【作者】 廖敏；

【导师】 李秀亮；

【作者基本信息】 成都中医药大学 ， 中医儿科学， 2009， 博士

【摘要】 目的：在中医理论指导下,结合现代科学研究技术,以养阴益胃法为主要治疗原则,通过加味益胃汤治疗小儿脾胃阴虚型厌食症的临床疗效研究及对实验动物胃肠运动、消化吸收功能的影响及脑肠肽的调节作用,探讨养阴益胃法治疗小儿脾胃阴虚型厌食症的临床疗效和作用机制。方法：按照随机对照的原则从临床观察方面探讨了加味益胃汤治疗小儿脾胃阴虚厌食症的临床疗效,并采用南京中医药大学幼龄厌食大鼠模型,分别给予加味益胃汤和儿宝颗粒进行灌胃治疗,观察大鼠摄食量、体重的变化；用放射免疫法检测大鼠血浆胃动素(MTL)、神经降压素(NT)、血浆胆囊收缩素(CCK)、神经肽Y(NPY)含量的变化；以Anson-Mirshy改良法测定加味益胃汤对大鼠胃蛋白酶活性和胃酸分泌的影响；以酶联免疫法测定大鼠血浆瘦素水平变化。结论：本实验结果显示加味益胃汤能显著抑制厌食模型大鼠胃酸分泌,明显地提高厌食模型大鼠的胃蛋白酶活性；对厌食模型大鼠MTL, NT紊乱有明显的调节作用；使厌食模型大鼠血浆CCK含量降低,下调结肠CCK-R基因表达。但对模型大鼠血浆瘦素和神经肽Y(NPY)水平影响不大。据此推测,胃肠动力减弱、消化吸收功能降低,可能是小儿阴虚厌食症发生发展的一个重要环节；MTL的降低及NT的增高与小儿阴虚厌食症的发生可能有着密切的联系。CCK-R基因高表达可能是厌食发生的主要病理环节之一,抑制或下调CCK.R基因表达可能是加味益胃汤治疗厌食症的主要作用靶点之一。加味益胃汤治疗阴虚厌食症的临床研究结果提示,加味益胃汤治疗阴虚厌食症总有效率93.3%,与阳性对照组比较无明显差异(P>0.05)。但在显愈率,改善患儿远期身高、体重及血中Zn元素的提高方面优于阳性对照组(P<0.05或P<0.01)。说明加味益胃汤治疗小儿阴虚厌食症有其独特的优势,值得进一步研究。更多还原

【Abstract】 Objective:Under the guidance of TCM theory and combined with modem method of scientific research, the study, taking the way of "replenishing Yin and strengthen stomach"as the direction, centerson the effect of Jia Wei Yi Wei Tang on the trial animal’s gastrointestinal function,digestion, assimilation and the regulating of its gastrointestinal hormone so as to further approach the pathological mechanism of immature anorexia and the acting mechanism of "replenishing Yin and strengthen stomach" in dealing with immature anorexia by improving the gastrointestinal function and hormone disorder.Methods:Two herbalp reparaitons:Jia Wei Yi Wei Tang and Er Bao Granules are used to conduct i.g treatment on immature anorexic rats which are fed with special forage developed by Nanjing University of T.C.M. Meanwhile, any forage intake and weight changes on the rats are closely watched and recorded.To be specific, using method of radioimmunization to check and measure the amount changes on MLT、N T、CCK and NPY of rats;using improved Anson-Mirshy method to measure the pharmaceutical effects of Jia Wei Yi Wei Tang on rats’ activities of gastric protein enzyme and the gastric acid secretion; And using determination of enzyme-linked immunosorbent assay in plasma leptin levels in rats; according to the principle of randomized comparison from the clinical practice respect, investigates curative effect of 30 cases Children with Yin-Deficiency anorexia using Jia Wei Yi Wei Tang.Conclusions:The results show that Jia Wei Yi Wei Tang is effective on inhibiting the gastrica cids ecertion of anorexia rats,and obviously activating the pepsin of anorexic rats; it may also works well on the regulation of trial anorexia rats’MTL and NT disorder. What’s more,it decrease anorexia rats’content of CCK in plasma and decrease the expression of CCK-R mRNA in colon smooth muscle cells of the anorexia rats. However, plasma Leptin and NPY levels of anorexia rats have little effect. Accordingly,the weakening of gastrointestinal motility and that of the digestive and assimilative function maybe defined as the important factors which contribute a lot to immature anorexia with Yin Deficiency; in addition, a close connection is found between the incerasing of NT along with the deficiency of MTL and the immature anorexia. The expression of CCK-R mRNA was obviously increased in colon smooth muscle cells of the anorexia pedo-rats, which is one of the mechanisms of anorexia.Modified Yiwei decoction can decrease the expression of CCK-R mRNA in colon smooth muscle cells of the anorexia rats. The clinical study results suggest that the total curative effect of Jia Wei Yi Wei Tang treating Yin-Deficiency anorexia is 93.3%, has no obvious difference. (P>0.05) But the Jia Wei Yi Wei Tang group has superiority on the evident control rate compares to the control group.And it has better effection on long-term improvement in children with height, weight and improving content of Zn elements in blood of children anorexia compares to Er Bao Granules group (P<0.05). It illustrates Jia Wei Yi Wei Tang treating Yin-Deficiency anorexia has unique superiority itself, worth researching a step further.更多还原