【作者】 李昊；

【导师】 赵映前；

【作者基本信息】 湖北中医药大学 ， 中医临床基础， 2011， 博士

【摘要】 临床部分目的根据中医“治未病”理论和春夏养阳、秋冬养阴的观点,采用“冬病夏治”穴位敷贴疗法防治缓解期小儿哮喘。通过观察经验方喘敷灵贴剂三伏穴位(大椎、双侧定喘、双侧肺俞、双侧脾俞、双侧肾俞)敷贴对缓解期哮喘患儿临床症状,红细胞C3b受体花环率(RBC-C3bRR),红细胞免疫复合物受体花环率(RBC-ICR),肿瘤坏死因子(TNF-α),非特异性免疫球蛋白E(IgE),集落刺激因子(GM-CSF),Thl、Th2细胞因子IFN-Y、IL-4的影响,并与疗效确切的布地奈德气雾剂比较,探讨中药喘敷灵贴剂穴位敷贴防治缓解期小儿哮喘的临床疗效及其作用机理,以证实“冬病夏治”疗法的科学性、有效性。方法选取60例病例均来自2009年7月湖北省中医院儿科门诊就诊患儿,符合中、西医小儿哮喘缓解期诊断标准及病例纳入标准。将所有病例随机分为喘敷灵贴剂三伏穴位敷贴组和布地奈德气雾剂口服防治组,每组各30例。所有患儿均按中医哮喘缓解期分型标准及病情分级标准进行中医分型和病情严重程度分级。对两组患儿的性别、年龄、发病年龄、病程、病情、中医辨证分型等进行比较,经统计学处理P>0.05,无显著性差异,具有可比性。观察期从2009年7月～2010年7月,共一年。观察组患儿分别在头伏、二伏、三伏的第一天以喘敷灵贴剂敷贴患儿背部大椎、双侧定喘、双侧肺俞、双侧脾俞、双侧肾俞等穴位；对照组单纯给予布地奈德气雾剂200μg/次,12小时一次,连续3月。此外,患儿于第一次敷贴前及观察期结束后分别检测TNF-α、IgE、GM-CSF、IFN-γ、IL-4、RBC-C3bRR、RBC-ICR水平,比较上述指标的变化情况。结果1.两组治疗后均能明显改善缓解期哮喘患儿的临床症状(P<0.01),两组之间比较无明显差异(P>0.05)；2.观察组不同年龄段、不同病程及不同中医证型组患儿治疗前后临床症状的改善,经组间比较无明显差异(P>0.05)；3.两组均能显著升高缓解期哮喘患儿RBC-C3bRR和降低RBC-ICR水平(P<0.05),两组之间比较无明显差异(P>0.05)；4.两组均能显著降低缓解期哮喘患儿血清非特异性IgE水平(P<0.01)和TNF-α水平(P<0.01),两组之间比较无明显差异(P>0.05)；5.两组均能显著降低缓解期哮喘患儿GM-CSF水平(P<0.05),两组之间比较无明显差异(P>0.05)；6.两组均能显著降低IL-4、升高IFN-γ水平(P<0.05),两组之间比较无明显差异(P>0.05)。结论1.喘敷灵可显著改善红细胞免疫功能,减少炎性介质的释放；2.喘敷灵可调节患儿的细胞免疫状态,提高患儿免疫能力及抵抗力,改善症状和降低哮喘发作次数,减轻哮喘发作程度。其机制可能是通过调节患儿T淋巴细胞的功能,从而调节T淋巴细胞分泌的IL-4、IFN-Y及其他细胞因子水平,抑制患儿IgE的合成来实现的；3.喘敷灵防治哮喘疗效确切,剂量准确,使用简便、卫生经济,值得临床推广应用。实验部分目的观察中药穴位敷贴治疗改善过敏性鼻炎大鼠的搔鼻、喷嚏、鼻溢等症状,促进过敏性鼻炎大鼠的生长发育,改善过敏性鼻炎大鼠通气功能,降低过敏性鼻炎大鼠IgE及ECP水平,调节血清IL-2、IL-4、IL-6、INF-Y水平及ICAM-1、VCAM-1等指标的表达水平,从细胞分子水平探讨中药穴位敷贴对过敏性鼻炎的免疫调节机制,为科学有效地治疗过敏性鼻炎提供理论依据,证实“冬病夏治”疗法的科学性、有效性。方法本研究将SD幼年大鼠随机分成4组：正常对照组、过敏性鼻炎模型组、地塞米松口服组、穴位敷贴组。敷贴药物组成：皂荚、白芥子、黄芪、辛夷花、苍耳子、细辛、延胡索、生姜汁。穴位选取：大椎、肺俞、脾俞、内关。采用双抗夹心ELISA法比较各组免疫球蛋白E(IgE)、嗜酸性粒细胞阳离子蛋白(ECP)水平及细胞因子(IL-2、IL-4、IL-6、IFN-γ)、细胞间粘附分子-1(ICAM-1)、血管细胞粘附分子-1(VCAM-1)的表达水平,观察各组鼻粘膜组织的病理改变及大鼠鼻粘膜中的嗜酸性粒细胞数、中性粒细胞数和淋巴细胞数。结果1.实验组与模型组IgE水平比较,P<0.01,有显著统计学意义；2.西药组与模型组IgE水平比较,P<0.01,有显著统计学意义；3.实验组与西药组IgE水平比较,P<0.05,有统计学意义；4.实验组与模型组ECP水平比较,P<0.01,有显著统计学意义；5.西药组与模型组ECP水平比较,P<0.05,有统计学意义；6.实验组与西药组ECP水平比较,P>0.05,无显著统计学意义；7.实验组与模型组IL-2水平比较,P<0.01,有显著统计学意义；8.西药组与模型组IL-2水平比较,P<0.01,有显著统计学意义；9.实验组与西药组IL-2水平比较,P>0.05,无显著统计学意义；10.实验组与模型组ICAM-1水平比较,P<0.01,有显著统计学意义；11.西药组与模型组ICAM-1水平比较,P<0.01,有显著统计学意义；12.实验组与西药组ICAM-1水平比较,P<0.05,有统计学意义。结论实验研究表明：实验组与模型组均能有效降低IgE水平,且实验组与西药组比较有统计学意义；实验组与模型组均能有效降低ECP水平,但实验组较明显；实验组与模型组均能有效升高IL-2水平,但实验组较明显；实验组与模型组均能有效降低ICAM-1水平,且实验组与西药组比较有统计学意义。更多还原

【Abstract】 THE PART OF CLINICAL OBSERVATIONOBJECTIVEAccording to TCM theory and the treatment of disease based on the concept of Yang Yang in the spring and summer, Yang Yin in the autumn and winter, the use of Winter Disease Control Point Application therapy in children with asthma in remission. Through the observation experience square patches volts meridians (Da Zhui, bilateral Dingchuan, bilateral Feishu, bilateral spleen, bilateral Shenshu) Application on the clinical symptoms of asthmatic children, red blood cell C3b receptor rosette (RBC-C3bRR), red blood cell receptor immune complex rosette (RBC-ICR), tumor necrosis factor-α(TNF-α), non-specific immunoglobulin E, colony stimulating factor (GM-CSF), Thl, Th2 cells factor IFN-γ, IL-4 in vitro and deposited with the effect of the exact spirit of the traditional formulations of asthma(paste) to compare, apply spirit of traditional Chinese medicine asthma control point