高剂量组的阳性面积明显降低,统计学上有显著性差异(P<0.01),低剂量组也有所降低,有统计学差异(P<0.05)。结论1中医益气养阴润肠法治疗便秘伴MC疗效确切,在临床症状、肠道动力及内镜下疗效方面优于大黄碳酸氢钠组,在临床症状、肠道动力疗效方面优于福松组；2中医益气养阴润肠法对小鼠肠道动力有明显的促进作用；3中医益气养阴润肠法对豚鼠MC有一定的改善作用。更多还原

【Abstract】 Objective The aim of this research is observing clinic curative about Decoction of YiQiYangYinRunChang treating constipation associated with melanosis coli. Through the clinical observations about the constipation with melanosis coli with Chinese medicine treatment, looking for a better treatment. And using the animal experiments to inspect the therapeutic effect of the intestinal motility, as well as melanosis coli itself.Methods The clinical part:This clinic study have select 45 cases are divided into three groups at random,who was diagnosed as constipation associated with melanosis coli. The treatment group of 15 cases taking the decoction of YiQiYangYinRunChang, the control A group of 15 patients taking Fusong powder, the other 15 cases in control group B as the observation group, taking the rhubarb sodium bicarbonate tablets, treatment for 2 months. Observing the clinic syndrome and constipation syndrome of the three groups before and after treatment, using the hydrogen breath test measured oro-cecal transit time (OCTT), and reviewing the endoscopic and histological score. The experimental part:the gastrointestinal motility experiments. The 40 mice were randomly divided into YiQiYangYinRunchang method of high, medium, low dose group,the normal group and the positive group. Each group was given 7 days before the death, and measure the rate of carbon propelling. The drugs’effect on the melanosis coli of the guinea pig. The 48 guinea pigs were taken 8 randomly as the normal group, the other 40 guinea pig were made models of melanosis coli. After 30 days they will be randomly divided into 5 groups,as the model group, Fusonj group YiQiYangYinRunChang method high dose group, middle dose group, low dose group. According to the group, they were given 30 days drugs before the death. Then take histological score and pathological examination.Result The clinical part:(1) The treatment group improved more than the control A group and the control B group on TCM symptoms (p<0.05); (2) TheTreatment group, h control A group and the control B group were significantly effective for constipation, but no statistical difference. (3) The control B group has no therapeutic value o endoscopic, the treatment group and control A group have significant effect o endoscopic, but no significant difference between them. (4) The treatment group improves much more than the control A group (p<0.05), the control B group ( <0.01) on oro-cecal transit time. The experimental part:(1) Compared with normal group, the positive group, YiQiYangYinRunChang low dose group, middle dose and high dose group were significantly increased carbon propelling, and have a statistically significant difference (P<0.01).(2) On histological score, compared with model group, Fusong group has the most obvious improvement, with statistically significant difference (P <0.01). The different dose decoction of YiQiYangYinRunChang have the improvement to the disease of guinea pigs’melanosis coli, but there are no significant difference (P> 0.05). (3) on Pathology, in addition to the normal group, the cecum and 10cm from the ileocecal, there are different degrees of brown pigment granules of macrophages exist in the Colonic lamina propria, the high dose group, Fusong group (+), medium dose (++), middle dose group, low dose group (+++). (4) The positive area of Melanin staining, compared with the model group, Fusong group, middle dose group and high dose group, the positive area was significantly lower, with significantly difference on Statistics (P<0.01), low dose group also decreased, with differences on Statistics (P<0.05).Conclusion (1)Chinese medicine of YiQiYangYinRunChang has the curative effect on treating constipation relax with melanosis coli. It has much more efficacy in the clinical symptoms, intestinal motility and endoscopic efficacy than the rhubarb sodium bicarbonate group. And it has much more efficacy in the clinical symptoms, intestinal motility than Fusong group. (2) Chinese medicine of YiQiYangYinRunChang has a significantly promotion on intestinal motility. (3) Chinese medicine of YiQiYangYinRunChang has a therapeutic effect on the guinea pigs’melanosis coli.更多还原