【作者】 周玉娟；

【导师】 甘君学；

【作者基本信息】 南京中医药大学 ， 中医学， 2010， 硕士

【摘要】 高脂血症是指血清(或血浆)中一种或几种脂质浓度明显升高。而血脂过高是引起心脑血管疾病的原因之一,其中胆固醇的升高是引起冠心病、动脉粥样硬化等心血管疾病的重要因素。而高胆固醇血症是高脂血症西医分型中的一种。随着社会的发展,人们生活水平提高的同时,工作、家庭压力也在增大,这都导致了人们饮食结构及生活习惯的改变,最终引起高脂血症的发生率逐年增高和向中年人群发展的趋势。人们也逐渐地认识到胆固醇异常是冠心病的重要、独立的危险因素。因此,如何防治高胆固醇血症,特别是探索非药物调脂的有效方法,对防治心脑血管疾病的发生与发展有着尤为重要的意义。目前针灸在治疗高胆固醇血症方面有着很好的调脂效果。但根据有关这方面的文献统计,穴位、针灸方法及疗程长短的选择都有很大差异,临床治疗上难以规范应用。本试验采用正交试验方法设计,探寻出针灸临床治疗高胆固醇血症的最优方案。目的：通过采用不同针灸方法、选取不同经穴、配合不同疗程治疗高胆固醇血症,观察并比较治疗前、后临床效果及总胆固醇(TC)水平的变化，通过总结疗效结果,进行统计学处理、分析,从而探寻出针灸治疗高胆固醇血症的最佳组合方案。方法：参照《中药新药临床研究指导原则》治疗高胆固醇血症的临床研究指导原则。选择3因素3水平的正交试验设计法,应用L9(34)正交试验用表,对符合试验条件的高胆固醇血症患者,采用随机分配方法,分为脾胃经穴+艾灸+治疗1个疗程组、脾胃经穴+、电针+治疗2个疗程组、脾胃经穴+穴位注射+治疗3个疗程组、背俞穴+艾灸+治疗2个疗程组、背俞穴+电针+治疗3个疗程组、背俞穴+穴位注射+治疗1个疗程组、任脉经穴+艾灸+治疗3个疗程组、任脉经穴+电针+治疗1个疗程组、任脉经穴+穴位注射+治疗2个疗程组,每组收取5例患者,共计45例。本试验研究中患者在治疗期间保持原有的饮食、生活习惯,不服用任何影响血脂代谢的药物,治疗前、后分别采血检测总胆固醇(TC)指标。结果：通过正交试验的统计结果提示：所有组对降低血清TC值均有效果,其中以脾胃经穴+艾灸+治疗3个疗程的组合为最优(FC> FB> FA, KA1> KA3> KA2, KB1> KB3 >KB2, KC3>KC2>KC1);所有组的治疗后较治疗前中医症候积分均有不同程度下降,即所有组对各年龄层次的高胆固醇血症患者临床表现出的眩晕、头痛、胸闷、心悸、肢麻、纳差等症候均有不同程度的改善,但其中以任脉经穴+艾灸+治疗3个疗程这一组合(FC>FA>FB, KA3>KA1>KA2, KB1>KB2>KB3, KC3>KC2>KC1),对减轻高胆固醇血症患者的临床症候表现效果最佳。结论：(1)所有组对降低血清TC值均有效果,其中以脾胃经穴+艾灸+治疗3个疗程的组合最优；(2)所有组对各年龄层次的高胆固醇血症患者临床表现出的眩晕、头痛、胸闷、心悸、肢麻、纳差等症候均有不同程度的改善,其中以任脉经穴+艾灸+治疗3个疗程这一组合,对减轻高胆固醇血症患者的临床症候表现效果最优。更多还原

【Abstract】 Hyperlipidemia is refers to the serum (or plasma) one or several lipid concentration significantly increased. While high blood is one of the reasons for causing cerebrovascular and heart disease. The part of the cholesterol rising is the most important factor of causing CHD, atherosclerosis. Etc. With the development of society, people’s living standards improved at the same time, and the pressure from work or family increased. These are carrying the changes in the diet and lifestyles. Finally, resulting in the raising of the incidence of hyperlipidemia and making it much younger. People also gradually realize dyslipidemia is the important and independent risk factor of CHD. Therefore, how to prevent against the hyperlipidemia, especially the effective method of non-drugs, is a particularly important meaning in cerebrovascular disease. Now in the treatment of acupuncture and moxibustion in hyperlipidemia has a very good effect of adjusting lipid. But according to the relevant literature, there are very big differences during the uses of points, methods and period of treatment on the clinical application. So I choose the orthogonal experiment in order to explore the optimal combination of acupuncture treatment on hypercholesterolemia.Objective:By using different acupuncture methods, choosing different acupuncture points and different periods of treatment on treating hypercholesterolemia. Observing the magnitudes of total cholesterol (TC) before and after the treatment and comparing the clinical effect. Through summarizing the results to explore the optimal combination of acupuncture therapy hypercholesterolemia.Methods:According to "The Chinese herbal medicine clinical research guiding principles" for the treatment of hypercholesterolemia clinical research guiding principle. Choosing 3 factors and 3 levels of the orthogonal test design. The application of L9(34)orthogonal test table, using random distribution method to the patients with hypercholesterolemia as points of spleen, stomach and pericardial meridian+moxibustion+1 period of treatment; points of spleen, stomach and pericardial meridian+electro acupuncture+2 periods of treatment; points of spleen, stomach and pericardial meridian+point injection+3 periods of treatment; Back-shu points+moxibustion+2 periods of treatment; Back-shu points+electro acupuncture+3 periods of treatment; Back-shu points+point injection+1 period of treatment; points of Conception Vessel+moxibustion+3 periods of treatment, points of Conception Vessel+electro acupuncture+1 period of treatment; points of Conception Vessel+point injection+2 periods of treatment; and five patients each group, totaling 45 patients. During the treatment, patients can keep the original diet and lifestyles, not taking any drugs that can make influence to blood metabolism. Before and after treatment, they should draw blood for a test of TC.Results:Through the results of the orthogonal test:all groups could reduce the magnitude of TC. The optimal combination is the points of spleen, stomach and pericardial meridians+ moxibustion+3 periods of treatment(FC>FB>FA, KA1>KA3>KA2, KB1>KB3>KB2, KC3>KC2>KC1). All groups’ symptoms of TCM are relieved after the treatment. But the optimal combination is points of Conception Vessel+moxibustion+3 periods of treatment (FC >FA>FB, KA3>KA1>KA2, KB1>KB2>KB3, KC3>KC2>KC1).Conclusion:(1) All groups could reduce the magnitude of TC. The optimal combination is the points of spleen, stomach and pericardial meridians+moxibustion+3 periods of treatment;(2) All groups’ symptoms of TCM are relieved after the treatment. But the optimal combination is points of Conception Vessel+moxibustion+3 periods of treatment.更多还原