【作者】 钟艳；

【导师】 严洁；

【作者基本信息】 湖南中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的：采用“本经配穴法”,“表里经配穴法”,“同名经配穴法”,“他经配穴法”选穴观察针刺对急性胃黏膜损伤大鼠的保护效应,从胃黏膜的组织形态学、前列腺素E2(PGE2)、生长抑素(SS)、胃动素(MTL)、肿瘤坏死因子(TNF-α)和表皮生长因子(EGF)、转化生长因子α(TGF-α)的表达比较不同配穴法针刺对大鼠胃黏膜损伤的保护差异。为经脉(穴)脏腑的内在联系及不同配穴法的针灸临床处方提供实验依据。方法：将SD大鼠60只随机分为6组,每组10只。即：空白组(A组),模型组(B组),本经配穴组(C组针刺足三里、冲阳穴),表里经配穴组(D组针刺足三里、太白穴),同名经配穴组(E组针刺足三里、合谷穴),他经配穴组(F组针刺承筋、京骨穴)。采用无水乙醇灌胃法制作急性胃黏膜损伤模型,按Guth法记录大鼠胃黏膜损伤指数,光镜下观察胃黏膜组织形态学变化；放射免疫法测定PGE2、SS.MTL、TNF-α；免疫组化法检测胃黏膜EGF和TGF-α的表达。结果：①模型组及各针刺组大鼠与空白组比较胃黏膜损伤指数升高,其中模型组、表里经配穴组、他经配穴组升高更明显(P<0.01或P<0.05)；本经配穴组、表里经配穴组、同名经配穴组与模型组比较胃黏膜损伤指数显著降低(P<0.05),他经配穴组回降不明显；同名经配穴组与他经配穴组比较,胃黏膜损伤指数降低更明显(P<0.05)。②肉眼及显微镜观察大鼠胃黏膜,结果显示：本经配穴组、表里经配穴组、同名经配穴组胃黏膜色泽红润,略有少数点状出血,上皮基本完整,腺体排列较整齐,少量炎细胞浸润,胃黏膜无充血或充血较轻微。模型组及他经配穴组大鼠胃黏膜充血、水肿,可见点状出血和糜烂,上皮不完整,腺体受损,结构紊乱,细胞排列无序,胞核胞质模糊,毛细血管增生及出血,可见大量炎性细胞浸润。③模型组、各针刺组大鼠与空白组比较胃黏膜及血浆PGE2含量无明显差异；各针刺组与模型组比较,仅见本经配穴组胃黏膜及血浆PGE2含量升高(P<0.05)；本经配穴组与他经配穴组比较血浆PGE2含量升高明显(P<0.05),其他针刺组之间比较未见明显差异。模型组、表里经配穴组、同名经配穴组、他经配穴组大鼠与空白组比较胃黏膜SS含量显著降低(P<0.01)；本经配穴组、表里经配穴组、同名经配穴组大鼠与模型组比较胃黏膜及血浆SS含量均显著升高(P<0.05或P<0.01),其中本经配穴组血浆SS含量升高明显强于表里经配穴组、同名经配穴组及他经配穴组(P<0.01)。模型组、各针刺组大鼠与空白组比较胃黏膜及血浆TNF-α含量明显升高(P<0.05或P<0.01),本经配穴组、表里经配穴组、同名经配穴组大鼠与模型组、他经配穴组比较胃黏膜及血浆TNF-α含量均显著降低(P<0.01),其中本经配穴组、表里经配穴组血浆TNF-α含量与同名经配穴组比较降低更为明显(P<0.05或P<0.01)。各组胃黏膜及血浆MTL含量未见明显差异。④各组大鼠均可检测到胃黏膜EGF、TGF-α的表达,阳性表达主要集中在胃腺部。本经配穴组、表里经配穴组均能上调EGF的表达,与空白组、模型组、同名经配穴组、他经配穴组比较差异均具有显著性意义(P<0.05或P<0.01)。本经配穴组能上调TGF-α的表达,与空白组、模型组、同名经配穴组、他经配穴组比较差异具有显著性意义(P<0.05或P<0.01)。结论：①大鼠急性胃黏膜损伤7d后,胃黏膜损伤指数升高,胃黏膜SS含量显著降低,胃黏膜及血浆TNF-α含量明显升高,提示上述物质的异常变化与酒精性胃黏膜损伤的病理机制有关。②本经配穴组、表里经配穴组、同名经配穴组均能降低胃黏膜损伤大鼠胃黏膜损伤指数,改善胃黏膜组织形态学的病理变化,他经配穴组大鼠组织形态学变化不明显,说明三种相关经脉配穴针刺均可促进大鼠胃黏膜损伤的修复,而他经配穴针刺作用不明显。③“本经配穴法”,“表里经配穴法”,“同名经配穴法”选穴针刺对大鼠急性胃黏膜损伤修复的作用机制可能与抑制炎性介质TNF-α释放,促进内源性保护物质PGE2、SS合成、促进EGF和TGF-α在胃黏膜的表达有关且存在差异,他经配穴组的对上述调整作用不明显。本经配穴法的保护效应与这三个方面均相关,表里经配穴法可能更侧重于调整TNF-α、SS的合成、释放及促进EGF的表达,同名经配穴法可能更侧重于调整TNF-α、SS的合成、释放。其作用差异机理有待继续研究。更多还原

