益气养血通络法干预糖尿病视网膜病变的临床与实验研究
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摘要
本课题在全面文献整理分析的基础上,借助证素辨证的方法,对厦门地区231例单纯型糖尿病视网膜病变患者进行研究,主要通过采集患者的一般资料及中医四诊资料,运用证素软件进行数据录入,根据得出的证素采用恰当的统计学方法进行分析,以此寻找可能存在的不同于既往认识的病机特点,针对这一病机提出益气养血通络法治法,实验研究证实了该法对血-视网膜屏障的保护作用,并研究了其作用机制,以此丰富中医眼底疾病的理论和方法,从而提高防病治病能力。
一、临床研究
目的：研究厦门地区单纯型糖尿病视网膜病变患者证素特点,根据得出的病位、病性证素,运用统计学方法进行分析,揭示本病可能存在的不同于以往认识的病机特点,根据病机特点提出相应的治法,为进一步实验及临床研究提供科学依据。
方法：本研究借助证素辨证的方法,搜集厦门地区231例单纯型糖尿病视网膜病变患者的临床资料,将数据输入福建中医药大学证研究基地的证素辨证软件,从而得出单一病位、病性证素,在此基础上,采用因子分析方法从变量群中提取共性因子,将相同本质的变量归入一个因子进行分析,得出主要的证素组合。
结果：1、231例单纯型糖尿病视网膜病变患者病位证素比例最高的是肾(67.1%),其次是肝(46.3%),脾(23.8%)位居之后；2、231例单纯型糖尿病视网膜病变患者主要的实性病性证素有：痰(65.4%)、湿(63.2%)、热(56.3%)、血瘀(39.8%)、燥(21.6%)、气滞(16.5%)；主要的虚性病性证素有：阴虚(80.1%)、血虚(65.8%)、阳虚(59.3%)、气虚(52.4%)；3、231例单纯型糖尿病视网膜病变患者存在四个主要的证素组合,它们分别是：气血亏虚、阳虚血瘀,痰湿夹热,阴虚燥热,气滞血瘀。
结论：1、单纯型糖尿病视网膜病变患者的主要病位是肝肾,亦和脾有关；2、气血亏虚,阳虚血瘀络阻是单纯型糖尿病视网膜病变的病机特点之一。
二、实验研究
目的：根据气血亏虚,阳虚血瘀络阻是单纯型糖尿病视网膜病变的病机特点之一,提出益气养血通络法治法,选取当归补血汤加味进行治疗,研究了其对GK大鼠血-视网膜的作用及其机制。具体通过评价GK大鼠视网膜血管的渗漏情况以及当归补血汤加味对血-视网膜屏障的保护作用,在此基础上,进一步探讨当归补血汤加味干预糖尿病视网膜病变的作用机制。
方法：选用24周龄GK大鼠作为糖尿病动物模型,并设立Wistar大鼠为正常对照组,以导升明为阳性对照药,中药当归补血汤加味分为低、高两种浓度,对大鼠灌胃给药3个月后,检测以下指标：
1、体重、血糖、血脂情况；
2、采用尾静脉注射伊凡思蓝(EB)示踪观察血-视网膜屏障的渗漏情况,并观察各治疗组对其影响情况；
3、采用酶联免疫吸附法检测各组大鼠视网膜组织NF-KB的含量,观察各组大鼠NF-KB的激活情况,以及各治疗组对其影响情况。
结果：
1、体重：模型组与各治疗组的体重进行比较,差异无统计学意义(P>0.05)；
2、血糖：模型组及各治疗组的血糖高于正常对照组,差异有统计学意义(P<0.05)；模型组与各治疗组的血糖进行比较,差异无统计学意义(P>0.05)；
3、血脂：模型组及各治疗组的总胆固醇高于正常对照组,差异有统计学意义(P<0.05)；正常对照组、模型组与各治疗组的甘油三酯进行比较,差异无统计学意义(P>0.05)；
4、血-视网膜屏障渗透量：模型组大鼠视网膜组织渗透量高于正常对照组,差异有统计学意义(P<0.05)；导升明组、当归补血汤加味低剂量组的组织渗透量与模型组相比,差异无统计学意义(P>0.05)；当归补血汤加味高剂量组的组织渗透量与模型组相比,差异有统计学意义(P<0.05)
5、NF-κB的检测结果：模型组及各治疗组的NF-κB含量高于正常对照组,差异有统计学意义(P<0.05)；导升明组与模型组相比,差异无统计学意义(P>0.05)；当归补血汤加味低剂量组及高剂量组的含量与模型组相比,差异有统计学意义(P<0.05)。
结论：
1、采用自发性2型糖尿病GK大鼠模型,观察当归补血汤加味对其体重、血糖、血脂的影响,结果表明,当归补血汤加味对GK大鼠的体重、血糖、血脂基本无影响。
2、采用尾静脉注射伊凡思蓝的方法,观察当归补血汤加味对自发性2型糖尿病GK大鼠模型血-视网膜屏障的影响,结果表明,当归补血汤加味能降低GK大鼠血-视网膜屏障的渗漏,从而对糖尿病视网膜早期病变有预防及治疗作用。
3、采用酶联免疫吸附法,检测自发性2型糖尿病GK大鼠视网膜组织中NF-κB的含量,结果表明,GK大鼠视网膜组织存在着NF-κB的激活。
4、采用酶联免疫吸附法,观察当归补血汤加味对自发性2型糖尿病GK大鼠视网膜组织中NF-κB的影响,结果表明,当归补血汤加味抑制了GK大鼠NF-κB水平的升高,提示其可能通过抑制NF-κB的激活而对血-视网膜屏障起保护作用。
Based on fully study of previous researches, this study uses the method of syndrome factor to observe the clinical symptoms of231cases of patients with non-proliferative diabetic retinopathy in Xiamen area. We collected the patient's general information and the four diagnostic information of Traditional Chinese Medicine. The data were input into the syndrome factor software, and we analyzed the results rightly using statistical methods. The purpose was to find that there may be different pathogenesis characteristics from the previous understanding. We raise the appropriate treatment method for it, and we also confirm its protective effect on the blood-retinal barrier by observation in animal studies. The purpose is to enrich in the theory and method of retinal diseases, thereby improving the capacity of prevention and treatment of disease.
