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| 題名: | 尿毒症血液透析患者之中醫辨證分型及其基因表現之研究;The Study of Syndrome Types of Traditional Chinese Medicine and Differential Gene Expression in Uremic Patients with Long-Term Hemodialysis |
| 作者: | 陳嘉聖;CHEN CHIA-SHENG |
| 貢獻者: | 中國醫藥大學中國醫學研究所 |
| 關鍵詞: | 中醫辨證分型、尿毒症、血液透析、智能障礙、血清生化值、基因晶片、基因表現;Classical differential diagnosis of Traditional Chinese Medicine (TCM), uremia, hemodialysis, intelligent impairment, Serum bioc |
| 日期: | 2005 |
| 上傳時間: | 2010-01-28 14:56:48 (UTC+8) |
| 摘要: | 尿毒症血液透析患者之中醫辨證分型及其基因表現之研究 研究生 陳嘉聖 指導教授 陳光偉 教授 中國醫藥大學 中國醫學研究所 本研究之目的在探討尿毒症血液透析患者之中醫辨證分型：脾腎氣虛、脾腎陽虛、肝腎陰虛、氣陰兩虛、陰陽兩虛及非虛型共六型在臨床治療的價值和意義。本研究分析尿毒症血液透析患者之中醫辨證分型之偏向性，以及各個中醫證型與尿毒症血液透析患者的年齡、透析時間長短、尿毒症原發病因、罹患智能障礙情形、和其血清生化值之相關性，並且進一步研究尿毒症血液透析寒證患者之基因表現。 首先，將尿毒症血液透析患者紀錄其基本資料、透析時間長短、尿毒症原發病因等，然後依據慢性腎衰竭中醫辨證分型和療效判定標準調整為血液透析患者之中醫辨證分型，進行尿毒症血液透析患者中醫辨證分型臨床問卷評估，將血液透析患者之中醫證型和其基本資料數據進行統計分析。其次，運用簡易智能測驗(Mini-Mental Status Examination)問卷，分析尿毒症血液透析患者的智能狀況，並將其智能狀況與其中醫證型交叉分析。 研究結果發現：脾腎陽虛型和陰陽兩虛型此兩型病患的年齡較大及接受血液透析時間較長；而且此兩型的血液透析患者較其他中醫證型之簡易智能測驗分數較低。又再以自動分析儀分析尿毒症血液透析患者之中醫證型與血清生化值之關係，發現其中醫證型與大部份之血清生化值並無顯著差異，但是血清白蛋白與肌酸酐在脾腎陽虛型和陰陽兩虛型患者有顯著之降低現象，顯示此兩型病患之營養狀況較差或是存在著慢性發炎狀態。 最後，以基因晶片(complementary DNA microarray)來研究尿毒症血液透析患者之寒證患者對於非寒證患者的基因表現，並使用反轉錄多聚?鏈式反應(reverse transcription polymerase chain reaction)，來確認基因晶片篩選之基因表現。結果顯示尿毒症血液透析之寒證患者其基因表現方面：與發炎(inflammation)相關之基因(ALOX5AP、S100A8、S100A12)表達有上升；但與免疫(immunity)相關之基因(DEFA4)、新陳代謝(metabolism)相關之基因(GNG11、PYGB、PRKAR2B)及與生長增殖(growth/proliferation)相關之基因(HSF2、DDR2、TK1)等表達有下降。 綜合以上結果，顯示尿毒症血液透析患者年齡愈大，血液透析時間愈長，愈會出現脾腎陽虛及陰陽兩虛之表現，而且此兩型的尿毒症血液透析患者較容易罹患智能障礙，及出現營養不良狀況。此外尿毒症血液透析之寒證患者，其基因表現中，與發炎相關之基因表現上升。本研究結果可供中醫師臨床上對於尿毒症血液透析患者就診時診斷及處方用藥之參考，同時，也是中醫基礎理論研究走向分子生物層次的一個開端。 關鍵詞：中醫辨證分型、尿毒症、血液透析、智能障礙、血清生化值、基因晶片、基因表現; The Study of Syndrome Types of Traditional Chinese Medicine and Differential Gene Expression in Uremic Patients with Long-Term Hemodialysis Chia-Sheng Chen Major professor: Guang-Wei Chen Institute of Chinese Medical Science, China Medical University The aim of this study was to explore the association between the Traditional Chinese medicine (TCM) differential syndrome types of uremic patients with long-term hemodialysis (HD) and etiology of uremia, level of dementia and serum biochemical parameters. In addition, differential gene expression between the cold Zheng (CZ) and non-cold Zheng (NCZ) of uremic patients with long-term hemodialysis was investigated by complementary DNA (cDNA) microarray technology. According to the syndrome types criteria of TCM in chronic renal failure, the total 169 HD patients were classified into the following six types. They are: Chi deficiency of Spleen and Kidney (CDSK), Yang deficiency of Spleen and Kidney (YDSK), Yin deficiency of Liver and Kidney (YDLK), deficiencies of Chi and Yin (DCY), deficiencies of Yin and Yang (DYY) and Non-deficiency (ND). Then we evaluated the Mini-mental status examination (MMSE) for these HD patients. Fasting blood (5 ml) was drawn from each HD patient before the dialysis session for biochemical analysis. Results showed that both YDSK and DYY types of HD patients were older, having longer dialysis times and lower MMSE scores than the other types of HD patients. There were no significant differences between the syndrome types of HD patients for their serum biochemical parameters, with the exception of lower levels of albumin and creatinine in YDSK and DYY types, which could result from malnutrition or chronic inflammation state. Moreover, Hemodialysis (HD) patients were randomly selected from the CZ and NCZ groups. The between-group differences in gene expression were assessed using the cDNA microarray. Differential gene expression was further validated by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Results demonstrated that the inflammation-associated genes, such as ALOX5AP, S100A8 and S100A12 were up-regulated, and the genes related to immunity (DEFA4), metabolism (GNG11, PYGB, PRKAR2B), and growth/proliferation (HSF2, DDR2, TK1) were down-regulated in the CZ group. The CZ HD patients had significantly lower serum albumin levels compared with their NCZ counterparts (3.31±0.08 g/dL versus 4.18±0.12 g/dL). In conclusion, the YDSK and DYY types of HD patients were older, having longer dialysis period, intelligence impairment and malnutrition. Up-regulated inflammatory-gene expression (ALOX5AP, S100A8 and S100A12) may play an important role in CZ HD patients. These results could be useful for TCM physicians as diagnosing and treating the patients. |
| 顯示於類別: | [中國醫學研究所] 博碩士論文
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