【Abstract】 Objective:To observe the effect on PGE2, SS, MTL, TNF-a, EGF, TGF-a, and histological changes of acute gastric mucosal lesion rats treated by different acupoint combination groups, and to analyze the protective effect of them.Method:60 SD rats were divided randomly into 6 groups,10 rats each group. Group A was blank control group. Group B was model group. Rats in group C (combining points on the same meridians) was electroacupunctured in Zusanli and Chongyang. Rats in group D (combining points on the exteriorly-interiorly related meridians) was electroacupunctured in Zusanli and Taibai. Rats in group E (combining points on the meridians sharing the same name) was electroacupunctured in Zusanli and Hegu. Rats in group F (combining points on the unrelated meridians) was electroacupunctured in Chengjin and Jinggu. Acute gastric mucosal lesion rat model was built by ethanol ingestion. Gastric mucosal lesion index was recorded and histological changes of gastric mucosal tissues were observed under microscope. Radioimmunoassay was used to determine contents of PGE2、SS、MTL、TNF-α, and Immunohistochemistry for expression of EGF and TGF-α.Results:①Compared with blank control group, UI was increased in other 5 groups, especially in group B, D, and F (P<0.05 or P<0.01). Compared with model group, UI was decreased in group C, D, E (P<0.05), no significant decrease in group F. Compared with group F, UI was decreased in group E (P<0.05).②In group C, D, and E, gastric mucosa looked bloom, few punctuate hemorrhage, epithelium tissue was integrated, glandular organs was regular, few inflammatory cell infiltration, gastric mucosa was lightly congestive. In model group, and group F, gastric mucosa was congestive, dropsied, punctuate hemorrhage and erosion, epithelium tissue was incomplete, glandular organs was damaged and disorder, nucleocytoplasmic was fuzzy, capillary proliferation, Substantial inflammatory cell infiltration.③Compared with group A, content of PGE2 were similar in each group. Compared with group B and F, content of PGE2 increased in group C (P<0.05).Content of SS was decreased in group B, D, E, F, compared with group A (P<0.01). compared with group B, content of SS was obviously increased in group C, D, E (P<0.05 or P<0.01), and that in group C was obviously higher than group D, E, F (P<0.01)Compared with group A, content of TNF-αwas increased in group B, C, D, E, F (P<0.05 or P<0.01). Compared with group B and F, that was decreased in group C, D, E (P<0.01), and that in group C, D was obviously lower than group E (P<0.05 or P<0.01)No significant difference showed in content of MTL in each group.④EGF, TGF-αexpressed in gastric mucosa of every group, located mainly in gastric gland. Compared with other groups, EGF expression was increased obviously in group C, D (P<0.01 or P<0.05). Compared with other 5 groups, TGF-a expression was increased obviously in group C (P<0.01 or P<0.05)。Conclusion:①7 days after acute gastric mucosal lesion, UI was increased, content of GM rats SS was descended, and TNF-αof gastric mucosa and plasma was increased. There might be some relationship between abnormity of SS and TNF-αwith GM pathomechanism.②Reparation effect on GM showed in 3 kind of point combination:acupoints of same Meridians, acupoints of Exteriorly-Interiorly Related Meridians, acupoints of Meridians Sharing the Same Name. But no significant effect showed in unrelated points.③The reparation effect of acupoints of the Same Meridians might be to inhibit TNF-αrelease, promote PGE2, SS synthesis, and promote expression of EGF and TNF-αin gastric mucosa. The reparation effect of acupoints of the Exteriorly-Interiorly Related Meridians might be to regulate TNF-αand SS synthesis, promote expression of EGF. The reparation effect of acupoints of the Meridians Sharing the Same Name might be to regulate TNF-αand SS synthesis and release.更多还原