五脏阴阳整体论对痹证发生的机理研究—关节痹证与肺痹发生的临床与实验研究

【作者】 邱新萍；

【导师】 郭霞珍；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2012， 博士

【摘要】 中医藏象学说是中医学理论体系的核心组成部分,认为五脏是一个有机联系的整体,每一脏、每一腑虽然都有各自的生理功能,但它们在生理上会相互影响,在病理上相互传变。类风湿关节炎属于中医痹证的范畴,该证由于邪气壅塞,气血凝滞,容易传变于脏,预后不佳。我们从五脏整体观念出发,探讨关节痹证传变肺痹的相关性,并探讨肾虚在关节痹证发生相关肺损害的作用机理,为关节痹证发生肺损害的发生机制提供分子生物学依据,为提高临床疗效做好铺垫。1.目的通过对五脏阴阳整体论思想的文献整理,以及类风湿关节炎合并间质性肺病的临床观察,结合实验研究,讨论类风湿关节炎发生肺损害的相关机理及肾虚对该病的影响,对指导临床用药有重要的指导意义。2.方法2.1理论研究采用文献学、逻辑分析等方法,对中医“五脏整体论”的内涵进行探讨分析,探讨关节痹证及肺痹发生的相关性,并探讨肾虚在关节痹证发生相关肺损害的影响。2.2实验研究2.2.1随机选取16只雌性SD大鼠,用注射CIA的方法造成痹证模型,观察关节痹证模型大鼠肺组织的病理改变,计算肺系数,分析肺组织上IL-1、IL-6、TNF-α、TGF-β的含量变化。2.2.2随机选取64只SD大鼠,雌、雄各半,造成关节痹证模型、肾虚痹证模型、伪手术组模型、生理组模型,观察各组大鼠前腕关节肿胀情况,计算胸腺指数,检测、分析各组大鼠肺组织上IL-1、IL-6、TNF-α、TGF-β的含量变化。3结果3.1关节痹证对肺组织IL-1、IL-6、TNF-α、TGF-β的影响3.1.1关节痹证模型组大鼠出现肺部的病理改变,且与生理组相比,关节痹证模型组大鼠肺系数比生理组高,P<0.05,具有统计学意义。3.1.2与生理组相比,关节痹证模型组大鼠肺组织上IL-1、IL-6、TNF-α、TGF-β均显著升高,具有统计学意义,P<0.05。3.2肾虚对关节痹证发生肺损害的影响3.2.1雌性大鼠比雄性大鼠的发病率高。肾虚痹证比单纯关节痹证、伪手术组的发病率高。3.2.2无论雌性还是雄性大鼠,与生理组相比,关节痹证组、肾虚痹证组、伪手术组胸腺指数降低,P<0.05,具有统计学意义,肾虚痹证的胸腺指数最低。3.2.3无论雄性还是雌性大鼠,与生理组相比,关节痹证组、肾虚痹证组、伪手术组大鼠的肺组织上IL-1、IL-6、TNF-α、TGF-β均显著升高,具有统计学意义,P<0.05。肾虚痹证模型上的细胞因子升高得更为显著。4结论4.1关节痹证导致肺组织损伤,且IL-1、IL-6、TNF-α、TGF-β在肺损伤的过程中发挥重要作用。4.2肾虚对关节痹证发生肺损害有相关性,肾虚可能会加重关节痹证及发生关节痹证继发性肺损伤。更多还原

【Abstract】 The core of theoretical system of TCM is "visceral manifestation theory".It think that the five visceral is an organic whole, their physical interaction with each other in the pathological mass change although they have their own physiological functions. Rheumatoid arthritis belongs to the scope of "arthralgia" in TCM. The disease is easy to mass change, and very difficult to cure. Our departure from the concept of the five internal organs as a whole, To explore joint Arthralgia mass change related to lung paralysis. and to explore the kidney in the mechanism of joint Arthralgia related lung damage.Which will offord mechanism of molecular biology basis for joint Arthralgia lung damage, and pave the way to improve clinical outcomes.1 PurposeSorting through the literature on the holism thinking of the five organs of yin and yang, And rheumatoid arthritis with interstitial lung disease, clinical observations, experimental research, Discuss rheumatoid arthritis occur related mechanism of lung damage and kidney disease, Significance in guiding clinical treatment.2 Methods2.1 Theoretical Study Use philology, logic analysis ways, Discuss analysis of the connotation of TCM "holism" of the five internal organs, Explore joint Arthralgia and pulmonary paralysis occurred, and to explore the kidney in joint Arthralgia related lung damage.2.2 Experimental study2.2.1 We selected 16 female SD rats Randomly, and then causing arthralgia model with Inject of CIA.Observed the pathological changes of the of arthralgia model of lung tissue, calculated the lung coefficient, analysised content of IL-1, IL-6, TNF-alpha and TGF-P of lung tissue.2.2.2 We selected 64 SD rats randomly, male and female half. Made the arthralgia model, kidney arthralgia model, pseudo-operation group model. Calculated the index of thymus. Analysised content of IL-1, IL-6, TNF-alpha and TGF-βof lung tissue.3 Result3.1 The effect of arthralgia pass to lung3.1.1 Arthralgia model group rats had lung pathological changes. And compared with the physiological group, lung coefficient is higher than the physical group, statistically significant(P<0.05). 3.1.2 Compared with the physiological group, the content of IL-1, IL-6, TNF-alpha, TGF-beta significantly increased in lung, statistically significant(P<0.05).3.2 The role of renal in pathogenesis3.2.1 High incidence of female rats than male rats. High incidence of kidney arthralgia than simply arthralgia, sham group.3.2.2 Whether female or male rats, compared with the physiological group, the thymus index in arthralgia group, kidney arthralgia group, the sham group are lower (P<0.05), with statistical significance. Thymus index was the lowest in kidney arthralgia group.3.2.3 Whether female or male rats, compared with the physiological group, the content of IL-1, IL-6, TNF-alpha, TGF-beta in arthralgia group, kidney arthralgia group, the sham group are higher (P<0.05), with statistical significance. The content in kidney arthralgia group are highest.4 Conclusion4.1 The arthralgia can cause lung tissue damage, IL-1, IL-6, TNF-alpha and TGF-beta in the process of lung injury play an important role.4.2 Kidney related lung damage occurs to the joint Arthralgia, Kidney dificiency will increase arthralgia, and arthralgia secondary lung injury.更多还原