摘要
目的寻找哮喘、变应性鼻炎发病时黏膜免疫作用的共同联系物质,为哮喘"肺病治鼻、肺鼻同治"提供科学依据,为阐明中医"肺开窍于鼻"理论的科学内涵打下一定基础。方法 1 150例哮喘患者进行问卷调查,记录患者主诉、首次发作原因、诱因、肺功能等并明确其诊断、分级等内容。同时收集单纯哮喘患者44例,哮喘合并鼻炎患者38例,变应性鼻炎患者30例,正常对照组30例,分别采集唾液、痰液、鼻腔分泌物各2 mL,用ELISA法测定分泌型免疫球蛋白(SIgA)的变化。采静脉血各2 mL,用流式细胞术测CD4+、CD8+淋巴细胞,用荧光酶联免疫法检测嗜酸性阳离子蛋白(ECP)、血清总免疫球蛋白E(T-IgE)。结果 1 150例哮喘患者中合并鼻炎632例,占55%,其中哮喘组较合并鼻炎组年龄偏大(P<0.01),肺功能第1秒用力呼气量(FEV1)哮喘组大于合并鼻炎组(P<0.05)。哮喘组、合并鼻炎组、鼻炎组与正常组比较痰液中SIgA均降低(P<0.01),鼻腔分泌物中SIgA均高于唾液和痰液,且有统计学意义(P<0.05)。血液中CD4+,哮喘组、合并鼻炎组、鼻炎组较正常组均增高,有统计学意义(P<0.05);血清T-IgE,合并组及鼻炎组均较正常组增高(P<0.01)。血清ECP,哮喘组、合并组、鼻炎组均较正常组增高(P<0.05)。哮喘组ECP与T-IgE成正相关性(r=0.467,P<0.05)。结论肺、鼻在哮喘发病中存在着一定的联系,而SIgA、CD4+、CD8+、ECP、T-IgE等黏膜免疫介质可能是肺、鼻相关联系物质基础之一,这也为阐明中医"肺开窍于鼻"理论的科学内涵打下一定基础,并提出哮喘常要"肺病治鼻、肺鼻同治"。
Objective To reveal the internal relationship between asthma and allergic rhinitis during their pathophysiological process through the clinical investigation on them and quantitative determination of relevant immune materials, to find out the common connected material effected by mucosal immunity, to provide a scientific base for the theory of treating lung disease from nose and treating asthma from both lung and nose, and to lay a foundation for expounding the connotation of TCM theory of lung opening at nose. Methods A questionnaire was used in 1 150 patients with asthma and their complains, causes of the first invasion, predisposing causes and lung function were recorded. At the same time, among them 44 with simple asthma （asthma group）, 38 with asthma complicating rhinitis （complicating group）, 30 with allergic rhinitis and 30 volunteers as the normal control group （normal group ）. The changes of secreted immunoglobulin A （SIgA） were detected by using ELISA in saliva, sputum and rhinal secretion （2 mL respectively ）. Flow cytometry was used for detecting lymphocyte CIM~ and CD8 ~, and fluorescent ELISA was used to detect the changes of eosinophil cationic protein （ECP） and total immunoglobuline E （T-IgE） in venous blood （2 mL）. Results Among 1 150 asthma patients, there were 632 complicating rhinitis （55%）. The age and FEV1 of the asthma group were higher than those of the complicating group （P 〈 0. 01, P 〈 0. 05 ）. SIgA in sputum decreased in the asthma group, complicating group and rhinitis group compared with the normal group （ P 〈 0. 01 ）. SIgA in rhinal secretion was higher than that in saliva and sputum （P 〈 0. 05 ）. CD4＋ in venous blood increased in the asthma group, complicating group and rhinitis group compared with the normal group （ P 〈 0. 05 ）. The level of serum T-IgE increased in the complicating group and rhinitis group compared with the normal group （ P 〈 0. 01 ）. The level of serum ECP increased in the asthma group, complicating group and rhinitis group compared with the normal group （ P 〈 0. 05 ）. In the asthma group ECP and T-IgE were correlated （r = 0. 467, P 〈 0. 05 ）. Conclusion There is a relationship between lung and nose when asthma invasion. The mucosal immune media, including SIgA, CD4＋ , CD8＋ , ECP and T-IgE, may be one of material bases connected lung and nose, which lays a foundation for TCM theory of lung opening at nose, and treating lung disease from nose and treating asthma from both lung and nose.
出处
《北京中医药大学学报》
CAS
CSCD
北大核心
2011年第7期500-504,共5页
Journal of Beijing University of Traditional Chinese Medicine
基金
国家自然科学基金资助项目(No.30860355)
新疆自然科学基金资助项目(No.2009211A21)
关键词
哮喘
黏膜免疫
肺鼻同治
asthma
mucosal immunity
treatment of both lung and nose