application patches remission of asthma in children and its possible role in clinical mechanism, so as to apply the Spirit of Chinese medicine formulations of asthma improved the feasibility and provide the basis for clinical application. METHODS60 cases were selected from July 2009 in Hubei Province Chinese Medicine Hospital pediatric outpatient children, in line with Western diagnostic criteria for children with asthma in remission and case inclusion criteria. Will apply in all cases randomly assigned to breathe Point Application Dog Days soul patch group and Budesonide Aerosol treatment group,30 patients in each group.All asthmatic patients in remission according to Chinese standards and classification of disease type classification standard for traditional Chinese medicine and disease classification. Two groups of children on gender, age, onset age, duration of disease, illness, TCM syndrome were compared, the statistical P>0.05, no significant differences between comparable. Observation period started from July 2009 to July 2010 only, a total of one year. Group of children were observed during the first V, the second V, volts) deposited on the first day to breathe a soul patch applicator children back Ojo, bilateral Dingchuan, bilateral Feishu, bilateral spleen, and other points of bilateral Shenshu; control group were given Budesonide Aerosol 200μg/times,12 hours, even for 3 months. In addition, patients in the first applicator before and after the observation period were used to detect RBC-C3bRR, RBC-ICR, TNF-α, IgE, GM-CSF, IFN-Y, IL-4 levels were compared before and after treatment the changes in these indicators.RESULTS1. After treatment, could significantly improve the remission of clinical symptoms in asthmatic children(P<0.01), no significant difference between the two groups (P>0.05);2. Observe the groups of different ages, different course and different set of TCM clinical symptoms in children improved after no significant difference between groups (P>0.05);3. Both groups can significantly eleated children remission asthma RBC-C3bRR and reduce RBC-ICR level (P< 0.05), no significant difference between the two groups (P>0.05); 4. Significantly decreased in both groups asthmatic non-specific IgE serum levels (P<0.01) and TNF-αlevels (P<0.01), no significant difference between the two groups (P>0.05);5. Significantly decreased in both groups asthmatic children wi th GM-CSF levels (P<0.05), no significant difference between the two groups (P>0.05);6. The blood in both groups significantly decreased IL-4, increased IFN-γlevels (P<0.05), no significant difference between the two groups (P>0.05).CONCLUSION1. Dyspnea can significantly improve the spiritual deposited immune function, reduce the release of inflammatory mediators to control asthma attacks;2. Panting spirit adjustable deposited cellular immune status of children, improve immunity and resistance in children, reduce the number of colds and asthma attacks degree, reduce the degree of asthma attacks.The mechanism may be by regulating T cell function in children, thereby regulating T lymphocyte secretion of IL-4, IFN-γand other cytokines, inhibiting the synthesis of IgE in children to achieve;3. Asthma is effective against the disease spirit