1. Clinical research
Purpose:We study the characteristics of clinical syndrome factor of non-proliferative diabetic retinopathy, and summarize the location and pathology of NDR to reveal the possible existence of different pathogenesis characteristics. Therefore, it can provide some basis for further experimental and clinical research.
Methods:This study uses the method of syndrome factor to observe the clinical symptoms of231cases of patients with non-proliferative diabetic retinopathy in Xiamen area. Data were input into the software of the research base of Fujian University of Traditional Chinese Medicine. We summarize the location and pathology of NDR, and analyze the results by factor analysis.
Results:1.Of the231cases of patients with non-proliferative diabetic retinopathy, the major location of NDR are kidney (67.1%), liver (46.3%), and spleen (23.8%).2. Of the231cases of patients with non-proliferative diabetic retinopathy, the major shi pathological elements are sputum (65.4%), wetlands (63.2%), fever (56.3%), blood stasis (39.8%), dry (21.6%), and Qi stagnation (16.5%); the major deficiency pathological elements are Yin deficiency (80.1%), blood deficiency (65.8%), Yang deficiency (59.3%) and Qi deficiency (52.4%).3. Of the231cases of patients with non-proliferative diabetic retinopathy, there are four syndrome elements, including Qi, blood, Yang deficiency and blood stasis, sputum, wetlands and fever, Yin deficiency and dry, Qi and blood stasis.
Conclusions:1. The major disease locations are liver, kidney and spleen;2. Blood deficiency, yang deficiency and blood stasis is one of the feature elements of the pathogenesis among NDR.
2. Experimental study
Purpose:Blood deficiency, yang deficiency and blood stasis is one of the feature elements of the pathogenesis among NDR, so nourishing Qi, blood and collaterals treatment are needed. To evaluate the leakage of the retinal vascular of GK rat and the protective effect of nourishing Qi, blood and collaterals on the blood retinal barrier. On this basis, to further explore the mechanism of nourishing Qi, blood and collaterals intervention of diabetic retinopathy.
Methods:24weeks of GK rats were selected as an animal model, and Wistar rats as the normal control group. Doxium was used as a positive control group. Chinese medicine decoction were divided into low and high concentrations. The rats administered orally for3months and studied as follow:1. To observe the body weight, blood glucose, blood lipids of rats in each group;2. By intravenous injection of Evans blue (EB) tracer to show the leakage of the blood retinal barrier and observe the effect in all treatment groups.3. To detect the content of NF-κB in the rat retinal tissue by enzyme-linked immunosorbent assay and observe the effect in all treatment groups.
