【作者】 恩和图娅；

【导师】 柴铁劬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的探讨艾灸关元对化疗期癌症病人生活质量及免疫功能的影响,将艾灸疗法介绍及应用到蒙古肿瘤姑息治疗方法1.使用单盲随机对照临床试验方案,观察艾灸关元对化疗期癌症患者生活质量的影响。在蒙古国肿瘤治疗中心受化疗的24例术后胃癌患者随机分为治疗组与对照组,采用癌症患者生活质量表EORTC QLQ30及M. D. Anderson症状调查表MDASI基础上研究者自行设计的一般资料调查表,进行化疗前后的QLQ30得分比较。治疗组为每天艾灸关元约25分钟,连续5天。本研究已获得蒙古卫生部医学伦理学委员会的批准。2.使用环磷酰胺免疫抑制小鼠模型,观察艾灸关元穴对癌症化疗毒副反应的减毒效应。动物模型使用36NIH小鼠(8周龄,体重20-22克),在适应实验环境后,随机分为3组：对照组,模型组及艾灸组。在第1,3,5天,模型组和治疗组分别给环磷酰胺(100毫克／kg,腹腔注射)。对照组使用生理盐水。艾灸组每天艾灸关元15分钟,连续10天。观察艾灸关元对癌症化疗毒副反应的减毒效应,测定外周血血细胞计数和T细胞亚群百分数及胃、胸腺和脾脏组织病理学改变。3.观察艾灸关元对环磷酰胺免疫抑制小鼠胃脏缝隙连接蛋白43表达的影响。结果1.参加本次研究的术后化疗前胃癌患者整体生活质量较差。接受化疗降低了患者的生活质量,尤其是恶心呕吐,食欲下降等消化道症状加重。艾灸关元可明显减轻化疗期癌症患者的疲劳症状(P<0.01),有所提高患者的整体生活质量,减少单项症状尤其是恶心呕吐、疼痛症状,从而提高肿瘤患者的生活质量。治疗期间接受艾灸治疗的患者没有出现艾灸副作用。2.艾灸关元能有效的对抗化疗所致毒副作用,改善患者的造血功能,使降低的白细胞数上升,减少环磷酰胺导致小鼠外周血T淋巴细胞CD3、CD4、CD8的百分比下降及使CD4/CD8比值向正常值调,拮抗环磷酰胺所致胸腺和脾脏的病理损伤的作用,以增强机体免疫功能,达到缓解化疗所致毒副作用,提高机体抗肿瘤能力。3.病理学观察显示,环磷酰胺可导致小鼠胃粘膜损伤,减少其壁细胞数量,而艾灸关元可防止和缓解此伤害。治疗组小鼠胃隐窝部缝隙连接蛋白Cx43强表达提示艾灸关元对化疗毒副反应的减毒效应是与缝隙连接蛋白Cx43表达有密切相关。结论关元是人生之关要,真元之所存,也为小肠募穴,与足三阴经(肝,脾,肾三经)、足阳明胃经、冲脉以及督脉等联系密切,可谓一穴集聚多经之功能,穴属阴中之阳,为生命之所系,一身元气之所在,功能培肾固本,补益精血,调理冲任,有培元补精化血之功。艾灸为非侵入性针灸治疗方法,可广泛应用在癌症姑息治疗方面,以减轻化疗的副作用,改善癌症患者的生活质量。更多还原

【Abstract】 ObjectiveTo explore effects of using direct moxa at Guanyuan acupoint in palliative care for cancer patients during the chemotherapyMethods1. In single blind, ramdomized controlled clinical trial, examined effects of using direct moxa at Guanyuan acupoint.24 gastric cancer patients undergoing post-operative chemotherapy at National Cancer Center of Mongolia were recruited and ramdomized into 2 groups:control and intervention. The intervention consisted of 25 min direct moxa at Guanyuan acupoint once a day for 5 days. The EORTC QoL 30 questionnaires were filled by the patients and self-designed patient assessment questionnaire based on MD Anderson Symptom Inventory were filled by blinded medical personal, before and after the chemotherapy. Study was approved by Ethical Committee of MOH of Mongolia.2. Using cyclophosphamide treated rodent model, we examined chemoprotective effects of moxa at Guanyuan. For the animal model,36 NIH mice (aged 8 week old, weight 20-22 g) after the adjustion in the environment, ramdomly divided into three groups:control, model and moxa. On the day 1,3,5 mice in model and treatment groups were treated with cyclophosphamide (100 mg/kg, i.p). Control animals were injected with saline. Moxa at Guanyuan were given for 10 days. Effects of moxa at Guanyuan were studied by counting blood cells and T cell subsets in peripheral blood and histopathological changes in thymus and spleen.3. Explored the relationship between moxa at Guanyuan acupoint and Connexin 43 (Cx43) expression in the cyclophosphamide treated mice stomach by IHC method.Results1. The QoL of post-operative gastric cancer patients before chemotherapy were similar to reference value. Chemotherapy will significantly decrease patients QoL especially nausea & vomiting, appetite loss symptom scales. Moxa at Guanyuan had significantly decreased fatigue score of the post-operative chemotherapy gastric cancer patients (P<0.05) and positively regulated Global Health score and other symptom scales especially nausea & vomiting, appetite loss scores. During the treatment no adverse effects of moxa treatment were observed.2. Moxa at Guanyuan had chemoprotective effects by decreasing reduction of WBC, RBC count, increased thymus medullary area and cellularity, number and size of lymph nodes of the spleen.3. IHC analysis of cyclophosphamide treated mice stomach reveals moxa at Guanyuan decreased mucosal surface epithelium injury and reduction of parietal cell number. Strong connexin 43 expresion in gastric crypt were detected.ConclusionGuanyuan (CV 4) is Front-Mu Point of the Small Intestine, a crossing point of Three Yin Meridians of Foot, Stomach meridian of Foot Yang Ming and Conception Vessel. It is the one acupoint can gather qi of many meridians, which has Yin within the yang character and considered the physical center of gravity of the human body and seat of one’s internal energy. Therefore it could warm the kidney to invigorate yang, tonify the Yuan-Primary qi, regulate Thoroughfare and Conception Vessels, thus can cultivate yuan-primary energy. Moxa is the non invasive treatment method of acupuncture and moxa at Guanyuan can be broadly used in cancer palliative care to reduce the side effects of chemotherapy and improve quality of life of cancer patients.更多还原