deposited, the dose is accurate, easy to use, health economics, is worthy of clinical application. THE PART OF EXPERIMENTAL RESEARCHOBJECTIVEObserve the effects of point application mainly to improve the treatment of allergic rhinitis in rats scratching the nose, sneezing, rhinorrhea and other symptoms of allergic rhinitis in rats to promote the growth and development, to improve ventilatory function in rats with allergic rhinitis, allergic rhinitis, decreased IgE and ECP level of regulation of serum IL-2, IL-4, IL-6, INF-γlevels and ICAM-1, VCAM-1 expression levels and other indicators, From the cellular and molecular level of Acupoint Application on the immune regulation of allergic rhinitis mechanism for scientific and effective treatment of allergic rhinitis provide a theoretical basis.METHODSIn this study, young SD rats were randomly divided into four groups:normal control group (control group), model group (model group), oral dexamethasone group (group B), point application group (experimental group).Sticking drugs:Chinese honey locust, Sinapis alba, Huang Qi, The lily magnolia is colored, Achene of xanthium sibiricum, Asarum, Fumitory, Ginger juice.Point selection:Ojo, Feishu, spleen, internal relations.Double antibody sandwich ELISA method in each group immunoglobulin E (IgE), eosinophil cationic protein(ECP) levels and cytokines (IL-2, IL-4, IL-6, IFN-γ),cells adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) expression. Nasal mucosa were observed pathological changes and rat nasal mucosa in the number of eosinophils, neutrophils and lymphocytes.RESULTS 1. Experimental group and model group than in the IgE, P<0.01, there was significant;2. Western group and model group than in the IgE, P<0.01, there was significant;3.Experimental group and the western medicine group than in the IgE, P<0.05, statistically significant;4. Experimental group and model group than in the ECP, P<0.01, there was significant;5. Western group and model group than in the ECP, P<0.05, statistically significant;6. Experimental group and the western medicine group than in the ECP, P>0.05, no statistically significant;7. Experimental group and model group than in the IL-2, P<0.01, there was significant;8. Western group and model group than in the IL-2, P<0.01, there was significant;9. Experimental group and WM group than in the IL-2, P>0.05, no statistically significant;10. Experimental group and model group than in the ICAM-1, P<0.01, there was significant;11. Western group and model group than in the ICAM-1, P<0.01, there was significant;12. Experimental group and WM group than in the ICAM-1, P<0.05, statistically significant.CONCLUSIONExperimental studies have shown:the experimental group and model group can effectively reduce IgE levels, and the experimental group and western medicine group were statistically significant; experimental group and model group can effectively reduce the ECP level, but the experimental group was more apparent; experimental group and model group can effectively increase IL-2 levels, but the experimental group was more apparent; experimental group and model group can effectively reduce the level of ICAM-1, and the experimental group and western medicine group were statistically significant.更多还原