Results:1. Weight:No significant difference between the weight of the model group and treatment groups in GK rats(P>0.05);2. Blood glucose:The model group and treatment groups were higher than the normal control group, the difference was statistically significant (P<0.05); there was no statistically significant difference between the model group and treatment groups (P>0.05);3. Lipids:Compared with the normal control group, the total cholesterol of the model group and treatment groups were higher, the difference statistically significant (P<0.05); the triglycerides among the normal control group, the model group and the treatment groups was no statistically significance (P>0.05).4. Blood retinal barrier permeability:the retinal penetration in model group was higher than normal control group, the difference statistically significant (P<0.05); By comparing the infiltration volume of Doxium group and the Chinese Medicine low dose model group, the difference was not statistically significant (P>0.05); By comparing the penetration of the organization of traditional Chinese medicine high dose group and model group, the difference was statistically significant (P<0.05).5. NF-κB test results:The content of the model group and treatment groups were higher than the normal control group, the difference was statistically significant (P<0.05); there was no statistically significant difference between Doxium group and model group (P>0.05); By comparing the content of low and high dose groups of Chinese medicine and the model group, the difference were statistically significant (P<0.05).
Conclusions:1. To observe the effect of Dang-gui-bu-xue tang to spontaneous type2diabetic GK rats model of their body weight, blood glucose, blood lipids, the results showed that Dang-gui-bu-xue tang had no effect on the weight, blood glucose and lipids of GK rats;2. To observe the effect of Dang-gui-bu-xue tang to spontaneous type2diabetic GK rats model of blood-retinal barrier by tail vein injection of Evans blue, the result showed that Dang-gui-bu-xue tang could reduce the leakage of blood retinal barrier of the GK rats, and thus the role of prevention and treatment of early diabetic retinopathy was obvious;3. To detect the content of NF-κB in the retinal of spontaneous type2diabetic GK rats model by enzyme-linked immunosorbent assay, the results showed that the retinal tissue of NF-κB of GK rats were activated.4. To detect the the effect of Dang-gui-bu-xue tang to NF-κB in the retinal of spontaneous type2diabetic GK rats model by enzyme-linked immunosorbent assay, the results showed that Dang-gui-bu-xue tang prevented the increased NF-κB level of GK rats, suggesting that by blocking the activation of NF-κB could protect the blood-retinal barrier.
一、临床研究
目的：研究厦门地区单纯型糖尿病视网膜病变患者证素特点,根据得出的病位、病性证素,运用统计学方法进行分析,揭示本病可能存在的不同于以往认识的病机特点,根据病机特点提出相应的治法,为进一步实验及临床研究提供科学依据。
方法：本研究借助证素辨证的方法,搜集厦门地区231例单纯型糖尿病视网膜病变患者的临床资料,将数据输入福建中医药大学证研究基地的证素辨证软件,从而得出单一病位、病性证素,在此基础上,采用因子分析方法从变量群中提取共性因子,将相同本质的变量归入一个因子进行分析,得出主要的证素组合。
