【作者】 王静云；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2005， 博士

【摘要】 研究目的 过敏性鼻炎是人体对某些过敏原敏感性增高而出现的以鼻粘膜病变为主的一种变态反应,是五官科常见、多发的一种过敏性疾病,亦称“常年发作型变应性鼻炎”,属Ⅰ型变态反应性疾病,是临床危害人民健康的常见病、多发病。临床以“鼻塞、鼻痒、流涕、喷嚏”为主症,具有反复发作、迁延难愈的特点,中医将其归属于“鼻鼽”范畴。 近年来,为了提高中医药对本病的研究已逐步从单纯的临床研究向实验研究或临床结合实验研究的角度深入开展,为过敏性鼻炎的发病机理及中医药防治本病寻求有力的科学依据,并取得了一定的成果。但相对于临床研究,探求针灸治疗过敏性鼻炎的实验研究就显得少之又少,特别是电针对本病的研究甚少,电针是否可通过激发机体免疫机能如T淋巴细胞和抑制IgE、IL-4等实现抗过敏的作用呢?故设立本课题进行相关实验研究,旨在为电针治疗过敏性鼻炎的作用机理寻求客观依据。电针对过敏性鼻炎的治疗效果可能是作用于患者炎症过程的多个环节,或至少是某个环节连锁的多个侧面,在细胞因子和炎症介质水平方面调节机体机能。本课题采用不同频率的电针对过敏性鼻炎SD大鼠的治疗作用进行研究,同时设立相应对照,探讨治疗作用的差异,并通过观察大鼠的行为学改变,鼻粘膜病理学改变及免疫学指标的变化,进一步探讨电针对过敏性鼻炎大鼠的作用机理,为电针防治过敏性鼻炎寻求有力的科学依据,同时为中医药防治过敏性鼻炎提供更广阔和有效的途径。 研究方法 1、本研究采用目前国内常用的“卵蛋白注射及其鼻粘膜刺激法”建立过敏性鼻炎SD大鼠模型。 2、采用设立多组对照进行多组间对照研究的方法,观察不同电针频率对过敏性鼻炎动物模型的作用机制。 3、采用行为学和光学显微镜观察的方法,观察治疗前后过敏性鼻炎大鼠搔鼻、喷嚏、鼻溢等行为的变化和鼻粘膜组织学改变。更多还原

【Abstract】 Purpose:Perennial allergic rhinitis, a Type I allergic reaction commonly seen at the ear-nose-throat department, is a year-round hypersensitivity to certain allergens. Chronic sneezing, nasal congestion, stuffy and runny nose are among the most common symptoms.In recent years, studies in this area have progressed from simple clinical observations to a combination of clinical and experimental researches to better understand the curative effect and mechanisms by which Chinese medicine has in perennial allergic rhinitis. Unlike the vast number of studies done on herbal treatment, researches regarding acupuncture treatment of the condition are limited, let alone electro-acupuncture treatment. Thus, the present study strives to discover whether electro-acupuncture can influence the immune system by increasing blood T lymphocytes (T-cells) and suppressing immunoglobulin E (IgE) and interleukin-4 (IL-4), thus, reversing the allergic reaction. Electro-acupuncture may play numerous or simply one role but in many aspects in the chain of curative actions at the cellular level. Electro-acupuncture of different frequencies were used to treat experimental mice with perennial allergic rhinitis. A control was established and used objectively to compare its therapeutic effects, such as pathological changes in the nasal membrane and the immune system, with those of the test groups. Findings would not only provide scientific support for the treatment of perennial allergic rhinitis by electro-acupuncture, but also introduce an effective method applied in the Chinese medical field.Method:1. "Intraperitoneal injection of egg albumin and stimulation on the nasal membrane",a common method used nationally, was used to set up a model of experimental SD mice with perennial allergic rhinitis.2. In order to discover the mechanisms of different frequencies of electro-acupuncture in treating perennial allergic rhinitis, a number of test groups are established to apply group-to-group comparisons, as well as within-group comparisons.3. The degree of irritation, sneezing and the severity of watery discharge were observed by ways of microscope and the study of behavior to determine the state of the nasal membrane.4. The amount of IgE, IL-4 and TNF were assayed by radioimmunology. The T lymphocytes were assayed by sensitized erythrocyte chaplet method.Results:1. Changes in ethology of the mice in the different treatment groupsElectro-acupuncture at Yongquan (KI 1) had no significant effect on the ethology of the mice (p>0.05). Results were significantly different when high and low frequencies were used during electro-acupuncture when compared with the blank control group (p<0.01). It was found that electro-acupuncture at high or low frequencies resulted in no significant difference (p>0.05).2. Changes in PathologyWhile the nasal mucous membrane in the blank control group became swollen and bluish red, no sign of inflammation was seen in the normal control group. Moderate swelling and redness was seen in all the test groups (low and high frequency electro-acupuncture groups and the mainstream therapy group). EOS assessment of all the test groups were significantly different from that of the blank control group (p<0.01). Eosinophile granulocytes in low frequency electro-acupuncture group were significantly less than those in high frequency electro-acupuncture group(p<0.01) and significantly more than those in western medicine group(p<0.01).3. Effect on Immunoglobulin E (IgE)The amount of IgE in the non-treatment and blank control groups had no significant difference (p>0.05). That of the test groups, western medicine group (p<0.01) and low frequency electro-acupuncture groups (p<0.01 or p<0.05), when compared with the blank control group was significantly different. The amount of all test groups (low, high frequency electro-acupuncture and western medicine group) had no significant difference (p>0.05).4. Effect on T lymphocytes and Interleukin-4 (IL-4)With respect to IL-4, its content of the non-treatment-acupoints group and blank control group had no significant difference (p>0.05). The amount found in thewestern medicine group was significantly different from that of the blank control group (p<0.01). Likewise, the content of both low and high frequency electro-acupuncture groups were significantly different from that of the blank control groups (p<0.01 or p<0.05). However, the amounts in the 3 tests groups showed no significant difference (p>0.05). Regarding the amount of T-lymphocytes, the level of CD3, CD4, CD8 and CD4/CD8 in the non-treatment and the blank control groups had no significant difference (p>0.05). The levels in the 3 test groups (western medicine group, low and high frequency electro-acupuncture groups) were significantly different from that of the blank control group (p<0.01). The two electro-acupuncture groups’ CD4 levels were significantly different from each other (p<0.05). The levels of CD3, CD4, CD8 and CD4/CD8 among all test groups showed no significant difference from that of the normal control group (p>0.05). 5. Effect on Tumor Necrosis Factor (TNF)The amount of TNF found in the non-treatment-acupoints group had no significant difference from that of the blank control group (p>0.05). The TNF found in all test groups (mainstream therapy, low and high frequency electro-acupuncture groups) were significantly different from that of the blank control group (p<0.01, p<0.01 or p<0.05 respectively). Among the 3 test groups, the level of TNF showed no significant difference (p>0.05).Conclusions:1. Electro-acupuncture on the Yongquan (KI 1) had not effect on relieving clinical symptoms (irritation, sneezing, runny nose) of the experimental mice with perennial allergic rhinitis. However, electro-acupuncture on the Feishu (BL 13) (regardless of its frequency used) was effective in relieving the above-mentioned symptoms. This finding further supports the TCM theory of selecting acupoints along the appropriate meridian according to the TCM symptoms.2. The mechanism by which electro-acupuncture on the Feishu (BL 13) has curative effect on the allergic mice is as follows: the method can reduce the level of eosinophile granulocyte in the nasal mucous membrane, IgE, CD3, CD4, CD8 and lower the CD4/CD8 ratio in the serum, thus decreasing both the interleukin-4 (IL-4) and TNF levels to reverse the overall allergic reaction. The finding clearly revealed the fact that electro-acupuncture plays a number of roles, both at the cellular and anti-inflammatory levels, to result in the clinical effect.3. Applying different frequencies on electro-acupuncture resulted in the following: low frequency electro-acupuncture better improved the EOS count and CD4 amount than that of high frequency one (results in the two groups differed significantly at p<0.01). However, with respect to improving the level of IgE, IL-4, T-lymphocytes更多还原