艾滋病元?dú)馓摀p證機(jī)的研究.pdf

1、艾滋病是由人類免疫缺陷病毒(human immunodeficiency virus,HIV)感染所導(dǎo)致的以進(jìn)行性CD<,4><'+>細(xì)胞數(shù)量減少與功能受損為特征的機(jī)體免疫缺陷、并易繼發(fā)多種機(jī)會(huì)性感染和腫瘤的一系列綜合征.該病潛伏期長(zhǎng)、傳播速度快、病情復(fù)雜深重,目前仍無法治愈,成為當(dāng)今世界矚目的課題.中醫(yī)關(guān)于艾滋病的研究尚處于探索階段,特別是通過艾滋病大宗病例的臨床證候觀察進(jìn)行病因病機(jī)探討、中醫(yī)藥治療艾滋病的臨床試驗(yàn)與療效評(píng)價(jià)等方面研究

2、還十分薄弱.為此,該研究通過對(duì)72例艾滋病患者常見中醫(yī)癥候/證候及218例舌象的觀察,運(yùn)用中醫(yī)元?dú)饫碚撆c溫疫理論作指導(dǎo),分析其病因病機(jī)及演變規(guī)律,并以疫毒致元?dú)馓摀p的證機(jī)作為重點(diǎn)進(jìn)行深入探討;同時(shí),通過觀察72例患者外周血CD<,4><'+>、CD<,8><'+>、CD<,45>RA<'+>T淋巴細(xì)胞亞群改變,分析艾滋病免疫損傷與元?dú)馓摀p的相關(guān)性,以探索艾滋病元?dú)馓摀p的細(xì)胞免疫學(xué)基礎(chǔ),也為中醫(yī)微觀辨證提供線索;此外,借助艾滋病"十五"國(guó)

3、家科技攻關(guān)課題,通過益氣養(yǎng)陰、清熱解毒法治療6 3例早中期HIV/AIDS患者臨床隨機(jī)雙盲對(duì)照試驗(yàn)的療效觀察,佐證溫邪疫毒致氣陰損傷、元?dú)馓澨撌前滩〔∽冞^程中重要病機(jī)之一.該研究還采用益氣養(yǎng)陰、清熱解毒法,對(duì)63例早中期HI V/AIDS患者進(jìn)行臨床隨機(jī)雙盲對(duì)照試驗(yàn)的療效觀察,臨床結(jié)果初步分析顯示(未揭盲情況下):①對(duì)HIV病毒載量的影響,63例患者總體觀察結(jié)果,總有效29例、占46.03％,初步顯示該方案可能具有一定降低HIV病毒載

4、量作用.②對(duì)機(jī)體免疫功能的影響,63例患者中,CD<,4><'+>細(xì)胞數(shù)上升者20例(31.75％),下降者43 例(68.25％),表明該益氣養(yǎng)陰、清熱解毒法方案對(duì)機(jī)體免疫功能可能有一定保護(hù)作用.③在臨床癥候方面,乏力、消瘦、少氣懶言、自汗、盜汗、脫發(fā)、咳嗽、氣短/氣喘、納呆、腹瀉、低熱、五心煩熱等,63例患者總體發(fā)生率治療前后初步分析,顯示有不同程度的降低,說明該治療方法對(duì)上述主要癥候有一定改善作用.通過上述研究初步揭示,艾滋病中醫(yī)

5、病變特點(diǎn)為病及三焦內(nèi)外、病性虛實(shí)錯(cuò)雜;艾滋病早中期中醫(yī)證機(jī)特點(diǎn)為熱毒濁瘀、氣陰兩傷、元?dú)馓摀p;艾滋病病變發(fā)展趨勢(shì)呈現(xiàn)出命門三焦元?dú)馑ソ摺⑻撜哂?熱毒濁瘀阻遏三焦、實(shí)者愈實(shí);以扶正祛邪為原則的益氣養(yǎng)陰、清熱解毒法是艾滋病早中期有效治法之一,從而佐證了溫邪疫毒致氣陰損傷、元?dú)馓摀p是艾滋病病變發(fā)展過程中重要證機(jī)之一,也為探索艾滋病從腎命元?dú)馓撍楸尽⑿岸緸闃?biāo)的診治體系提供了重要依據(jù).主題詞:艾滋病 元?dú)鈸p傷 證候 病機(jī) 扶正祛邪 療效評(píng)價(jià)