结果：1、231例单纯型糖尿病视网膜病变患者病位证素比例最高的是肾(67.1%),其次是肝(46.3%),脾(23.8%)位居之后；2、231例单纯型糖尿病视网膜病变患者主要的实性病性证素有：痰(65.4%)、湿(63.2%)、热(56.3%)、血瘀(39.8%)、燥(21.6%)、气滞(16.5%)；主要的虚性病性证素有：阴虚(80.1%)、血虚(65.8%)、阳虚(59.3%)、气虚(52.4%)；3、231例单纯型糖尿病视网膜病变患者存在四个主要的证素组合,它们分别是：气血亏虚、阳虚血瘀,痰湿夹热,阴虚燥热,气滞血瘀。
结论：1、单纯型糖尿病视网膜病变患者的主要病位是肝肾,亦和脾有关；2、气血亏虚,阳虚血瘀络阻是单纯型糖尿病视网膜病变的病机特点之一。
二、实验研究
目的：根据气血亏虚,阳虚血瘀络阻是单纯型糖尿病视网膜病变的病机特点之一,提出益气养血通络法治法,选取当归补血汤加味进行治疗,研究了其对GK大鼠血-视网膜的作用及其机制。具体通过评价GK大鼠视网膜血管的渗漏情况以及当归补血汤加味对血-视网膜屏障的保护作用,在此基础上,进一步探讨当归补血汤加味干预糖尿病视网膜病变的作用机制。
方法：选用24周龄GK大鼠作为糖尿病动物模型,并设立Wistar大鼠为正常对照组,以导升明为阳性对照药,中药当归补血汤加味分为低、高两种浓度,对大鼠灌胃给药3个月后,检测以下指标：
1、体重、血糖、血脂情况；
2、采用尾静脉注射伊凡思蓝(EB)示踪观察血-视网膜屏障的渗漏情况,并观察各治疗组对其影响情况；
3、采用酶联免疫吸附法检测各组大鼠视网膜组织NF-KB的含量,观察各组大鼠NF-KB的激活情况,以及各治疗组对其影响情况。
结果：
1、体重：模型组与各治疗组的体重进行比较,差异无统计学意义(P>0.05)；
2、血糖：模型组及各治疗组的血糖高于正常对照组,差异有统计学意义(P<0.05)；模型组与各治疗组的血糖进行比较,差异无统计学意义(P>0.05)；
3、血脂：模型组及各治疗组的总胆固醇高于正常对照组,差异有统计学意义(P<0.05)；正常对照组、模型组与各治疗组的甘油三酯进行比较,差异无统计学意义(P>0.05)；
4、血-视网膜屏障渗透量：模型组大鼠视网膜组织渗透量高于正常对照组,差异有统计学意义(P<0.05)；导升明组、当归补血汤加味低剂量组的组织渗透量与模型组相比,差异无统计学意义(P>0.05)；当归补血汤加味高剂量组的组织渗透量与模型组相比,差异有统计学意义(P<0.05)
5、NF-κB的检测结果：模型组及各治疗组的NF-κB含量高于正常对照组,差异有统计学意义(P<0.05)；导升明组与模型组相比,差异无统计学意义(P>0.05)；当归补血汤加味低剂量组及高剂量组的含量与模型组相比,差异有统计学意义(P<0.05)。
结论：
1、采用自发性2型糖尿病GK大鼠模型,观察当归补血汤加味对其体重、血糖、血脂的影响,结果表明,当归补血汤加味对GK大鼠的体重、血糖、血脂基本无影响。
2、采用尾静脉注射伊凡思蓝的方法,观察当归补血汤加味对自发性2型糖尿病GK大鼠模型血-视网膜屏障的影响,结果表明,当归补血汤加味能降低GK大鼠血-视网膜屏障的渗漏,从而对糖尿病视网膜早期病变有预防及治疗作用。
3、采用酶联免疫吸附法,检测自发性2型糖尿病GK大鼠视网膜组织中NF-κB的含量,结果表明,GK大鼠视网膜组织存在着NF-κB的激活。
4、采用酶联免疫吸附法,观察当归补血汤加味对自发性2型糖尿病GK大鼠视网膜组织中NF-κB的影响,结果表明,当归补血汤加味抑制了GK大鼠NF-κB水平的升高,提示其可能通过抑制NF-κB的激活而对血-视网膜屏障起保护作用。
Based on fully study of previous researches, this study uses the method of syndrome factor to observe the clinical symptoms of231cases of patients with non-proliferative diabetic retinopathy in Xiamen area. We collected the patient's general information and the four diagnostic information of Traditional Chinese Medicine. The data were input into the syndrome factor software, and we analyzed the results rightly using statistical methods. The purpose was to find that there may be different pathogenesis characteristics from the previous understanding. We raise the appropriate treatment method for it, and we also confirm its protective effect on the blood-retinal barrier by observation in animal studies. The purpose is to enrich in the theory and method of retinal diseases, thereby improving the capacity of prevention and treatment of disease.
1. Clinical research
Purpose:We study the characteristics of clinical syndrome factor of non-proliferative diabetic retinopathy, and summarize the location and pathology of NDR to reveal the possible existence of different pathogenesis characteristics. Therefore, it can provide some basis for further experimental and clinical research.
Methods:This study uses the method of syndrome factor to observe the clinical symptoms of231cases of patients with non-proliferative diabetic retinopathy in Xiamen area. Data were input into the software of the research base of Fujian University of Traditional Chinese Medicine. We summarize the location and pathology of NDR, and analyze the results by factor analysis.
