【作者】 梁振栋；

【导师】 陈邦国；

【作者基本信息】 湖北中医学院 ， 针灸推拿学， 2009， 博士

【摘要】 目的低血压是一种世界各地广泛发生的常见病、多发病。据不完全统计，低血压发病率为4％左右，老年人群中可达10％。长期低血压可导致机体功能大大下降，还可能导致脑梗塞和心肌梗塞，低血压人群的死亡率也高于正常人群，给病人、家庭和社会带来了严重的问题，不容忽视。目前对该病的基础研究和临床研究甚少，低血压的病因和发病机制尚未完全明了，因此低血压是一个期待研究的课题。西医对本病目前缺乏有效的治疗方法，一般采取对症处理，药物治疗效果多不理想，且药物疗法有致高血压及其它并发症的副作用，停药后难以使血压维持正常。而中医学对本病的治疗具有一定的优势。其中，针灸作为治疗此病的常用方法，具有简便易行、疗效稳定的特点。近年来，广大医务工作者在临床上采用针灸治疗低血压的过程中，肯定了针灸治疗低血压确有良好疗效，受到了人们的关注，但对针灸升高血压的机制的研究报道甚少。本课题通过动物实验，观察电针对低血压模型大鼠的血压影响，并检测循环及脑组织中一氧化氮／一氧化氮合酶(NO／NOS)、血管紧张素Ⅱ(AngⅡ)、环核苷酸(cAMP／cGMP)等的含量，以探讨针刺升高血压的可能机制，从而为研究针刺防治低血压提供一定的实验依据。方法采用SD大鼠随机分为正常组、假手术组、模型对照组、电针治疗组。缩窄腹主动脉建立低血压模型，MP150WSW型16导生理记录仪行股动脉插管法测血压。电针组大鼠选取双侧“合谷”穴进行治疗，用LH202H型韩氏仪，选用疏密波，频率2Hz／15Hz，强度1mA，每次持续刺激20分钟，7天为1疗程，连续治疗2个疗程。分别运用硝酸还原酶法检测血清及脑组织中NO含量，用化学比色法测定血清及脑组织中总NOS活性，放射免疫法检测血浆及脑组织中AngⅡ、cAMP、cGMP等的含量。所有数据均输入计算机，以SPSS12.0软件统计包处理，实验结果用均数±标准差表示。结果(1)与正常组相比，模型对照组大鼠血压显著下降(P＜0.01)。治疗后，电针治疗组血压均有所上升，与模型对照组相比有显著性差异(P＜0.05)，但尚未恢复到正常水平(P＜0.01)。(2)与正常组相比，模型对照组大鼠血清及脑组织中NO含量均明显升高(P＜0.01)，总NOS活性明显增强(P＜0.01)。治疗后，电针治疗组血清及脑组织NO含量、总NOS活性均有所下降，与模型对照组相比有显著性差异(P＜0.05)。(3)与正常组相比，模型对照组大鼠血浆AngⅡ含量明显升高(P＜0.05)，脑组织中AngⅡ含量下降(P＜0.05)。治疗后，电针治疗组大鼠血浆AngⅡ含量进一步升高，脑组织中AngⅡ含量也明显增加。与正常组相比，模型对照组大鼠血清ACE活性明显增强(P＜0.05)，脑组织中ACE活性减弱；治疗后，电针治疗组大鼠血清及脑组织中ACE活性均有所增强。(4)与正常对照组相比，模型对照组大鼠血浆cAMP、cGMP含量均明显减少，而且两者比值cAMP／cGMP低于正常对照组(P＜0.05)，治疗后电针组大鼠血浆cAMP含量明显回升，高于模型对照组(P＜0.05)，但均未恢复到正常组的水平，cGMP含量进一步下降，cAMP／cGMP回升并超过正常组水平(P＜0.05)。与正常对照组相比，模型对照组大鼠脑组织中cAMP含量明显减少，cGMP含量无明显变化，cAMP／cGMP降低，治疗后电针组大鼠脑组织中cAMP含量明显回升，高于模型对照组(P＜0.05)，但均未恢复到正常组的水平，脑组织中cGMP含量下降，cAMP／cGMP恢复到正常组水平。结论本实验研究证实电针“合谷”穴有升高血压的作用，能明显抑制低血压模型大鼠血清及脑组织中NOS活性，减少NO的生成，增强ACE的活性，促进AngⅡ的生成，能调节血浆及脑组织中参与血管调节的cAMP／cGMP的水平，其升高血压的可能机制为：(1)电针能调节上述血管活性物质，增强心肌收缩力，增加心排出量；(2)电针能调节血管舒缩功能，增强外周血管阻力，增加循环血量；(3)电针能激活神经中枢对血压的调节，从而升高血压。更多还原