6、Exploring the pathogenesis of AIDSin yuan qi deficiency in TCM(Abstract)AIDSis anacquiredimmunodeficiencysyndrome, which iscaused by HIV(human immunodeficiency virus).It makesCD4 counts down and makes body' s immunodefic

7、iency.It causesa series of complex syndromes, such asmany opportunity infections and cancers. There is no cure on AIDS in the world, AIDSwithalonglatentperiod and transmit quickly has became a mainly terrible problem. Th

8、e research on treatment of AIDS in TCM is on the primary stage,lacking ofmass samples of clinical trail, no criterion of the efficacy, and the weakness of the research onexperiment. According to the theory of yuan qi in

9、TCM we observed TCM syndromes with 72 cases and tongues with 218 cases, to analyzethe pathogenesis and its evolutive regulars, as well as toresearchCD4+、 CD8+、 CD45RA+count' s changes, to investigatetherelativitybetweeny

10、uan qi deficiency and immune function, to explore the bases of immune cell of yuan qi and microcosmic different syndromes. The programis one of the national scientific tackle key project, using supplement qi and nourish

11、yin and clearingaway heat and toxic material method treating 63HIV/AIDS with double blind, random, control group clinical research, finding the deficiency of yuan qi is the important pathogenesis of AIDS. In order to fin

12、d the development of yuan qi theory in TCM, firstly we consulted all interrelated literatures. Secondly, we explored the relation betweenyuan qi and AIDSon the basis ofour clinical experience. From these researches, we f

13、ound the infections epidemic diseases'happening ,developing, pathogenesis, prognosis is determined bythe deficiency and excess of yuan qi, such as AIDS.We observed the TCM syndromes of 72 cases by the clinical epidemiolo

14、gy crossing method, analyzing the results we found thatmore than half patients had fever, tired, spontaneous perspiration night sweat,anorexia emaciated, cough, diarrhea and so on. Slippery pulse, threadypulse, kinds of

15、feebly pulses are all appeared in these patients. The syndromes of red tongue, deep red tongue, lingua geographica,curdy tongue coating are very ordinary in these patients by analyzing the 218cases,which has a significan

16、ce between HIV/AIDS patients and normal persons. (P<0.0001).These research shows that thepathogenesisof AIDS in TCM is deficiency complicated with excess; involvingtri-jiao;includingwei ,qi ,ying,xue; deficiencyqi, wue,y

17、in,yang.The regular of syndrome is complex with yin and yang ,fever and cold ,deficiency and excess. Analyzing the TCM syndromes of72 caseswe find that all of these patientshadfever,turbid pathogenic factor accounting fo

18、r 81.95％;blood stasis accountingfor 44.44％; deficiency yin accountingfor 62.50％;deficiency qi accountingfor 63.89％; deficiency yang accountingfor 13.89％. These results showed that TCM syndrome of AIDS is caused by accumu

19、lation of heat in the interior, deficiency of both qi and yin, body resistance weakened while pathogenic factors prevailing,deficiency complicated with excess. There is a affinity between deficient qi and the body' s imm

20、une function deficiency by the relativity research of TCM syndrome and immune function. T cell counts is very important for the feedback of immune function, which also may bea indexfordeficient qi. In these patientswho s

21、tagnated blood weremore serious on stagnated blood with the development of AIDS. Using the methods of supplementing qi and nourishing yin, clearing away heat and toxic material in treating 63 cases with double blind, ran

22、dom,control clinical trial, we primarily discovered the Chinese therapeusis (supplementingqi and nourishingyin and clearing away heat and toxic material) maybe reduce viral load, enhance the body' s immune function and i

23、mprove patients' symptoms. Though these exploration we think that the TCM pathogenesis of AIDS is deficiency complicated with excess, involvingtri-jiao, regularity of TCM syndrome is accumulation of heat in the interior,

24、 deficiency qi and yin. Supplementingqi and nourishingyin and clearing away heat and toxic material are effective treatments. Yuan qi deficiency in origin is a very important pathogenesis in AIDS. key words :AIDS, defici