Results:1.Of the231cases of patients with non-proliferative diabetic retinopathy, the major location of NDR are kidney (67.1%), liver (46.3%), and spleen (23.8%).2. Of the231cases of patients with non-proliferative diabetic retinopathy, the major shi pathological elements are sputum (65.4%), wetlands (63.2%), fever (56.3%), blood stasis (39.8%), dry (21.6%), and Qi stagnation (16.5%); the major deficiency pathological elements are Yin deficiency (80.1%), blood deficiency (65.8%), Yang deficiency (59.3%) and Qi deficiency (52.4%).3. Of the231cases of patients with non-proliferative diabetic retinopathy, there are four syndrome elements, including Qi, blood, Yang deficiency and blood stasis, sputum, wetlands and fever, Yin deficiency and dry, Qi and blood stasis.
Conclusions:1. The major disease locations are liver, kidney and spleen;2. Blood deficiency, yang deficiency and blood stasis is one of the feature elements of the pathogenesis among NDR.
2. Experimental study
Purpose:Blood deficiency, yang deficiency and blood stasis is one of the feature elements of the pathogenesis among NDR, so nourishing Qi, blood and collaterals treatment are needed. To evaluate the leakage of the retinal vascular of GK rat and the protective effect of nourishing Qi, blood and collaterals on the blood retinal barrier. On this basis, to further explore the mechanism of nourishing Qi, blood and collaterals intervention of diabetic retinopathy.
Methods:24weeks of GK rats were selected as an animal model, and Wistar rats as the normal control group. Doxium was used as a positive control group. Chinese medicine decoction were divided into low and high concentrations. The rats administered orally for3months and studied as follow:1. To observe the body weight, blood glucose, blood lipids of rats in each group;2. By intravenous injection of Evans blue (EB) tracer to show the leakage of the blood retinal barrier and observe the effect in all treatment groups.3. To detect the content of NF-κB in the rat retinal tissue by enzyme-linked immunosorbent assay and observe the effect in all treatment groups.
Results:1. Weight:No significant difference between the weight of the model group and treatment groups in GK rats(P>0.05);2. Blood glucose:The model group and treatment groups were higher than the normal control group, the difference was statistically significant (P<0.05); there was no statistically significant difference between the model group and treatment groups (P>0.05);3. Lipids:Compared with the normal control group, the total cholesterol of the model group and treatment groups were higher, the difference statistically significant (P<0.05); the triglycerides among the normal control group, the model group and the treatment groups was no statistically significance (P>0.05).4. Blood retinal barrier permeability:the retinal penetration in model group was higher than normal control group, the difference statistically significant (P<0.05); By comparing the infiltration volume of Doxium group and the Chinese Medicine low dose model group, the difference was not statistically significant (P>0.05); By comparing the penetration of the organization of traditional Chinese medicine high dose group and model group, the difference was statistically significant (P<0.05).5. NF-κB test results:The content of the model group and treatment groups were higher than the normal control group, the difference was statistically significant (P<0.05); there was no statistically significant difference between Doxium group and model group (P>0.05); By comparing the content of low and high dose groups of Chinese medicine and the model group, the difference were statistically significant (P<0.05).
Conclusions:1. To observe the effect of Dang-gui-bu-xue tang to spontaneous type2diabetic GK rats model of their body weight, blood glucose, blood lipids, the results showed that Dang-gui-bu-xue tang had no effect on the weight, blood glucose and lipids of GK rats;2. To observe the effect of Dang-gui-bu-xue tang to spontaneous type2diabetic GK rats model of blood-retinal barrier by tail vein injection of Evans blue, the result showed that Dang-gui-bu-xue tang could reduce the leakage of blood retinal barrier of the GK rats, and thus the role of prevention and treatment of early diabetic retinopathy was obvious;3. To detect the content of NF-κB in the retinal of spontaneous type2diabetic GK rats model by enzyme-linked immunosorbent assay, the results showed that the retinal tissue of NF-κB of GK rats were activated.4. To detect the the effect of Dang-gui-bu-xue tang to NF-κB in the retinal of spontaneous type2diabetic GK rats model by enzyme-linked immunosorbent assay, the results showed that Dang-gui-bu-xue tang prevented the increased NF-κB level of GK rats, suggesting that by blocking the activation of NF-κB could protect the blood-retinal barrier.
引文
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