【作者】 张美军；

【导师】 冯桂梅；

【作者基本信息】 吉林大学 ， 中医内科学， 2008， 硕士

【摘要】 目的:本文通过实验研究,探讨益肾健脾解毒汤灌肠治疗慢性肾功能不全(CRI)的疗效及作用机理,同时观察通过灌肠给药治疗慢性肾功能不全的优点,为益肾健脾、活血化瘀、泄浊解毒法治疗慢性肾功能不全提供理论依据。方方法:本实验以大鼠为实验对象,进行相关实验研究。结结果:经益肾健脾解毒汤治疗后的实验大鼠在肾功能、血生化和常规指标、血液流变学指标上与治疗前或与对照组比较均有差异(P<0.05,P<0.01)。经益肾健脾解毒汤治疗后的大鼠肾功能、血液流变学与对照组和模型组比较均有差异(P<0.05);与正常组比较无显著性差异,中药组与模型组比较肾功能不全大鼠实验前后肾功能均有明显差异(P<0.05)。结结论:1、益肾健脾解毒汤可改善CRI大鼠肾功能或延缓肾功能恶化;2、益肾健脾解毒汤可改善CRI大鼠的血液流变学;3、益肾健脾解毒汤可提高大鼠血红细胞数、血清总蛋白、白蛋白水平,改善贫血症状;4、益肾健脾解毒汤可增强CRI大鼠的免疫功能;5、益肾健脾解毒汤可改善CRI大鼠肾脏病理改变,延缓肾小球硬化及肾间质纤维化。更多还原