【Abstract】 Objective Hypotension is a common and frequently-occurringdisease, which happens extensively in various places inworld. According to statistics unentirely, the incidence ofhypotension is about 4% and it could reach 10% in oldpeoples. Long-term hypotension coule lead to the depression in boayfunction greaily. It also could lead to brain and myocardialinfarction. Mortality of hypotension is higher than the normalpeople. It brings serious problems to the patients, familes andsociety. At present, the basical and clinical study of hypotensionis just a liale. The cause and pathogenesis of hypotension is notcompletely clarified. So hypotension is a subject which need to befurtherly studied. Westem medicine lack of effective treatment,often use symptomatic treatment and the effect of drugs is usuallynot good. The treatment of drugs could bring the side effects ofcausing hypertension and other complications, and the bloodpressure is hard to keep normal when the drugs are stopped toused. While our traditional chinese medicine has a strong advantageon the treatment of hypotension. Acupuncture is the treatment incommon use, which has the features of simple operation and stable effect. In recent years, the effect of acupuncture on hypotensionis good in clinic and it brings people’ S concern. But the reportof pathogenesis study of promoting the blood pressure is just aliUle. Through the animal experiment, we could observe the effectof treating the hypotension rats on electroacupuncture, detect thecontent of NO/NOS、AngⅡ、cAMP/cGMP in blood and brain, in order todiscuss the possible pathogenesis of ascending the blood pressureon acupuncture and provide some experimental basis for the studyof preveming and treating hypotension on acupuncture.Methods The SD rats were divided into 5 groups at random: the normalcontrol group, sham operation group,model group, electroacupuncturetreatment group. Toproduct the hypotension model on lessening theabdomen aorta, and measure theblood pressure in intubating into thefemoral artery. Electroacupuncture treatmentgroup: we select the"UeGu"(pair),using LN202H HanShi therapeutic equipment,selectingdensity wave, frequency 2Hz/1 5Hz, strength 1 mA, stimulating 20mineverytime, ltime a day, it is a couse of treatment in 14 days. Wedetected the content of NO/NON、ACE、AngⅡ、cAMP/cGMP in blood andbrain. All the datum were processed by SPSS 1 2.0 statistics softwarepackage and all results were demonstrated by mean+standarddeviation.Results (1)Gomparedwith the normal control group, the bloodpressure of the model group descend obviously(P＜0.01).Aftertreatment, the blood pressure of the electroacupuncture treatmentgroup, which was’ t rehabilitate to the normal. There was asignificant difference compared with the modelgroup(P＜0.05). (2)Compared with the normal control group, thecontent of NO in serum and brain ascended obviously (P＜0.01), the activity of total NOS heightened(P＜0.01).After treatment, thecontent Of NO and the activity of total NOS in serum and brain bothdescend in the electroacupuncture treatment group. There was asignificant difference compared with the modelgroup(P＜0.05). (3)Compared with the normal control group, thecontent of AngⅡin plasma ascended(P＜0.05), while the content ofAngⅡin brain descend (P＜0.05). After treatment, the content of AngⅡin plasma ascended furtherly in the electroacupuncturetreatment group. The content of AngⅡin brain also ascended.Compared with the normal control group, the activity of ACE in theserum of the model group strengthened, while which decreased in thebrain. After treatment, activity of ACE in the serum and the brainboth heightened in the electroacupuncture treatmentgroup. (4)Compared with the normal control group, the content ofcAMP、cGMP in plasma of the model group both reduced obviously andthe ratio of cAMP/cGMP lowered than the normal group. Aftertreatment, the content of cAMP in plasma of the electroacupuncturetreatment group rose again, which was higher than the model groupand didn’ t reach the level of the normal. The content of cGMP descendfurtherly. The ratio of cAMP/cGNP rose again and exceeded the normallevel. Compared with the normal control group, the content of cAMPin brain of the model group descend obviously, the content of cGMPin brain of the model group didn’t change obviously, the ratio ofcAMP/cGMP reduced. After treatment, the content of cAMP in brain ofthe electroacupuncture treatment group rose again, which was higherthan the model group and didn’t reach the level of the normal. Thecontent of Cgmp in brain descend and the ratio of cAMP/cGMPrehabilitate the normal level. Conclusion Electroacupuncture "HeGu" could promote the bloodpressure. Electroacupuncture could restrain the activity of NOS inthe serum and the brain, reduce the produce of NO, strengthen theactivity of ACE, promote the produce of AngⅡ, and regulate the levelof cAMP/cGME The possible mechanism is: (1) Electroacupuncturecould regulate those active substance in blood, strengthen thecardiac mucle systole, increase the cardiac transpiration;(2)Electroacupuncture could regulate the function of cardiacdiastole and systole, increase the blood content incirculation; (3)Electroacupuncture could activate nervous centerto regulate the blood pressure.更多还原