【作者】 孙洪福；

【导师】 张庆祥；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2015， 博士

【摘要】 目的:通过理论研究,探讨从肝失疏泄论治慢性非细菌性前列腺炎的理论基础;通过实验研究,探讨肝失疏泄与慢性非细菌性前列腺炎的关系,探究慢性非细菌前列腺炎的病因、病机,寻找治疗该病的辨证规律。方法:(1)理论研究方法:通过对肝失疏泄的源流、内涵、生理表现、病理特点、现代医学研究等方面进行研究,并对慢性非细菌性前列腺炎的病因、病机和现代医学研究进行归纳,探讨肝失疏泄和慢性非细菌性前列腺炎的相关性。(2)实验研究方法:实验一:选择Wistar雄性大鼠,制备慢性非细菌性前列腺炎模型,处死部分大鼠,观察前列腺组织病理,检测前列腺组织中TNF-α、IL-1β、IL-6、IL-8的浓度;实验二:将慢性非细菌性前列腺炎模型大鼠,分A、B两组,A组采用束缚法制备慢性非细菌性前列腺炎大鼠肝郁病证结合模型,B组正常饲养;通过行为观察,结合旷场实验和糖水偏好实验证实A组肝郁模型制备成功后,处死A组部分大鼠和B组大鼠,观察前列腺组织病理,比较前列腺组织中TNF-α、IL-1β、IL-6、IL-8的浓度;实验三:将肝郁并慢性非细菌性前列腺炎模型大鼠随机分为三组,分别用逍遥止痛方、前列康、生理盐水灌胃2周,分别在灌胃前1天、第7天、第14天进行旷场实验和糖水偏好实验,观察大鼠行为学变化并进行比较,上述两实验结束后,处死三组大鼠,行前列腺组织病理学检查和TNF-α、IL-1β、IL-6、IL-8检测。结果:肝主疏泄影响广泛,肝疏泄失常导致的症状与慢性非细菌性前列腺炎的症状相似;历代中医典籍对慢性前列腺炎论述较多,但病因、病机不统一;当代医家多从湿热和血瘀进行论治,部分医家采用疏肝方药治疗取得了较好疗效;现代医学对慢性非细菌性前列腺炎的病因阐述不明,治疗效果差;采用大鼠前列腺蛋白提取液结合免疫佐剂法,能够导致大鼠前列腺组织出现前列腺炎炎性改变,TNF-α、IL-1β、IL-6、IL-8浓度相对空白对照组升高,有统计学意义;通过束缚法能够制备慢性非细菌性前列腺炎肝郁病症结合模型;采用疏肝理气的方法能够改善大鼠的行为和前列腺组织病理,TNF-α、IL-1β、IL-6、IL-8相对治疗前降低,有统计学意义。结论:(1)肝失疏泄是导致慢性前列腺炎的基本病机;(2)采用大鼠前列腺蛋白提取液结合免疫佐剂法是一种制备慢性非细菌性前列腺炎科学、有效的方法;(3)肝郁能够导致慢性非细菌性前列腺炎炎性改变加重;(4)慢性非细菌性前列腺炎从肝主疏泄论治疗的分子生物学机制是降低TNF-α、IL-1β、IL-6、IL-8的表达。更多还原

【Abstract】 Objectives: By theoretical research, the author intends to probe into the theoretical basis for chronic non-bacterial prostatitis in terms of liver dysfunction. By experimental research, the author tries to testify the relations between liver dysfunction and chronic non-bacterial prostatitis, exploring the etiology and pathogenesis of chronic non-bacterial prostatitis,thus pursuing the laws of syndrome differentiation for the disease.Methods:(1) Theoretical research: The author investigated the headstream, connotation, physiological manifestations, pathological features and modern researches of liver dysfunction, followed by an investigation into chronic non-bacterial prostatitis in terms of etiology and pathogenesis. Based on the above findings, the author discussed the correlation between liver dysfunction and chronic non-bacterial prostatitis.(2) Experimental research: Experiment one: male wistar rats were chosen to make model of typical chronic non-bacterial prostatitis, some of whom were killed to observe the pathological changes of their prostate tissues and to test the concentration of TNF-α, IL-1β, IL-6, and IL-8 respectively. Experiment two:the other wistar rats with chronic non-bacterial prostatitis were divided into two groups. Rats of group A were made to fit into the syndrome of liver depression by employing method of tight-binding while those of group B were raised normally. After being confirmed by behavioral observation, open field test and sucrose preference test that the model of group A was effective, some rats of both group A and group B were killed to observe their pathological state of prostate tissues and to compare the concentration of TNF-α, IL-1β, IL-6, and IL-8 of the two groups. Experiment three: the remaining rats of group A were divided into 3 sub-groups at random and were tested by gavage by using peripatetic analgesic, qianliekang tablets and normal saline respectively. Prior to gavage, open field test and sucrose preference test were employed on the first, seventh, and fourteenth day respectively to observe and compare their behavior. Then, all rats were killed to inspect the pathological state of their prostate tissues and test their TNF-α, IL-1β, IL-6 and IL-8.Results: Liver governs free flow of qi, which is important for organism. Liver dysfunction tend to induce chronic non-bacterial prostatitis; there are various statements about chronic non-bacterial prostatitis in medical classics but differ in etiology and pathogenesis; modern physicians tend to treat chronic non-bacterial prostatitis in terms of dampness-heat and blood stasis and method of soothing liver is reported to be effective by some physicians; modern medicine does not show the specific etiology of chronic non-bacterial prostatitis and its treatment is ineffective; The rat prostate protein extract combined with immunologic adjuvant can induce symptoms of prostatitis and the concentration of TNF-α, IL-1β, IL-6 and IL-8 is rising, which has statistical significance in contrast with control group; method of tight-binding is effective in making model of chronic non-bacterial prostatitis with liver depression syndrome; soothing liver and regulating qi can change rat’s behavior and improve the pathological state of their prostate tissues; the concentration of TNF-α, IL-1β, IL-6 and IL-8 is reduced, which has statistical significance in contrast with pre-treatment.Conclusions:(1) Liver dysfunction is the basic pathogenesis of chronicnon-bacterial prostatitis;(2) The rat prostate protein extract combined with immunologic adjuvant is a convenient and effective method to make model of chronic non-bacterial prostatitis;(3) Liver depression increases the incidence of chronic non-bacterial prostatitis;(4) The treatment of chronic non-bacterial prostatitis should be based on the theory of liver governing free flow of qi, the molecular biological mechanism of which is to reduce the expression of TNF-α, IL-1β, IL-6 and IL-8.更多还原