【作者】 邓国樑；

【导师】 崔学教；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2008， 博士

【摘要】 目的:通过观察益肾通胶囊治疗BPH的临床疗效及对尿流动力学等指标的影响,探索能综合调节前列腺形态及膀胱逼尿肌、膀胱颈括约肌功能的药物;并通过动物试验,探讨益肾通方中单味中药广王不留行醇提物大鼠慢性膀胱颈梗阻模型平滑肌凋亡细胞的影响及对大鼠慢性膀胱颈梗阻模型逼尿肌半定量逆转录聚合酶链式反应(RT-PCR)法检测平滑肌肌球蛋白的表达的影响,探讨广王不留行醇提物在影响平滑肌细胞分子病理学改变方面的作用及意义,推测其治疗BPH的机理,为进一步应用和开发祖国传统中医药提供现代科学理论依据。方法:本课题由临床研究和动物实验两部分组成。临床研究部分采用前瞻性随机对照方法,以非那雄胺为对照组,进行治疗组和对照组治疗前后自身对照和组间对照的研究。研究对象来源于广州中医药大学第一附属医院泌尿男科门诊及住院患者,共60例,两组患者一般资料和实验室指标经统计学分析无显著性差异,具有可比性,并将其随机分为治疗组40例,对照组20例。治疗组给予益肾通胶囊,每次4粒,每日3次,对照组给予非那雄胺,每次1粒(5mg),每日1次,疗程共3个月。观察两组治疗前后I-PSS评分、前列腺体积、膀胱残余尿、最大尿流率及膀胱逼尿肌收缩力等指标。动物实验部分选择普通级SD雄性大鼠45只,随机分为空白组、造模组、实验组各15只。参照文献资料制作大鼠膀胱颈梗阻模型,药物应用广王不留行醇提取液(广王不留行为益肾通中主要药物之一)。其中空白组未进行造模而给药灌胃,造模组造模不给物,实验组造模并给药。应用TUNEL法检测大鼠慢性膀胱颈梗阻模型逼尿肌平滑肌凋亡细胞及其广王不留行醇提物对其影响;通过半定量逆转录聚合酶链式反应(RT-PCR)法检测平滑肌肌球蛋白的表达。所有数据用spss11.0软件包进行统计分析。结果:临床研究部分:治疗组的综合疗效与对照组相比有统计学差异(P＜0.05)。与治疗前相比,治疗组与对照组在I-PSS评分、最大尿流率方面,分别为P＜0.01和P＜0.05,均有统计学差异,而前者更显著;在膀胱残余尿和膀胱逼尿肌收缩力方面,治疗组为P＜0.05、P＜0.01,有统计学差异,而对照组无统计学差异(P＞0.05);在前列腺体积方面,两组均与治疗无统计学差异(P＞0.05)。与对照组相比,治疗组I-PSS评分、膀胱残余尿、最大尿流率、膀胱逼尿肌收缩力方面均有统计学差异(P＜0.05);对前列腺体积改变两组均无统计学差异(P＞0.05)。动物实验部分:(1)镜下空白组凋亡细胞数目为15.5%,造模组凋亡细胞数目为50.2%,实验组凋亡细胞数目为30.4%,各组相比均有统计学意义(p＜0.05)。(2)电泳鉴定结果空白组条带最清晰,造模组最弱,而实验组介于两者之间。结论:本课题应用益肾通胶囊治疗BPH的临床疗效优于对照组并在改善I-PSS评分、膀胱残余尿、最大尿流率和膀胱逼尿肌收缩力方面具有较明显的优势,推测益肾通方治疗BPH的机理存在多方面的综合的作用机理,既能够改善慢性膀胱颈梗阻症状也能提高膀胱逼尿肌功能,为BPH的治疗提供了新的思路。动物实验提示广王不留行醇提物可以抑制大鼠慢性膀胱颈梗阻模型膀胱逼尿肌平滑肌细胞凋亡和平滑肌细胞的退化状态,从而改善逼尿肌功能。更多还原

