臺灣博碩士論文加值系統

糖尿病是全世界罹患人口最多的疾病之一，其所造成的併發症困擾著許多人也耗費龐大的醫療成本。對眼部方面，糖尿病視網膜病變與白內障是造成正值工作年齡之成年人後天失明最主要的原因。本研究利用streptozotocin誘導Spague-Dawley大鼠做為糖尿病眼部病變的動物模式，並投予枸杞與菊花兩種傳統中草藥為期8週，研究它們對視網膜病變以及白內障的影響。結果發現實驗期間大鼠一直維持在高血糖的狀態，糖尿病大鼠出現生長遲滯，體重隨著時間而逐漸減少，且體內醣類代謝指標糖化血紅素濃度隨時間逐漸上升。水晶體病變方面，白內障最早於糖尿病後第2週便可發現細小空泡化的形成，水晶體混濁的區域也隨時間慢慢的進展增加，病理檢查下發現水晶體除了空泡化外，還有異常的赤道區細胞增生與移行等現象。視網膜病變方面，視網膜電波圖功能之檢查發現糖尿病8週後a波與b波振幅皆顯著地下降，以及b波誘發時間延遲等情況。配合組織病理檢查發現視網膜異常的微血管突起、與感光細胞層空洞等發現，以及免疫組織化學染色所偵測到Müller cells不正常的表現glial fibrillary acidic protein (GFAP)等現象，代表糖尿病時視網膜出現功能異常與神經細胞傷害的證據。研究發現枸杞與菊花在糖尿病程的早期能減緩體重下降的速度與程度，而且枸杞能有效阻止糖尿病8週後大鼠視網膜電波圖a波與b波振幅的降低，對於神經細胞功能具有保護的效果。但是枸杞與菊花對於白內障的惡化、視網膜組織病理與糖尿病後期體重等影響皆不大。

Diabetes mellitus (DM) is a disease characterized by impaired glucose metabolism that affects all tissue in the body, including the lens and retina of the eye. Diabetic cataract and retinopathy are major ocular diseases caused by chronic hyperglycemia. In this study, streptozotocin (STZ) was intraperitoneally injected to 8 weeks old Spague-Dawley rats. Cataract formation, eletroretinography, retinal angiography and histopathology were observed and studied in the rats for a period of 8 weeks. Two Chinese herbal medicines, Lycium barbarum (Gou Qi Zi) And Chrysanthemum morifolium extract, were administrated to assess the effects of diabetic ocular complications. The cataractogenic process of lens was observed from 2nd week following streptozotocin induction, and the process was not significantly delayed by Chrysanthemum or Lycium group. Electroretinographic alternations were observed in diabetic group compared to control group 8 weeks after diabetes, the amplitudes of a- and b-waves were significantly decreased and the implicit time of b-wave was significantly delayed. However, the reductions of of a- and b-wave amplitudes were not observed in the Lycium group. Histopathological study and retinal angiography were also examined for morphologic changes and neovascularization, but no significant differences between herb-treated groups and un-treated group in diabetic rats. The results suggested that Lycium has a protective role in diabetic retinopathy.

中文摘要.......................................................1.
英文摘要.......................................................2.
第一章 緒言.......................................................3.
第一節 糖尿病與糖尿病眼部病變....................................3.
第二節 糖尿病與中草藥之應用......................................3.
第三節 研究目的..................................................4.
第二章 文獻探討....................................................5.
第一節 糖尿病視網膜病變與目前治療策略之介紹.....................5.
第1-1節 視網膜病變.............................................5.
第1-2節 治療策略...............................................9.
第二節 糖尿病視網膜病變生理病理機制之研究探討....................9.
第2-1節 糖尿病視網膜血管系統之變化.............................9.
第2-2節 糖尿病視網膜神經系統之變化............................12.
第三節 糖尿病水晶體病變生理病理機制之研究探討....................18.
第四節 枸杞與菊花成份與作用之介紹................................20.
第三章 實驗材料與方法..............................................21.
第一節 實驗動物..................................................21.
第二節 糖尿病大鼠模式建立方式....................................21.
第三節 實驗材料與分組............................................21.
第四節 糖尿病大鼠之生理紀錄......................................22.
第五節 白內障之記錄與分級........................................23.
第六節 水晶體中山梨醇(sorbitol)之測定..............................23.
第七節 視網膜電波圖之紀錄與分析..................................24.
第八節 組織病理學切片評估........................................24.
第九節 GFAP免疫組織化學染色評估.................................25.
第十節 視網膜血管螢光造影的影像學分析............................26.
第十一節 統計與分析方法..........................................26.
第四章 實驗結果....................................................28.
第一節 大鼠之各項生理紀錄分析結果................................28.
第1-1節 體重之變化............................................28.
第1-2節 血糖之變化............................................32.
第1-3節 糖化血紅素百分比之變化................................36.
第二節 白內障記錄與分級之分析結果................................38.
第三節 水晶體中山梨醇(sorbitol)之測定結果..........................43.
第四節 視網膜電波圖之分析比較結果................................45.
第4-1節 視網膜電波圖a波......................................45.
第4-2節 視網膜電波圖b波......................................51.
第五節 組織病理之分析比較結果....................................56.
第5-1節 視網膜各層厚度比較....................................56.
第5-2節 GFAP表現結果.........................................59.
第5-3節 視網膜型態之檢查......................................60.
第5-4節 水晶體型態之檢查......................................62.
第六節 視網膜血管螢光造影........................................64.
第五章 討論......................................................65.
第一節 糖尿病大鼠模式之建立......................................65.
第1-1節 糖尿病的動物模式......................................65.
第1-2節 誘導糖尿病之藥物選擇..................................67.
第二節 中草藥之藥性評估..........................................69.
第2-1節 生理代謝變化之討論....................................69.
第2-2節 白內障惡化之討論......................................73.
第2-3節 視網膜電波圖之討論....................................74.
第2-4節 視網膜與水晶體組織病理變化之討論......................76.
第六章 結論......................................................81.
第七章 參考文獻....................................................82.

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