【作者】 李建保；

【导师】 刘小凡；

【作者基本信息】 成都中医药大学 ， 中医儿科学， 2010， 博士

【摘要】 目的：研究小儿防哮敷贴粉穴位敷贴对哮喘豚鼠气道慢性炎症的作用机制及其治疗小儿哮喘的临床疗效。方法：实验研究：将60只健康豚鼠随机分为正常组、模型组、治疗组1组和2组,每组15只。正常组自然喂养,其余3组采用卵蛋白致敏法建立哮喘豚鼠模型。其中模型组进行哮喘造模,不敷贴治疗；治疗1组于哮喘造模第1天起,在豚鼠背部由颈根部起,做3cm×3cm剃毛,用小儿防哮敷贴粉敷贴治疗,每日1次,每次30分钟,共10天；治疗2组哮喘造模,并于雾化激发第11天起,给予小儿防哮敷贴粉敷贴治疗,方法同治疗1组。实验结束24小时内取血,采用酶联免疫吸附试验双抗体夹心法测定血清IL-4、IFN-γ、LXA4含量。临床研究：118例哮喘缓解期患儿分别在夏季三伏天(一伏、二伏、三伏的第一天)予以小儿防哮敷贴粉敷贴大椎穴、肺俞穴和膏肓穴治疗,每次敷贴4-6小时。敷贴治疗结束后一年内观察患儿哮喘发作次数、发作程度以及哮喘治疗用药变化。结果：实验研究：(1)小儿防哮敷贴粉敷贴治疗1组、2组哮喘豚鼠引喘潜伏期较模型组均明显延长,相比有显著性差异(P<0.01)；(2)模型组、敷贴治疗1组和2组豚鼠血清IL-4水平均较正常对照组增高,相比具有显著性差异(P<0.01),但治疗1组、2组与模型组之间比较无显著性差异(P>0.05)；(3)敷贴治疗1组和2组与模型组比较血清IFN-y水平均增高,有显著性差异(P<0.01),但治疗1、2组之间无显著性差异(P>0.05)；(4)敷贴治疗1组豚鼠血清LXA4水平较正常对照组、模型组和治疗2组明显增高,具有显著性差异(P<0.01),但正常组、模型组和治疗2组之间无显著性差异(P<0.01)临床研究：患者敷贴治疗后哮喘发作次数、发作程度、哮喘控制用药与治疗前相比均明显减少或减轻,有显著性差异(P<0.01)结论：实验研究：(1)小儿防哮敷贴粉可以有效延长哮喘豚鼠引喘潜伏期,减轻哮喘症状及预防哮喘复发；(2)小儿防哮敷贴粉对哮喘气道慢性炎症密切相关的细胞因子IL-4未见明显影响；(3)小儿防哮敷贴粉对哮喘豚鼠IFN-γ分泌有促进作用,从而间接起到调节Th1/Th2平衡作用；(4)小儿防哮敷贴粉早期敷贴治疗对哮喘豚鼠LXA4释放有较强的促进作用,可调节机体内LXA4发挥广泛的抗炎促消散作用。临床研究：小儿防哮敷贴粉三伏天穴位敷贴治疗,可有效改善患儿临床症状,减少哮喘发作次数和哮喘控制用药,延长哮喘缓解期。更多还原

【Abstract】 ObjectiveStudy the influence of Acupoint Application Therapy(AAT) in bronchial asthma(BA) airway inflammation of BA Guinea-Pigs treated with Child Fangxiao Application Powder(CFAP), and the clinical effects of AAT with CFAP in Children with BA.MethodExperimental research:60 healthy guinea pigs were devided randomly into four groups:normal control group, BA model group, the first group with AAT and the second group. The three groups except normal control grouop were established BA Model Guinea-Pigs allergized with OVA. The BA model group did not make a Acupoint Application Therapy. The first group was treated with CFAP on the special acupoint on the back and neck where the hair was removed in 3cm×3cm square from the first day of BA molding made, Meanwhile, the second group was given the same therapy from the 11th days of aerosol inhalation with OVA. The two groups were treated for 30 minutes, one time per day and ten days continuously. Within 24 hours at the end of experiment, we took the sample blood to detect IL-4, IFN-y and LXA4 with the way of enzyme linked immunosorbent assay-sandwich technique.Clinical research:118 cases of childhood asthma in remission stage were given Acupoint Application therapy with CFAP on dog days in summer. The acupoints are DAzhui, Feishu and Gaohuang. Time:Every time for 4-6 hours. After the treatment we observe the changes of asthmatic attack times, degree and control drugs within one year.ResultExperimental research:(1) The period of asthma induction was prolonged obviously in the first group with AAT and the second group(P<0.01); (2)The level of IL-4 in three groups were significantly higher than that of normal control group (P<0.01). However, there was no difference in the level of IL-4 among the three groups (P>0.05); (3) The level of IFN-y in the first group with AAT and the second group were significantly higher than that of BA model group(P<0.01). However, there was no difference between the two treatment groups (P>0.05); (4) The level of LXA4 in the first group with AAT was significantly higher than other three groups (P<0.01). However, there was no difference among the control group, model group and the second group with AAT(P>0.05).Clinical research:It demonstrated a significant improvement in asthmatic attack times, degree and asthma control drugs with AAT(P<0.01).ConclusionExperimental research:(1)The CFAP can effectively prolong the period of guinea pigs asthma induction which may be beneficial to alleviate or prevent the relapse of asthma. (2)The CFAP has no significant influence on the Thlcytokines IL-4 which was correlated well with asthma. (3)The CFAP can contribute to the secretion of IFN-γin guinea pigs with BA which can indirectly regulate Thl/Th2 balance. (4)The CFAP, especially early used in the treatment, can contribute to the secretion of LXA4 in guinea pigs with BA, which has a wide-ranging effects of anti-inflammatory and reducing inflammation.Clinical research:The AAT with CFAP can improve the symptoms, decrease asthmatic attack times and asthma control drugs which can effectively prolong the remission stage of children with asthma.更多还原