【作者】 丁哲；

【导师】 丁淑华；

【作者基本信息】 南京中医药大学 ， 中医五官科学， 2009， 博士

【摘要】 视网膜色素变性(RP)是一种遗传性视网膜变性疾病,本文从理论、实验二个方面对治疗视网膜色素变性的自拟益气补肾活血方“夜明颗粒”进行了研究。RP发病具有遗传倾向,因先天不足,肝肾亏虚,致脾肾阳虚,命门火衰,使气血不利,目络瘀阻而致。这一过程是一个以虚为本,因虚致瘀,最终发展为虚中夹瘀的缓慢病理过程。在此认识的基础上,导师丁淑华教授根据自己多年临床经验,针对其发病机理,以补益肝肾、益气活血、化瘀通络为法,自拟单味中药浓缩颗粒配方夜明颗粒治疗RP。临床上观察夜明颗粒治疗RP患者,对治疗后患者视力、视敏度、闪光视网膜电图进行分析,所得临床资料表明夜明颗粒在治疗RP和减缓病情发展方面有一定的疗效,各项指标均有不同程度的改善,有效率达84.5%。前期的动物实验是通过观察、分析夜明颗粒不同剂量对小鼠微循环、清除体内自由基、调节免疫,对大鼠血液流变学影响等7个实验的结果来探讨夜明颗粒制剂治疗RP的机理。实验数据表明夜明颗粒可以改善微循环,降低血黏度,具有活血化瘀作用;改善小鼠血液SOD活性,降低MDA值,增强小鼠清除体内自由基和积存的脂质过氧化物的能力;对免疫功能有调节作用。为了进一步探讨夜明颗粒制剂对RP的疗效机制,我们通过观察rds小鼠视网膜光感受器细胞的病理变化来探讨夜明颗粒对遗传性视网膜色素变性小鼠可能的治疗作用。取4周龄、12周龄、24周龄rds鼠各9只,都随机分为三组,夜明颗粒组4只、杞菊地黄丸组3只和对照组2只。给药28d后取眼球,立即经10%中性甲醛固定,光学显微镜下观察水平视网膜近赤道部位光感受器细胞的厚度。经夜明颗粒治疗后,光镜结果显示,rds小鼠光感受器细胞层数、细胞数明显增加及光感受器细胞凋亡率的下降(P＜0.05)。实验的结果表明夜明颗粒可延缓rds小鼠视网膜感受器细胞的破坏。更多还原

【Abstract】 Retinitis pigmentosa(RP) is a hereditary retinal degenerative disease. This paper researches treating the RP with "Yeming grain" from three aspects which are the theory studying,the clinical research and the empirical study, as well as explores the possible mechanism of the qi and kidney tonics and blood-activating and stasis-removing drugs "Yeming grain" treating the RP.The morbility of the RP possesses genetic predisposition. The cause is inherent deficiency,deficiency of the liver and kidney,which results in asdthenic splenonephro-yang,decline of vital gate-fire,qi and blood disorder,eye collaterals stagnation. This is a slow-moving patho- process which is based on void, then results in stagnation,and develops to void nipping stagnation at last. My tutor Shuhua Ding invents the prescription of "Yeming grain" to treat the RP according to her clinical experience. This prescription aims directly at the etiopathogenesis of the RP,and establishes the principle of removing stagnation and filling void.The clinical observation of the patient who is treated by "Yeming grain" and the analyses of eyesight, visual acuity,and bright-flash electroretinogram indicate that "Yeming grain" is effective."Yeming grain" can not only relieve the progression of disease but improve each index. The effective rate is 84.5%.In the first text,we give the treatment to rats,then observe and analyze the effect of different dosages on the microcirculation,cleaning up the free radicle in vivo,accommodating the immunity and the rat’s hemorheology.Results:"Yeming grain" can improve the microcirculation,step down the blood viscosity, promote blood flow and remove stagnation;it can improve the SOD activity of rat’s blood,step down the value of MDA,and enhance the cat’s capability of cleaning up the free radicle in vivo and the accumulation of lipid peroxidate;it also have accommodative effect on the immune function.To go deep into exploring the mechanism of "Yeming grain" treating the RP and to determine whether tetram ethylpyrazine hydrochlorde has an efficacy on hereditary retinitis pigmentosa of rds mice by the observation of the photo receptor cells. Nine rds mice of 4 week old were randomly divided into three groups, "Yeming grain" group(4 mice),"qujudihuangwan" group(3 mice) and control group(2 mice).All mice were sacrificed after 28d with eyes being immediately enucleated and fixed in 10% form aldehyde in PBS. Routine pathologic process was done and sections were stained by hematoxylin and eosin(HE).The layer numbers of retinal photo receptor cells at equator posterior center was counted under light micro scopy. Nine rds mice of 12week old did as so on.Result from light microscopy showed that the layer numbers and numbers of retinal photo receptor cells in the tetram ethylpyrazine treatment group were increased in rds mice,compared with the control group(P<0.05).Conclusion from light microscopy and electron microscope suggest that tetram ethylpyrazine has a significant efficacy to the retinal photo receptor cells of rds mice.更多还原