【作者】 罗勇华；

【导师】 陈如泉；

【作者基本信息】 湖北中医药大学 ， 中医内科学， 2011， 博士

【摘要】 目的：以甲状腺相关性眼病(TAO)患者为研究对象,开展其临床辨证治疗及基因多态性的相关研究,进一步研究中医药治疗甲状腺相关眼病的辨证治疗疗效,探讨甲状腺相关眼病中医病因病机理论。探讨中医药、中西医结合治疗规律以及甲状腺相关眼病与基因多态性之间的关系,为中医辨证施治提供可能辨证诊断依据。方法：根据临床表现及中医分型辨治原理,将临床病例分为肝火亢盛、肝肾阴虚、脾虚湿盛三个证型,运用相应中药方剂辨证施治,观察临床疗效；对相关病例全血标本进行基于TAO发病机制和遗传学规律的单核苷酸多态性(SNP)检测,观察不同证型之间相关基因单核苷酸多态性的表现。结果：对观察病例进行了证型分析,甲亢合并突眼患者主要集中于肝火亢盛型、肝肾阴虚型,提示临床证型具有相对集中性。两组治疗前后全身症状、体征中医证候评价分析经统计分析,辨证治疗组对改善TAO全身综合症状有明显改善；优于西药对照组。辨证治疗组治疗前后突眼度明显改善,有显著差异(P<0.05)、西药对照组治疗前后突眼度可见改善,但经统计处理,无显著差异(P>0.05)辨证治疗组治疗前后突眼症状明显改善,有显著差异(P<0.05)；眼胀、流泪、畏光、眼睑浮肿症状,两组均可以明显改善；甲亢合并眼突经中医药辨证治疗眼局部症状改善情况明显优于西药对照治疗组。甲状腺相关性眼病脾虚与肝火在CTLA-4 AG基因型存在差异,上述两组之差异可能体现在虚实和不同脏腑之间的区别,而肝肾阴虚与上述两组无差异,而肝肾阴虚存在交叉性。各基因位点检测结果存在一定的规律。结论：1、辨证治疗组对TAO全身综合症状有明显改善；优于西药对照组。2、辨证治疗组治疗前后突眼度明显改善,有显著差异(P<0.05)优于西药对照组。3、眼部局部临床表现改善情况,中医药辨证治疗组优于西药对照治疗组。4、TAO证型经SNP检测证明相关表达基因单核苷酸多态性存在一定规律性。更多还原

【Abstract】 Objective:Choose the TAO(Thyroid-associated ophthalmopathy) patients as the objects and study on the TCM dialectical therapy and the SNP(Single Nucleotide Polymorphism) situation of this disease for the further study on the clinical effects of TCM dialectical therapy and the pathogenisis of this disease. Methods:Divide all the patiens into 3 groups based on thieir different clinical manifestation and TCM dialetical diagnosis theory and then use Chinese herb drugs to treat them and observe the clinical effects;Meantime detect these patients’ blood samples to superficially discover the situation of TAO’s patients some cytokines and inflammatory factors’s SNP based on the pathogenisis of TAO and the hereditism rules. Results:By observing the analysis of the types of the detected cases, hyperthyroidism merging with prominent eyes focused on excessive hotness of liver type, Yin deficiency of 1 iver and kidney, and the type of deficiency of spleen’s qi and excessive moist indicating clinical syndrome type has relative concentration. Two groups body symptoms and signs before and after the treatment of TCM syndrome by statistical analysis, evaluation and analysis of dialectical therapy to improve TAO systemic comprehensive symptoms were obviously improved; Better than western medicine control group.Syndrome differentiation and treatment group before and after the treatment prominent eyes obviously improved, a significant degree of difference (P< 0.05), western medicine control group before and after the treatment prominent eyes improvement, but the degree of visible statistical processing, no significant difference (P> 0.05)Syndrome differentiation and treatment group (before and after the treatment significantly improved exophthalmos significant difference (P< 0.05). Eye bloated, tears, photophobia, eyelid edema symptoms, both groups can significantly improve; Hyperthyroidism merger by TCM syndrome differentiation and treatment eye axon eye local symptoms improve significantly better than western medicine circumstance comparator treatment group. Thyroid correlation with Thyroid-associated Disease (TAO) suffered CTLA pixu 4 AG in genotype differences, the two groups may reflect the differences between different unionizing and viscera in liver-kidney Yin deficiency distinction, and with the above two groups, and no difference does liver-kidney Yin deficiency existing. The testing results of that there are certain rules existing on the genetic loci.Conclusion:1, syndrome differentiation and treatment group of TAO systemic comprehensive symptoms were obviously improved; Better than western medicine control group.2, syndrome differentiation and treatment group before and after the treatment prominent eyes obviously improved, a significant degree of difference (P< 0.05), better than western medicine in control group (P> 0.05)3,eye local clinical manifestation, diagnosis and treatment of traditional Chinese medicine to improve treatment group than western medicine control group.4, TAO syndrome types related by SNP detection proof that there are some certain rules existing among different TAO synfrome types on the polymorphism for the nucleotide of the genes from those patients.更多还原