摘要
目的观察综合外治法对支气管哮喘慢性持续期患者γ干扰素(IFN-γ)、白细胞介素4(IL-4)、白细胞介素17(IL-17)、免疫球蛋白E(IgE)及嗜酸性粒细胞计数(EOS)的影响和作用机制。方法将120例支气管哮喘慢性持续期患者按照随机数字表法分为4组。对照组30例予沙美特罗替卡松粉吸入剂;穴位注射组29例在对照组治疗基础上应用卡介菌多糖核酸注射液穴位注射;拔罐组31例在对照组治疗基础上应用拔罐疗法;治疗组30例在对照组治疗基础上应用卡介菌多糖核酸注射液穴位注射联合拔罐疗法。4组均治疗4周。比较4组治疗前后及疗程结束后1、3个月哮喘控制测试(ACT)评分、呼出气一氧化氮(FeNO)变化;比较4组治疗前后血清IFN-γ、IL-4、IL-17、IgE水平及EOS;分析治疗组治疗前后EOS、IFN-γ及IL-17相关性。结果 4组治疗后、疗程结束后1个月ACT评分均较本组治疗前升高(P<0.05),治疗组、穴位注射组、拔罐组疗程结束后3个月ACT评分均较本组治疗前升高(P<0.05),而对照组疗程结束后3个月ACT评分与本组治疗前比较差异无统计学意义(P>0.05)。治疗组、穴位注射组、拔罐组治疗后及疗程结束后1、3个月ACT评分均高于对照组同期(P<0.05),且治疗组治疗后及疗程结束后1、3个月ACT评分均高于穴位注射组、拔罐组同期(P<0.05)。穴位注射组与拔罐组治疗后及疗程结束后1、3个月同期ACT评分比较差异无统计学意义(P>0.05)。4组治疗后、疗程结束后1个月FeNO均较本组治疗前降低(P<0.05),治疗组、穴位注射组、拔罐组疗程结束后3个月FeNO均较本组治疗前降低(P<0.05),而对照组疗程结束后3个月FeNO与本组治疗前比较差异无统计学意义(P>0.05)。治疗组、穴位注射组、拔罐组治疗后及疗程结束后1、3个月FeNO均低于对照组同期(P<0.05),且治疗组治疗后及疗程结束后1、3个月FeNO均低于穴位注射组、拔罐组同期(P<0.05)。穴位注射组与拔罐组治疗后及疗程结束后1、3个月同期FeNO比较差异无统计学意义(P>0.05)。4组治疗后IFN-γ含量均较本组治疗前升高(P<0.05),IL-17、IL-4、IgE、EOS含量均较本组治疗前降低(P<0.05)。治疗组、穴位注射组、拔罐组治疗后IFN-γ含量均高于对照组(P<0.05),IL-17、IL-4、IgE、EOS含量均低于对照组(P<0.05)。治疗组治疗后IFN-γ含量均高于穴位注射组、拔罐组(P<0.05),IL-17、IL-4、IgE、EOS含量均低于穴位注射组、拔罐组(P<0.05)。穴位注射组与拔罐组治疗后IFN-γ、IL-17、IL-4、IgE、EOS含量比较差异无统计学意义(P>0.05)。治疗组治疗前EOS与IFN-γ呈负相关,与IL-17呈正相关,治疗后EOS与IFN-γ仍呈负相关。结论综合外治法在控制支气管哮喘复发方面有更大优势,能显著改善患者临床症状,可能通过调控免疫因子分泌、调节炎症因子释放改善患者免疫功能,起到治疗和预防作用。
Objective To observe the effects and mechanism of comprehensive external treatment on interferon-γ(IFN-γ), interleukin-4(IL-4), interleukin-17(IL-17), immunoglobulin E(IgE) and eosinophil count(EOS) in patients with chronic persistent bronchial asthma. Methods 120 patients with chronic persistent bronchial asthma were divided into 4 groups according to the random number table method. In the control group, 30 patients were treated by salmeterol xinafoate and fluticasone propionate powder for inhalation. In the acupoint injection group, 29 patients were treated by bacilli calmette-giierin polysaccharide and nucleic acid injection on the basis of the control group. In the cupping group, 31 patients were treated by cupping therapy on the basis of the control group. In the treatment group, 30 patients were treated by bacilli calmette-giierin polysaccharide and nucleic acid injection combined with cupping therapy. All 4 groups were treated for 4 weeks. Asthma control test(ACT) score and the change of fractional exhaled nitric oxide(FeNO) before and after treatment were compared and 1 and 3 months after the end of the treatment period in the 4 groups. Serum IFN-γ, IL-4, IL-17, IgE levels and EOS of the four groups were compared before and after treatment. The correlation of EOS, IFN-γ and IL-17 before and after treatment in the treatment group was analyzed. Results The ACT scores of the four groups after treatment and one month after the end of treatment were all higher than those in the group before treatment(P<0.05). The ACT scores of the treatment group, acupoint injection group and cupping group at 3 months after the end of treatment were all higher than those in the group before treatment(P<0.05), while there was no statistically significant difference in ACT scores between the control group and the control group at 3 months after the end of treatment(P>0.05). The ACT scores of the treatment group, acupoint injection group and cupping group were all higher than those of the control group