【Abstract】 Objective: To observe the treatment of BPH of Yishentong capsule and the clinical effect on urodynamic indicators such as the impact of exploration can be integrated form of regulation and detrusor prostate, bladder neck sphincter function of the drug, and through animal testing, of Yishentong Arguably the GuangWangBuLiuXing (Ficus Pumila L) to alcohol extracts of rat model of chronic bladder neck obstruction apoptosis smooth muscle cells of rats and chronic bladder neck obstruction model detrusor semi-quantitative reverse transcription-polymerase chain reaction (RT - PCR) testing of the smooth muscle myosin expression of on-line-do not stay in the influence of alcohol extract of molecular pathology smooth muscle cells to change the role and significance, its treatment of BPH speculate the mechanism for application and further development of the motherland Traditional Chinese medicine in the provision of modern scientific theory.Methods: The subjects from clinical studies and animal experiments composed of two parts. Clinical studies of the use of randomized controlled forward-looking approach to non-finasteride for the control group, treatment and control groups before and after treatment self-control and the control group study. Study from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine surgery department and andrology clinics and patients, a total of 60 cases, two groups of patients with general information and laboratory analysis of statistical indicators, as no significant difference, comparable, and were randomly divided into For the treatment group of 40 patients, 20 cases of the control group. The treatment group to Yishentong capsule, four capsule each, tid, the control group to finasteride, (5 mg), a day, a total of three months of treatment. Observation of the two groups before and after the treatment I-PSS score, prostate volume, bladder residual urine, the largest flow rate and detrusor contraction, and other indicators. Some animal experiments choose general-level SD 45 male lab rats were divided into the blank group, the model group, and the experimental group of 15 each. Reference to literature produced in the bladder neck obstruction model, the application of Chinese Medicine call GuangWangBuLiuXing (Ficus Pumila L)liquid (main medicine of Yishentong capsule). Blank group model and the administration gavage, the model of model not to the experimental group of modeling and administration. GuangWangBuLiuXing (Ficus Pumila L) observed to remain alcohol extract of the rat model of chronic bladder neck obstruction and detrusor contraction organizations and the morphology of apoptosis detrusor smooth muscle cells seizure (TUNEL). Spss11.0 package with all the data for statistical analysis. Results: The clinical study: the comprehensive effect of the treatment group compared with the control group a significant difference (P<0.05). Compared with before treatment, the treatment group and control group in the I-PSS score, the largest flow rate, respectively, P <0.01 and P <0.05, both significant difference, while the former more visible; residual urine in the bladder and bladder Detrusor contraction, the treatment group for the P<0.05, P<0.01, a significant difference, but no significant difference in the control group (P>0.05); in prostate volume, both groups with no significant difference in treatment (P>0.05). Compared with the control group, treatment group I-PSS score, bladder residual urine, the largest flow rate, the detrusor contraction in both statistical difference (P<0.05); prostate volume of the two groups had no statistical change Differences (P>0.05). Animal experiments: (1) under the number of blank group apoptosis of 15.5 percent, the model number of apoptosis 50.2 percent, the experimental group apoptosis number was 30.4 percent, compared to the group were statistically significant ( p<0.05). (2) electrophoretic analysis of the results of the blank group with the most clarity, the model weakest, and between the experimental group between the two.Conclusion: The subject of Yishen capsule treatment of BPH clinical efficacy than the control group and to improve the I-PSS score, bladder residual urine, the largest flow rate and detrusor contraction has obvious advantages, benefits to speculate Kidney-treatment of BPH, the existence of the multi-faceted and integrated mechanism, both to improve the symptoms of chronic bladder neck obstruction can also improve the detrusor function, for the treatment of BPH provide a new way of thinking. GuangWangBuLiuXing(Ficus Pumila L) for animal experiments suggested that alcohol does not stay in line extract can inhibit the rat model of chronic bladder neck obstruction detrusor smooth muscle apoptosis and degraded state of the smooth muscle cells, thereby improving the detrusor function.更多还原