【作者】 殷晓轩；

【导师】 尹常健；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2011， 博士

【摘要】 目的:分别通过维肝降酶复方和辨证代表方对模拟临床病证相合肝损伤动物模型的治疗研究,探讨两类处方抗肝损伤的作用机制和优劣势,为总结肝损伤的优势治疗途径和规范用药提供实验基础与理论依据。方法:清洁级Wistar雄性大鼠200只,酒精灌胃造模的同时,按照肝郁脾虚和湿热内蕴造模方法制造出复合模型,分别予以中医经典代表方、辨病专方、辨病专方加减方治疗,比较各组治疗效果,从微观角度分析维肝降酶复方治疗酒精性肝病的优势与机理,并发现不足。结果:成功复制出肝胆湿热、肝郁脾虚型酒精性肝病病症相合大鼠模型;维肝降酶饮、维肝降酶饮加味、辨证方剂对病症相合酒精性肝病大鼠模型均有明显的治疗作用(p<0.05,p<0.01)。在湿热证组别里,各给药组之间,在降低肝指数、降低GGT、FFA、肝脏结构的改变等方面龙胆泻肝汤合茵陈蒿汤组有较为明显的作用;在降低TNF含量和瘦素水平方面,维肝降酶饮加龙胆草车前草组有着较好优势,而病理组织学检查中,维肝降酶饮较其他组有较好的优势;肝郁脾虚组别里,维肝降酶饮加柴胡薏仁的综合疗效由于其它组。说明了不同的治疗方法,优势各不相同。进一步证实维肝降酶饮在多组证型中,改善大鼠的一般状况、降低血清本斌甘酸氨基转移酶和谷氨基转移酶的含量、降低血清自由基含量、提高血清SOD和GSH活力、降低TNF含量和瘦素水平、减少肝组织CD14表达等等方面疗效确切,从而起到减轻肝细胞炎症,保护机体的作用。结论:通过实验研究证实,在疾病的诊疗过程中,应当遵循在辨病论治的基础上,突出辨证论治,即辨病与辨证相结合、宏观与微观相结合、阶段用药与环节用药相结合、四气五味性味归经与现代药理研究相结合。同时发现,在证型较为突出的基础上,依据辨证论治,参考古籍经典方,临床有更有优势之处。更多还原

【Abstract】 Objective: Through investigating the effect of Weiganjiangmei prescription and treatment based on syndrome differentiation about combination model of disease and syndrome of alcoholic hepatic injury, explore its functional mechanism about anti-hepatic injury and advantages and disadvantages, summarize the prevalent treatment routine and provide the experimental and theoretical basis for standard medication. Methods: 200 Wistar male rats with alcohol intragastric administration. Produced the endoretention of damp heat and stagnation of liver-qi and deficiency of spleen model rats which were treated by TCM classical Prescription, specified prescription based on disease differentiation to compare effects. Through micro view to analyze the Weiganjiangmei Prescription advantages and disadvantages as well as its mechanism. Results: Successfully produced the endoretention of damp heat and stagnation of liver-qi and deficiency of spleen combination model rats of disease and syndrome of alcoholic hepatic injury .Weiganjiangmei decoction as well as specified prescription based syndrome differentiation had obvious therapeutical effect. In all the endoretention of dampheat treatment groups,Longdanxiegan decoction combined with Yinchenhao decotion could reduce the liver index,lowered down the GGF,FFA changed the liver structure.Weiganjiangmei combined with Longdancan Cheqiancao groups could effectively cut down the content of TNF and LEP. In the histopathologic examination,Weiganjiangmei group outweighed the other groups.In the stagnation of liver qi combined with deficiency of spleen group,Weiganjiangmei combined with Chaihu Yiren outweighed the other groups in the total curative effect.It showed that different treatment had its own advantages. In all the Weiganjiangmei groups, it had certain curative effect in the side of changing the model rats normal condition,cutting down the content of Glycine aminotransferase and Gluetamic aminotransferase as well as serum radical, enhancing the activity of SOD and GSH, degrading the content of TNF and LEP, inhibiting the expression of CD14 in the liver tissure. It could relieve the hepatocyte inflammation to protect our body. Conclusions: Through the experimental research, during the course of diagnosis and treatment, should follow the principle of treatment based on syndrome differentiation, outstanding the combination of syndrome differentiation and disease differentiation.Pay attention to the combination of macroscopy and microscopy, combination of phase-medication and cycle medication, combination of four properties five tastes and modern pharmaco-research. On the other side, on the basis of syndrome, according to the syndrome differentiation, referring to TCM classic prescription, it has more advantages.更多还原