补气通络方对周围神经再生影响的实验研究

【作者】 姚珍松；

【导师】 何振辉； 梁德；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2001， 硕士

【摘要】 周围神经损伤（peripheral nerve injury）相当于中医的经络损伤，是临床上的常见疾患之一。补气通络方（Buqi TongluoFormula）是导师何振辉教授在临床医疗实践中根据对周围神经损伤后气血不续、经络不通之虚实夹杂这一基本病理状态的把握，遵攻补兼施为治则，以补气生肌、通络行血立法总结出来的一张治疗周围神经损伤的中药方剂。本方由黄芪、人参（新开河参）、当归、川芎、丹参等中药组成，具有补气行血、通络散结、生肌长肉的功效。适用于Sunderland 3度以下及已行手术修复的Sunderland 4、5度周围神经损伤，本方现已成为广州中医药大学第一附属医院协定处方，制成胶囊剂和注射剂运用于临床。为了进一步验证本方的作用，探讨其作用机制，试图为周围神经损伤的中医和中西医结合治疗提供新的制剂、方法和思路，进行了本实验研究。 实验研究在随机、对照、均衡的原则下，将48只清洁级Wistar大鼠，统一在右后肢坐骨神经横形切断并即刻作神经外膜吻合术，造成Sunderland 5度周围神经损伤模型，然后将48只大鼠随机分成补气通络胶囊治疗组（Ⅰ组）、补气通络注射液治疗组（Ⅱ组）、维生素B₁＋B₆治疗组（Ⅲ组）和空白对照组（Ⅳ组）4组进行处理，每组12只，分别在用药后4、8、12周于每组随机抽取4只大鼠依次作坐骨神经功能指数（sciatic nerve function index，SFI）、神经传导速度（nerve conduct velocity，NCV）、小腿三头肌湿重（tricipital muscle wet weight，TWW）及图像分析系统下作神经轴突计数（nerve axon counting，NAC）4个指标从功能恢复（SFI、NCV、TWW）和结构恢复（NAC）两方面对大鼠坐骨神经损伤后神经再生情况进行判断。最后结果显示补气通络胶囊治疗组、补气通络注射液治疗组和维生素B₁＋B₆治疗组大鼠的神经功能与结构的恢复均较空白对照组好（P＜0.01或P＜0.05），而补气通络胶囊治疗组、补气通络注射液治疗组均又比维生素B₁＋B₆治疗组效——．果好(P＜O．05＊补气通络胶囊治疗组与补气通络注射剂治疗组的恢复情况无显著性差异（P＞0刀5）。说明补气通络胶囊与补气通络注射液在治疗周围神经损伤方面有肯定的效果，能加快周围神经损伤后神经功能恢复和神经轴突再生，值得进一步的研究与开发利用，且口服给药与注射给药（本实验中为腹腔注射）药物效果，无明显差异。其作用机理可能在于本方攻补兼施，调和周围神经” （经络）的气血运行，改善失神经支配的肌肉的营养，促进神经肌肉支配的重新构建，促进周围神经传导和营养功能的恢复，并直接促进神经轴突的再生，从功能恢复与形态结构两方面促进周围神经损伤的修复与功能重建。从本实验结果，结合文献资料，认为对周围神经损伤的中医或中西医结合治疗，在适当手术修复重建神经的连续性之后，中医药从补气养血与祛瘀通络相结合，攻补兼施，是切实可行的治疗方法。更多还原

【Abstract】 Peripheral nerve injury (PNI) is a kind of disease easy to meet, which belongs to meridian injury or flaccidity-syndrome in Traditional Chinese Medicine field. Buqi Tongluo Formula which has been made into capsule and injection is a compound Chinese herbal medicine prescription for PNI treating designed by professor He Zhenhui through long-term clinical practice. The major pathogenesis of PNI is meridian obstacle, deficiency of Qi and blood stasis, skin and muscle arthralgia due to nourishment deficiency carried by meridian. Professor He designed Buqi Tongluo Formula according to principal of therapy aiming at both the elimination of evils and restoration of healthy energy, with the methods of invigorating Qi to promote tissue regeneration and dredging collateral to promote blood circulation. Buqi Tongluo Formula composed of Radix Astragali, Radix Ginseng, Radix Angelicas Sinesis, Rhizoma Chuangxiong, Radix Saviae Miltiorrhizae etc has the function of invigorating Qi and dredging collateral. Buqi Tongluo Formula is designed for Sunderland I to 5 degree PNI after operative reparation if necessarily. Having been composed and refined in clinical study and practice through several years, the formula has each component herb’s proportion was the best, and has served as a conventional prescription in No. 1 affiliated hospital of Guangzhou University of Traditional Chinese Medicine. Now the formula is made into capsule and injection so that it can be used conveniently with precise dose and absorbed completely by patients. With the aim to test the formula’s effect by experiment, to discover its effective mechanism if there had any effect and to find some new medicine, method or ideas for PNI treating in the field of 1CM or 1CM-west-combined this experimental study was designed and carried out. By the light of principal of random, controlling, equilibrium forty-eight clean Wistar rat models were made after all rats?right sciatic nerves were cut and then repaired with technique of neurorrhaphy. Then all injured rats were randomly allocated to 4 groups with 12 rats in each group: group I , group 11, group III and group IV. All rats allocated to group I were treated with Buqi Tongluo Capsule, group II with Buqi Tongluo Injection, group III with vitamin B1 and B6 capsule, group IV with no drugs (blank control). Having been treated for 4, 8 and 12 weeks, each time 4 rats were randomly picked out from each group, and their Sciatic Nerve Function Index (SF1), sciatic nerve conduct velocity (NCV), tricipital muscle wet weight (TWW) and sciatic nerve axon counting (NAC) were checked and compared with each other. The results of SF1, NCV and TWW could measure functional restoration of injured sciatic nerve while the result of NAC could measure injured nerve morphological restoration. When all results of SF1, NCV, TWW and NAC were got, Buqi Tongluo Formula’s effect on rats?sciatic nerve regeneration after injury could be discovered. All results revealed no remarkable difference between group I (treated with Buqi Tingluo Capsule) and group II (treated with Buqi Tongluo Injection)(P>O.05). The results of both group I and group II had remarkable difference compared with those of group III (treated vitamin B1 and B6) (p<O.OS) and of group IV(blank control group) (p<O.Ol). The results of group III had obvious difference with those of group IV(p<O.05). It was showed that all rats treated with Buqi Tongluo Capsule, Buqi Tongluo Inject更多还原