【Abstract】 Chronic Renal Insufficiency(CRI) is also called Chronic Renal Failure(CRF). CRI is a clinical syndrome that because of renal units seriouslysuffered by a variety of reasons and glomerular filtration rate(G.F.R)sustaining declining, the excretion of body’s metabolic waste and theaccommodation of water electrolyte’s and acid base’s balance are disordered.The major of clinical symptoms of CRI are composed of graduallydeteriorating kidney, disturbance of lipid metabolism, hypoproteinemia,immunologic inadequacy, glomerular sclerosis, renal interstitial fibrosis. CRIbelongs to Dropsy, Shenfeng, NiDu, Longbi, Guange, Xulao and so on, in thefield of traditional Chinese medicine. This paper is to make a zoopery study onthe effect and mechanism that the mixture of Yishen Jianpi Jiedu treat CRI byclyster, and the advantages of this measure. The main purpose is to offertheoretical supports of CRI treated by Yishen Jianpi, Huoxue Huayu, XiezuoJiedu .In the experimental, male Wistar rats were given 2% adenine for 4 weeksto making CRI model. The model were randomly divided into model group,oxyamylitectus aldehydum group, traditional medicine treated by clystergroup ,and nomal control group, each 12. Traditional medicine group wereclysised 2ml mixture daily, and oxyamylitectus aldehydum group were given2ml Oxystarch by gavage. Other groups were given equal normal saline bygavage everyday. Continue administration for 6 weeks. Usea nitrogen,creatinine, total serum protein, albumin, blood ion, carban dioxide combiningpower, hemoglobin, red cell count, blood rheology (BHV, BLV PV) andkidney pathological examination are as the detected guideline, and compare the changes in each group.Test results show that :①The Yishen Jianpijiedu decoction can improveCRI rats renal function, and compared with the oxyamylitectus aldehydumgroup, there are significant differences (P<0.05). Compared with the normalcontrol group statistics, it have no differences (P>0.05).②The Yishen Jianpijiedu decoction can improve CRI rats blood clotting. After the treatment , thetraditional medicine group’s indicators in the blood rheology (BHV, BLV, PV)have dropped significantly. Compared with the oxyamylitectus aldehydumgroup, there are significant differences (P<0.05).③The Yishen Jianpijiedudecoction can improve plasma protein and red cell count. There are significantdifferences (P<0.05) compared with the oxyamylitectus aldehydum group.④The Yishen Jianpijiedu decoction can improve the immune cells in rats andstronger rats’immunity. The number of lymphocytes of the traditionalmedicine group are more than the oxyamylitectus aldehydum group, and thereare significant differences (P<0.05).⑤Pathologically , in the traditionalmedicine group the cells of glomerulus do not grow and swell renal tubulesarrange in ranks, in which there is a small amount of drug crystallization and alittle cast. Renal interstitium hardens unsignificantly.From the experimental data we can see that : The Yishen Jianpi jiedudecoction can improve CRI rats renal function and blood rheology, canincrease the level of red cell count, hemoglobin, total serum protein andalbumin, can stronger rats,immunity, can improve the its kidney pathologicalchange, and delay glomerulosclerosis and renal interstitial fibrosis.Prescriptions of rhubarb, Salvia miltiorrhiza ,Astragalus, Chuanxiong byreducing intestinal absorption of the raw materials amino acid that synthesizethe urea, increase the concentration of essential amino acids in the blood, anduse its to synthesize protein. Liver and kidney reduce the synthesis of urea and inhibit of protein decomposition in vivo. Thereby, they can reduce urea andcreatinine in the source and improve CRI azotemia.Prescriptions of Salvia miltiorrhiza, Chuanxiong, Sanqi, Spatholobussuberectus, Astragalus, Rhubarb increase blood flow in the microcirculationand accelerate blood flow velocity by improving microcirculation, forbiddingthe release of vasoconstrictor factor and expanding micro artery. They canreinforce fiber protein solubility to inhibit platelet aggregation and coagulation.They also can resist free radical oxidation , reduce lipid peroxidation ofglomerular injuried , increase the activity of SOD and scavenge free radicals.At the same time, the herb can lower the level of Serum triglyceride ,cholesterol and plasma lipid peroxidation. So, They can improve CRIhemorheology.Prescriptions of rhubarb, Chuanxiong, Sanqi, Salvia miltiorrhiza reduceglomerular mesangial cell proliferation, extracellular matrix deposition andimmune complexes deposited in the glomerular, and regulate the genetranscription of smooth muscle cells in the kidney and apoptosis in order toimprove CRI pathological changes in the kidney and delay glomerulosclerosisand renal interstitial fibrosis.Prescriptions of Astragalus, Poria the rhizome of large headedatractylodes, Dangshen, Rehmannia glutinosa, Zexie, Cinnamon, Herbaepimedii enhance the immune function of CRI, through enhancing humoralimmune function, cell mediated immune function and non specific immunefunction.Prescriptions of Rehmannia glutinosa, Astragalus, Chuanxiong, SuberectSpatholobus, Sanqi can improve renal anemia of CRI by promoting theproliferation of hematopoietic growth factors, regulating the increase of theprotein synthesis and the differentiation related gene expression of hematopoietic cell proliferation and differentiation , improving erythroidprogenitor cell proliferation and differentiation, enhancing immune acticalcells involved in regulating and controlling the proliferation and differentiationof hematopoietic cells, and promoting bone marrow micro environment andbone marrow stem cells to cell hyperplasia.The Yishen Jianpi jiedu decoction perform the unique advantages of thetreatment of CRI through enema administration :①. The PH value of therectum is more moderate compared with stomach and small intestine. There isno destruction of drugs, so it can be avoided that drug which were destructedin the digestive tract by acid and digestive enzymes by the oral low the effectand reduce. At the same time, it can avoid or reduce the drug side effects, suchas gastric stimulation.②. Drug absorbed in the rectum directly, can avoid thedecomposition and destruction when the drug at the first pass liver by the oral,thereby it reduce drugs on liver toxicity or side effects. The drug can directlygo into a cycle of drug and increase the release and absorption. It promote thebiological availability.③. For unable or unwilling to swallow the drugpatients, especially the late CIR, rectal administration is a convenient andeffective way because that uremic toxins stimulate the gastrointestinal tractand most of the patients have the symptoms such as nausea, vomiting.更多还原