【作者】 王勇；

【导师】 马玉琛；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2010， 硕士

【摘要】 导师马玉琛教授认为风湿性间质性肺病应属于《素问·痹论》肺痹,与一般具有咳、哮、痰、喘症状的慢性支气管炎、肺气肿、肺炎等不同：一是伴有五体痹,有不同程度的肢体症状；二是肺脏症状缠绵反复,重浊粘滞。结合其雍膨肿胀的临床表现,符合广义有形之痰,为顽痰、积痰、痰核之类；或疼痛剧烈,或关节畸形,肌肉萎缩,这种浸淫腐蚀、损害严重等特点,也符合邪实蕴结体内,久而酿生之内毒。其在现代辅助检查的微观表现,如CT的肺纤维化、条索样变,病理的肺泡结构紊乱、扩张、陷萎,泡腔渗出瘀积,泡壁增厚、断裂,肺泡间隔纤维化,胶原纤维增生,以及系列免疫指标的改变,也符合传统中医痰和毒的特点,可以认为是痰、毒侵袭或内生,痰积毒淫,痰结蕴毒,毒存助痰,坏血食气,蚀筋腐肉过程的表现。提出痰毒共同致痹,风湿性间质性肺病与痰、毒关系尤为密切,以及无毒不足以治痹,药物毒性相对论,痹病痰毒并治等观点。本课题秉承先生以上观点,应用痰毒并治法,并以先生经验方雄附散为主,对风湿性间质性肺病进行了动物实验研究和前瞻性临床对照研究。诊断明确的本院住院风湿病患者,参考美国胸科协会和欧洲呼吸学会标准,选择其中间质性肺病63例纳入观察,常规中药辨证治疗,治疗组33例加雄附散(雄黄,僵蚕、白附子)冲服,治疗3个月；疗效评定：治疗组显效6例,有效21例,与对照组有效率对比X2=6.70,P<0.05；肺病症状,肺功能,CT影像变化：治疗后各项指标及与对照组比较都有显著性意义(P<0.05)。实验观察雄附散干预博莱霉素诱导的肺间质纤维化大鼠模型,肺组织中超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-PX)活性明显高于其它各组(P<0.01),丙二醛(MDA)含量明显低于各药物干预组(P<0.01)。提示雄附散能够干预痰积毒蚀的过程可能与其早期提高受损组织中抗氧化酶活性,从而有效阻断氧自由基引发肺组织纤维化过程。对其机制还应进一步研究。更多还原

【Abstract】 Professor Ma Yu-chen thinks that rheumatosis-related interstitial lung disease can be considered as Arthromyodynia in lung from TCM theory. It is different from the common lung disease, such as chronic bronchitis, pulmonary emphysema and pneumonitis, which are characterized by cough, wheeze, phlegm and gasping. It has two individual features. Firstly, patients feel uncomfortable in limbs, which are called Arthromyodynia in five-ti. Patients may have arthralgia, joint deformities or muscle atrophy. Those destructions of joints coincide with the damage caused by "Toxin". Secondly, the lung symptoms persist for a long time and are easy to recur. These can be distinguished as phlegm syndromes. Besides, both CT manifestation and histopathology observation show the typical appearance of pulmonary fibrosis. The microscopic observation and the changes of its related immune indexes are in accordance with "Phlegm" and "Toxin" theories. In conclusion, rheumatosis-related interstitial lung disease can be considered as the consequence of invasion and turbid accumulation of "Toxin" and "Phlegm". So Professor Ma argues that a combination of expelling toxin and eliminating phlegm can be effective in the treatment of rheumatosis-related interstitial lung disease. This study was aimed to testify this view and to evaluate the efficacy of Xiongfusan on the treatment of rheumatosis-related interstitial lung disease by animal trial and clinical trial.In the clinical trial, a total of 63 patients diagnosed with rheumatosis-related interstitial lung disease from Department of rheumatology in our hospital were randomly assigned into two groups. There are 30 patients in control group treated with regular decoction, and 33 patients in treatment group treated with Xiongfusan. Three months was a treatment course. As a result, there was significant difference on effective rate (x2=6.7 P<0.05). There are significant differences between two groups in the symptoms, the lung function and CT manifestation. In the animal trial, we found that enzymatic activity of SOD and GSH-PX were obviously higher than other groups (P<0.01) and the level of MDA was lower (P<0.05) in the lung tissues of the herbal treatment group. These showed that Xiongfusan can promote the activity of antioxidant enzyme in the damaged tissue, stop the fibrosis process initiated by oxygen free radical. Its concrete mechanisms should be studied in the future.更多还原