黎氏哮喘Ⅰ号方对小儿哮喘发作期环核苷酸的影响及实验研究

【作者】 刘华；

【导师】 谢昭亮；

【作者基本信息】 广州中医药大学 ， 中医儿科学， 2001， 硕士

【摘要】 小儿支气管哮喘（简称小儿哮喘，Pediatric Bronchial Asthma）是小儿时期常见的一种呼吸道变态反应性疾病。近年来，小儿哮喘的发病率和死亡率均有上升趋势，已引起世界性的广泛关注。目前认为气道高反应性是哮喘的一个关键性特征，气道炎症是气道高反应性的主要病理基础。其病因复杂，受遗传和环境因素的影响，学者们提出了气道炎症学说、气道重塑学说、神经-受体失衡学说、免疫失调学说、胃食管反流学说、微血管渗漏学说、迷走神经紧张学说等。抗炎治疗是哮喘防治的根本已成为共识，吸入疗法已逐渐普及。许多新的药物正在研制或已投入临床。目前常用治疗哮喘的药物主要有三大类：抗炎性平喘药、抗过敏性平喘药、支气管扩张药。 中医学认为，本病的病因病机是内有宿根，复感外邪而诱发；先天不足，肺脾肾三脏亏虚。痰阻气闭是病机关键。治疗上多主张分期分型辨证施治，发作期以祛邪为主，缓解期以扶正固本为主。近年来，有学者提出辨病与辨证治疗相结合，采用攻补兼施之法，疗效颇佳。同时采用综合措施进行治疗，常可有效的防止本病的复发。 黎氏哮喘Ⅰ号方（简称哮喘Ⅰ号方）是在广东省名老中医黎炳南教授的经验方基础上，综合导师的临床体会化裁而成。本方确立外邪内侵、寒热错杂、虚实互见为小儿哮喘发作时的病因病机，具有外散风寒、内清里热、补气养血、宣肺平喘之功。主治哮喘急性发作期轻、中度患儿。 本研究旨在通过临床与实验研究对哮喘Ⅰ号方的疗效加以验证，对其作用机理进行初步探讨。 临床研究中，将60例哮喘急性发作的轻、中度患儿分为中药治疗组和氨茶碱对照组，疗程均为一周，并设正常组10例。结果显示：哮喘Ⅰ号方与氨茶碱的近期临床疗效无显著性差异，均具有良好的平喘、祛疾、止咳作用，且祛痰作用较后者为优。实验室指标：治疗后两组哮喘儿童的血浆cAMP、cAMP/cGMP比值与治疗前比较，有显著性差 广州中医药大学学位论文异，两组间比较无显著性差异。提示哮喘1号方能够提高哮喘患儿的GAMP／CGMP LL值。 用 10％卵清蛋白溶液对实验豚鼠进行过敏性哮喘模型的复制，采用放射免疫分析法，对叭＊P、。＊＊P进行检测：同时，取豚鼠肺组织在显微镜及电子显微镜下进行病理形态学的观察。结果显示：治疗前造模组豚鼠血浆CAMP、CAMP儿GMP 比值降低，。GMP升高，提示CAMP儿GMP比值降低是哮喘发作的主要原因。治疗后中药组、氨茶碱组均能提高CAMPICGMP比值，而且两组无显著性差异。各组自身治疗前后比较差异有显著性。哮喘1号方连续治疗7天后，肺毛细血管壁增厚程度减轻，胶原纤维增生消失，这表明哮喘豚鼠肺组织炎症程度的减轻。实验表明哮喘互号方能提高哮喘豚鼠CAMP／CGMP比值，并减轻哮喘豚鼠肺组织的炎症程度。更多还原

【Abstract】 Pediatric Bronchial Asthmas is the common allergic disease of respiratory tract. The incidence rate and death rate of Pediatric Bronchial Asthma is increased recently, and caused the worldwide attention. Most of the doctors believe that the high reactivity of the airway is the main trait of asthma, and the main pathological basis of the high reactivity of the airway is related to the inflammation of respiratory tract. Complicated etiology of the disease is affected by the factor of heredity and environment. Scholars suggest the different themry, such as the themry of inflammation of airway, unbalance of nerve-receptor, the unbalance of immunity, the themry of gastroesophageal reflux. The therapy of anti-inflammation is the common prevention of the infant asthma, and inhalation is popular treatment with infant asthma all around the world, doctors also developed some new medicines for the patients. The drugs of the asthma are divided into three parts: anti-inflammatory antiasthma medicine; anti-hypersensitive antiasthma medicines; the medicine for bronchiectasis.The etiology and pathology of the disease is that asthma is developed by the external evils because of the usual basis, the congenital deficiency, and the deficiency of lung, spleen, and kidney according to the theory of TCM. The main pathology is the blockage of Qi due to the stagnation of phlegm. Different stage, different treatment. Attacking page treated with eliminating of the evils, the remission stage treated with invigorate vital qi and consolidated the root. Some physicians believe that the combination of differentiating syndrome and disease, the complicated attacking and invigorating methods is effective, which can prevent the concurrence of the disease.Prescription I for asthma is based on the professor Li Bingnan?s experienced prescription, the main etiology and pathology of the disease isattacking of external evils, the complication of cold and heat in nature, and the combination of deficiency and excess. The prescription has got the effect of clearing away the exterior wind-cold and interior heat, tonifying qi and blood, dispersing qi and calming asthma. The main range of the application include slight and middle acute episode of asthma in infants.This research mainly focus on the clinical effect of Prescription I for asthma through the experience on the clinic and laboratory and try to find out the mechanism of the infant asthma.During clinical study, we divide the acute episode in slight and middle degree of 60 infant patients into TCM treatment group and aminophylline group for one week, and the 10 normal groups. Results show that Prescription I for asthma has got the same effect as aminophylline, the same effect of antiasthma,dispelling phlegm, cough-stopping, and the effect of dispelling phlegm is better than aminophylline?s. there is no significance comparing the ratio of cAMP cAMP/cGMP in plasma of infants after treatment. It indicated the Prescription I for asthma could improve the ration of cAMP/cGMP of infant asthma.Checking cAMP, cGMP through the methods of radio-immunity based on the duplication of the allergic asthma in Guinea pig using the 10% ovalbumin fluids and observing the pathomorphology changes of the Guinea pig lung tissues under the microscop and electron microscop. The results showed that the ratio of cAMP, cAMPkGMP of Guinea pigs in plasma is lowered down, and cGMP is increased before treatment, indicates the main etiology is related to the ration of cAMP/cGMP. The ratio cAMP, cAMP/cGMP is increased between two groups, and there is no significant comparing two groups, there is obvious significant of the two groups before and after treatment. After continuous 7 days?treatment, dissepiments of blood capillary in lung is relieved and the hyperplasia of collagen is disappeared, which indicated the degree of inflammation intissiues of guinea pig lung. The results of laboratory indicated the prescription could increased the ration of cAMP/cGMP, and relived the inflammatory degree of guinea更多还原