after treatment and at 1 and 3 months after the end of treatment course(P<0.05), and ACT scores of the treatment group and at 1 and 3 months after the end of treatment were all higher than those of the acupoint injection group and the cupping group at the same period(P<0.05). There was no statistically significant difference in ACT scores between acupoint injection group and cupping group after treatment and at 1 and 3 months after the end of treatment(P>0.05). The levels of FeNO in the 4 groups after treatment and 1 month after the end of the treatment period were lower than those in the group before treatment(P<0.05). The levels of FeNO in the treatment group, acupoint injection group and cupping group at 3 months after the end of treatment were all lower than those in the group before treatment(P<0.05). However, there was no significant difference between FeNO at 3 months after the end of treatment and that before treatment in the control group(P>0.05). FeNO in the treatment group, acupoint injection group and cupping group was lower than that in the control group at the same period after the end of treatment and at 1 and 3 months after the end of treatment(P<0.05), and FeNO in the treatment group and at 1 and 3 months after the end of treatment was lower than that in the acupoint injection group and cupping group at the same period(P<0.05). There was no significant difference in FeNO between the acupoint injection group and the cupping group after the end of treatment and at 1 and 3 months after the end of treatment(P>0.05). After treatment, the IFN-γ content in the four groups was higher than that in the group before treatment(P<0.05), and IL-17, IL-4, IgE and EOS content were all lower than those in the group before treatment(P<0.05). The IFN-γ content in the treatment group, acupoint injection group and cupping group was higher than that in the control group(P<0.05), and the content of IL-17, IL-4, IgE and EOS was lower than that in the control group(P<0.05). After treatment, IFN-γ content in the treatment group was higher than that in the acupoint injection group and the cupping group(P<0.05), and the content of IL-17, IL-4, IgE and EOS was lower than that in the acupoint injection group and the cupping group(P<0.05). There was no significant difference in IFN-γ, IL-17, IL-4, IgE and EOS content between acupoint injection group and cupping group(P> 0.05). Before treatment, EOS was negatively correlated with IFN-γ and positively correlated with IL-17 in the treatment group, while EOS was still negatively correlated with IFN-γ after treatment. Conclusion Integrated external treatment has more advantages in the control of chronic persistent bronchial asthm recurrence, which can significantly improve the clinical symptoms of patients. It may improve the immune function of patients by regulating the secretion of immune factors and the release of inflammatory factors, so as to play a therapeutic and preventive role.
作者
闫红倩
耿立梅
任虹
于向艳
牛晓燕
刘新发
黄书花
Yan Hongqian;Geng Limei;Ren Hong(Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei 050011)
出处
《河北中医》
2019年第5期667-672,678,共7页
Hebei Journal of Traditional Chinese Medicine
基金
河北省科技计划项目(编号:14277798D)
关键词
慢性病
哮喘
中医疗法
水针
拔罐
Chronic diseases
Asthma
Traditional Chinese medicine therapy
Hydro-acupuncture
Cupping
