【作者】 刘敏；

【导师】 张勤修；

【作者基本信息】 成都中医药大学 ， 中西医临床， 2013， 博士

【摘要】 目的：变应性鼻炎(AR)是耳鼻喉科常见病,多发病,是导致哮喘发生的主要因素之一。AR已经成为影响全球人群健康的多发性疾病。恩师张勤修教授认为该病主要为肺、脾、肾三脏功能失调,气阳虚衰为本,外感风邪为标,临床辨证分型以虚证为主,特别是肺脾气虚多见,治疗多采用补气固表,健脾益胃,升阳益气的方法。临床实践证明穴位埋线对AR具有良好的治疗效果。本课题通过动物实验验证穴位埋线治疗AR的疗效,并从病理形态、免疫学机制方面探讨其作用机制。方法：将健康SPF级SD大鼠70只随机分为空白组(Ⅰ)、AR模型组(Ⅱ)、AR西药组(Ⅲ)、AR穴位假埋线组(Ⅳ)、AR穴位埋线组(V)。采用经我们改进后的卵白蛋白注射及鼻黏膜刺激法进行AR大鼠造模。除空白组外各组予以不同治疗方法,治疗末日在卵白蛋白激发后,观察30分钟,了解大鼠AR症状情况并记录比较各组大鼠变应性鼻炎症状评分,之后立即处死动物,采集大鼠血液、鼻中隔黏膜。在电镜下观察大鼠鼻黏膜病理形态变化,采用ELISA方法检测大鼠血清IgE含量,采用免疫组化方法检测鼻黏膜组织IFN-γ、IL-4,TGF-β1、IL-17、P物质的表达情况。数据采用SPSS17.0软件进行统计分析。结果：穴位埋线能明显缓解AR大鼠变应性鼻炎症状(喷嚏、流涕、抓搔鼻部)。与模型组比较,穴位埋线能改善AR大鼠鼻黏膜病理改变,降低AR大鼠血清IgE含量,降低鼻黏膜中IL-4,TGF-β1、IL-17、P物质含量,升高IFN-γ含量。穴位假埋线能降低AR大鼠鼻黏膜中TGF-β1含量。结论：本研究通过卵白蛋白致敏法建立变应性鼻炎大鼠,对AR大鼠进行穴位埋线治疗,并设立西药组对(?)通过比较各组免疫指标我们发现：1、变应性鼻炎大鼠血清IgE,鼻黏膜P物质、IL-4、IL-17、TGF-βI表达明显升高,鼻黏膜INF-γ表达降低,显示鼻黏膜Thl/Th2, Treg/Th17免疫平衡破坏是变应性鼻炎大鼠重要的病理改变。2、穴位埋线可明显缓解SD大鼠变应性鼻炎相关症状。3、穴位埋线能降低变应性鼻炎大鼠血清IgE含量；降低鼻黏膜中IL-4, IL-17,TGF-β1含量;升高鼻黏膜INF-γ含量,从而缓解变应性鼻炎炎症反应进程,调节变应性鼻炎大鼠鼻黏膜Thl/Th2,Treg/Th17免疫平衡。4、穴位埋线与曲安奈德喷鼻剂相比,在对血清IgE,鼻黏膜中P物质、IL-4、 IL-17、TGF-β1.INF-γ的影响方面无明显差异。更多还原

【Abstract】 Object:Allergic rhinitis (AR) is a common frequently-occurring disease in otolaryngology, which is one of the main factors leading to asthma and has become a global public health impact. ZhangQinXiu professors consider that the pathogenesis of this disease is the lung, spleen, kidney disorders, Yang failure is basic, pathogeny is actuating factors for this disease. To therapy AR, Professor Zhang uses catgut implantation at acupoints to benefit lung and spleen and to rise Yang and exorcising pathogeny which has been approved effectively in clinic. This topic will approve the effect of catgut implantation at acupoints for AR through the animal experiment and discusses the mechanism based on pathological morphology and immunology.Method:Health SPF SD rats were randomly divided into blank group (Ⅰ), AR model group (Ⅱ), AR western medicine group (Ⅲ), AR false catgut implantation at acupoint (Ⅳ), AR catgut implantation at acupoint (Ⅴ). We made AR animal model according the method of improved ovalbumin injection and nasal mucosa stimulation. Every group received different therapies except blank group (Ⅰ). After last therapy day, we gave ovalbumin nasal mucosa stimulation,then we observed and record the AR symptoms to compare the symptom records. We killed SD rats and collected rats blood, septum mucosa to observe rat nasal mucosa pathological change under electron microscopy, to detect rat serum IgE content using ELISA method, to detect nasal mucosa tissue IFN-y, IL-4, TGF-β1, IL-17, SP expression using immunohistochemical method. We used the data SPSS17.0software for statistical analysis.Outcome:Catgut implantation at acupoints can obviously alleviate the symptoms allergic rhinitis (sneezing, runny nose, scratching) of AR rats. Compared with model group(Ⅱ), catgut implantation at acupoints can improve pathological changes of AR rat nasal mucosa,reduce IgE content in AR rat serum, reduce IL-4, TGF-β1, IL-17, SP content, increase IFN-γ content in the AR rat nasal mucosa. Catgut implantation at acupoints can reduce TGF-β1content AR rats in nasal mucosa.Conelus i on:This research established" allergic rhinitis rats model" by ovalbumin sensitization method. We operated Catgut implantation at acupoints in allergic rhinitis rats, and set up the control group (Triamcinolone acetonide nasal spray), then we found:1、The serum IgE and nasal mucosa SP, IL-4, IL-17, TGF-β1increased and nasal mucosa INF-y lowered significantly in allergic rhinitis rats, which means Th1/Th2and Treg/Th17immune disbalance of nasal mucosa is the most important pathogenesis in AR rats.2^’Catgut implantation at acupoints’can alleviate symptoms of AR rats.3^’Catgut implantation at acupoints’can reduce IL-4, TGF-β1, IL-17, SP content, increase IFN-γ content in the AR rat nasal mucosa to regulate Th1/Th2and Treg/Th17immune balance in AR rat nasal mucosa.4、Catgut implantation at acupoints’ and Triamcinolone acetonide nasal spray’ have similar effect at serum IgE and nasal mucosa substance P, IL-4, IL-17, TGF-β1、INF-γ in allergic rhinitis rats.更多还原