【作者】 刘文杰；

【导师】 禤国维；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2006， 博士

【摘要】 目的:通过对AD中医各证型的有关理化指标观察,分析其与AD证候的相关性。采用PCR-SSP技术对HLA—Ⅱ类基因进行基因分型,探讨AD中医辨证分型与HLA—Ⅱ类基因分型的相关性。同时用SCORAD评分法分析AD证候与该评分值之间的相关性。为AD的中医辨证提供客观科学的依据,以期从多方面为AD中医辨证规范化提供有益的帮助。 方法:首先通过收集整理有关文献,确定AD的基本证型,即风湿蕴肤型、湿热浸淫型和血虚风燥型。基本证型确定后,选取35例广东籍符合“康克菲”诊断标准及中医征候诊断标准的AD病例。另选54例无血缘关系的广东籍健康者54例作为健康对照组。对所有纳入研究的患者和健康对照组均进行了血清总IgE、甲皱微循环检查。同时分别对AD各中医证型进行了相关实验室检查,如肝肾功能、血清总IgE、甲皱微循环及SCORAD评分等,并对各结果的分值或出现频率经统计学处理分析,总结以上结果与AD各中医证型之间的关系。建立AD的DNA资源库,采用PCR-SSP技术对HLA—Ⅱ类基因进行基因分型,同时对两组进行了HLA-DR基因分布频率分析,观察AD辨证分型与HLA-DR的相关性。 结果:AD组血清总IgE显著高于正常对照组(P<0.05),三组中又以湿热蕴肤型最高。观察发现AD患者存在明显的甲皱微循环异常,说明AD患者普遍存在“血瘀”现象。部分AD患者存在肝肾功能异常,可能与其原发或继发感染有关。AD各中医证型中血清总IgE、SCORAD评分方面存在明显差异。我们尚采用PCR-SSP方法对广东籍AD患者及健康对照组进行了HLA-DR基因分型,发现患者组DRB1*15及DR7基因频率较正常对照组增高(P<0.05)。AD各中医证型中DR7基因频率湿热浸淫型较风湿蕴肤型显著增高(Pc<0.05),其它各等位基因在各型间比较无统计学意义。 结论: 1.通过查阅有关文献并结合临床,将风湿蕴肤、湿热浸淫及血虚风燥三型确定为AD的基本证型,此三型基本能概括临床所有证型。 2.部分实验室指标和功能性检测指标与AD辨证分型有一定的相关性,如TIgE值湿热浸淫型显著高于其它两型(P<0.05)。肝肾功能异常较常见于湿热浸淫型。以SCORAD评分对AD严重程度分级,发现不同的积分与AD中医不同分型有较高的符合率,以上检查结果或可作为AD辨证分型的参考指标。 3.HLA-DR基因频率分析结果,患者组DRB1*15及DR7基因频率较正常对照组增高更多还原

【Abstract】 Objective To confirm the basic type of syndrome based on an overall analysis of signs and symptoms of AD in TCM and to investigate the relationship between HLA-DR genes and the type of syndrome of AD.Methods We confirm the basic type of syndrome of AD based on an overall analysis of signs and symptoms in TCM by reviewing literature and collection of clinic data.We used Polymerase chain reaction-Sequence specific primer technique to type HLA-DR sub-region in patients with AD and matched control subjects of healthy, unrelated in blood relationship of Han nationality from Guangdong province, to study the relationship between typing of diagnosis based on an overall analysis of signs and symptoms of AD in TCM and HLA-DR gene.We also observe blood serum total IgE, ALT/AST,BUN/Cr and the microcirculation in nail wrinkle in patients with AD and control subjects, to study the relationship between typing of diagnosis based on an overall analysis of signs and symptoms of AD in TCM and blood serum total IgE, ALT/AST,BUN/Cr. The severe scoring of atopic dermatitis was also observed in patients with AD.Results The allele frequencies of DRB1*15, DR7 were higher in AD patients than those in normal controls (P<0.05) .The allele frequency of DR7 was significantly higher in members with the type of accumulated of damp-heat in the skin than those in the other two types. The blood serum total IgE were higher in AD patients than those in normal controls ( P<0.05) the type of accumulated of damp-heat in the skin was the highest. the score of SCORAD were also significantly difference in all types. The result of the microcirculation in nail wrinkle in patients with AD were abnormity.Conclusion The basic type of syndrome of AD based on an overall analysis of signs and symptoms in TCM include the type of accumulated of wind-witness evil in theskin, the accumulated of damp-heat in the skin and the type of blood deficiency and wind-dryness. The result indicated the blood serum total IgE and the score of SCORAD can be looked as the judgment marker of the type of accumulated of damp-heat in the skin. The result also indicated The allele of DRB1*15? DR7 probably are the predisposing genes of AD and the DR7 genes probably is the predisposing genes of the type of accumulated of damp-heat in the skin. Above index can be used as the objective index of differentiation of symptoms and signs for classification syndrome of AD.更多还原