【作者】 张明选；

【导师】 戴春福；

【作者基本信息】 福建中医学院 ， 中医临床基础， 2003， 硕士

【摘要】 背景：目前慢性前列腺炎(CP)发病率和复发率较高，治疗颇为棘手，其病因和发病机理尚不完全清楚，临床缺乏治疗CP理想的中药制剂。因此，探索CP的发病机制和开发研制针对CP的有效中成药具有重要意义。本课题是男泌清(具有苦寒解毒、活血化瘀、益气扶正的作用)治疗CP的临床与实验研究系列中的一部分。前阶段我们进行了男泌清治疗CP药效学、毒理学和部分作用机理的研究，发现该制剂疗效较好，毒副作用少，临床应用前景看好。因此，本文在此基础上进一步探讨其中的益气法对CP的疗效和部分治疗作用机理，以完善男泌清治疗CP的系列研究。目的：通过广泛收集、分析古今医学文献，为益气法治疗CP提供理论依据，并通过临床与实验研究揭示益气法在男泌清治疗CP中的作用机理，进一步指导临床用药。材料与方法：临床研究选择CP患者74例作为研究对象，单盲随机分为治疗组42例、对照组32例。前者用男泌清煎剂(简称男泌组，具有益气清热化瘀作用)治疗，与清热化瘀煎剂(简称清化组，不具有益气作用)治疗组40例进行比较。观察CP患者的前列腺液卵磷脂小体、白细胞数、pH值及锌含量的变化和临床症状的改善情况。同时，为更深入地探讨益气药的作用机理，在实验研究中选择44只健康雄性SD大鼠随机分为：清热化瘀益气组(男泌组)、清热化瘀组(清化组)、模型组、空白组，以大肠杆菌制作大鼠前列腺炎模型，分别采用清热化瘀煎剂和男泌清煎剂予以灌胃治疗，模型组给予同剂量0.9％生理盐水，空白组不处理。给药25天后，观察大鼠前列腺腺体的色泽、质地、粘连3项体征及病理组织学变化，检测大鼠血液中酸性磷酸酶、超氧化物歧化酶、白介素-6、肿瘤坏死因子、免疫球蛋白G和免疫球蛋白M的水平，经统计后分析各指标在实验中变化的意义。结果：临床观察男泌组疗效优于清化组，有显著性差异(P＜0.01)。实验研究中男泌清能显著改善大鼠前列腺体的炎症损害，降低异常增高的炎症介质白介素-6、肿瘤坏死因子和抑制免役的酸性磷酸酶水平，升高具有抗炎护体作用的超氧化物歧化酶水平，调节反映免疫功能的免疫球蛋白G和免疫球蛋白M的水平。男泌清煎剂的以上作用均明显优于清化煎剂。结论：气虚是CP的一个重要病理变化为CP的三大病机(热毒内蕴、血瘀内阻、气虚)之一，益气法是治疗CP三大治法(清热解毒、活血化瘀和益气)之一。以具有苦寒解毒、活血化瘀和益气功效的中药组成的男泌清煎剂是治疗CP的有效方剂。更多还原

【Abstract】 BACKGROUNDS: These days the incidence and the rates of recrudescence of chronic prostatitis (CP) are high. It is fearfully difficult to cure CP. Its pathogeny and pathogenesis still have not been clear. It has been short of perfect preparation of Chinese Traditional Medicine for curing CP in clinic. Therefore empoldering the effective Chinese patent medicine to treat CP and revealing its mechanism have an important significance. The thesis is one of the clinical and experimental researches of curing CP with nanmiqing. In the former phases, the study on effectivity,toxin and part mechanism of nanmiqing treating CP had been done. It showed that Nanmiqing has the functions of Clearing away heat and promoting diuresis, promoting blood circulation by removing blood stasis and replenishing Qi. It has a credible curative effect with little toxic reactions and side-effects. On the base of above research,the thesis deeply studied curative effect and its mechanism of replenishing Qi in treating CP. It is hopeful to perfect the research of the treatment for CP by Nanmiqing decoction.OBJECTIVE: To provide theoretical basis for the treatment of chronic prostatitis (CP) by reinforcing Qi through widely collecting past and present medicine reference material and reveal the mechanism through the clinical and experimental researches, so as to guide the choice of the medicine in treatment of CP in clinic.MATERIAL AND METHOD: In clinic research we chosed 74 cases of CP patients and randomly divided them into 2 groups. 42 cases as curing group NanMiQing (group A),32cases as QingHua control group(group B).Above two groups were separately treated them with decoction of NanMiQing (NMQ) and decoction of QinReHuaYu (QRHYM) (Clearing-away heat &Promoting blood circulation by removing blood stasis). EPS-Rt including PH, FAT and Zn ofEPS from the two groups of patients with CP were examined, the scoring(NIH-CPSI) of CP symptoms were evaluated before and after treatment.In the experimental research we used colitoxin to make the rat model of chronic protatitis and divided 44 SD male rats randomly into 4 groups: normal group (group A), model group(group B), QingHua group (group C), and NMQ group (group D). and separately treated the rats through pouring into their stomach with QingHua decoction, NanMiQing decoction by contrasting with two groups of normal and model. After treating 25 days we observed three physical symptom and pathological tissue slices of prostate of rats,and in the rats’ blood we tested the level of AGP, CuZn-SOD, IL-6,TNF- a ,IgG and IgM. Through scientific statistics we analyzed the meaning of every index used in the experiment.RESULT: NanMiQing decoction can remarkably improve the inflammation damage of the rats’ prostate; reduce the abnormally high level of IL-6. TNF- a and ACP; romote the level of CuZn-SOD that can resist inflammation and protect body; promote the level of IgG and IgM that can represent the immunocompetence. The function of NanMiQing decoction was remarkably more advantageous than the medicine of compared groups.CONCLUSION: NanMiQing decoction made by some Traditional Chinese Medicine which have the function of clearing away heat and promoting diuresis, promoting blood circulation by removing blood stasis and replenishing Qi is the efficiency prescription to cure experimental chronic prostatitis of rats. Deficiency of Qi is a kind of important pathogenesis of CP.And Reinforcing Qi is one of important treatments to cure CP.更多还原