| Asthma is a common chronic inflammatory disease, characterized by airway inflammation and airways remodeling, anti-inflammatory and anti-airway remodeling therapy are the two basic treatments. The treatment based on the glucocorticoid and broncho.dilators can improve.the asthmatic airway inflammation to a certain extent, but the effect on airways remodeling is limited. Furthermore, long-term and large doses use of glucocorticoid in asthma patients will inevitably cause adverse reactions and side effects. The Chinese medicine have advantages of good curative effect, less side effects and lasting effect in treating asthma. That phlegm and blood stasis, failure of lung qi in dispersion is the basic pathological mechanism of asthma. The method of Xuanfeihuatanhuoxue is the basic treatment of asthma. Our earlier research showed that the method of Xuanfeihuatanhuoxue not only can improve the clinical symptoms and pulmonary function of the asthma patients, but also can balance cAMP/cGMP, restrain airway inflammation and airways remodeling.This study includes clinical research and experimental research. In the clinical research part, clinical symptoms, pulmonary function and the level of LTD4and NGF were observed. In the experimental research part, pathological change, bronchial wall thickness, smooth muscle thickness and the level of LTD4and NGF were observed. Finally, the effect and possible mechanisms of the Xuanfeihuatanhuoxue method on asthma were discussed.1. Clinical research partObjective: To observe the clinical symptoms, pulmonary function and the level of LTD4and NGF on asthma patients treating with the method of Xuanfeihuatanhuoxue so as to discuss the effect of this method.Methods:58patients were randomly divided into two groups:treatment group and control group. The control group was treated only with budesonide Aerosol or Salmeterol Xinafoate and Fluticasone Propionate Powder for Inhalation, and the treatment group was treated with the method of Xuanfeihuatanhuoxue combined with the treatment of control group, The course was10days. The clinical symptoms, pulmonary function and the level of LTD4and NGF were observed and compared.Results:(1) The clinical symptoms of both groups were improved after10days treatment compared with that of the pre-treatment, and the change have significant difference (p<0.01). The treatment group showed better effect in improving dyspnea, expectoration and wheeze compared with the control group (P<0.05)(2) The symptom scores of both groups were improved after10days treatment compared with that of the pre-treatment, and the change have significant difference(p<0.05). The treatment group showed better effect in improving symptom scores compared with the control group (P<0.05)(3) There was no significant difference in improving comprehensive clinical curative effect in both groups (P>0.05)(4) PEF%and FEV1%in both groups were increased after treatment (P<0.05), but there was no significant difference between two groups(P>0.05).(5) The level of LTD4and NGF in both groups were decreased after treatment compared with that of the pre-treatment (P<0.01), The treatment group showed better effect in reducing the level of LTD4and NGF compared with the control group (P<0.01)(6)The level of WBC, RBC, PLT,ALT, AST, BUN and Cr in both groups had no significant difference after treatment compared with that of the pre-treatment (P>0.05)Conclusions:(1)The method of Western medicine combined with Xuanfeihuatanhuoxue Chinese medicine can improve the clinical symptoms, the symptom scores and comprehensive clinical curative effect. It could relieve dyspnea, expectoration, wheeze and symptom scores better than that of the control group, which showed advantages of the treating asthma.(2) The method of Western medicine combined with Xuanfeihuatanhuoxue Chinese medicine could improve pulmonary function in patients with asthma, but it showed no advantages while compared with the treatment of Western medicine.(3) LTD4and NGF is the index that could reflect the airway inflammation and airways remodeling in asthma, and close correlates to the severity of asthma. The method of Western medicine combined with Xuanfeihuatanhuoxue Chinese medicine could reduce the level of LTD4and NGF, which suggested that the Xuanfeihuatanhuoxue Chinese medicine may cure asthma by reducing the level of LTD4and NGF. This effect may be one of important factors of the Xuanfeihuatanhuoxue Chinese medicine in treating asthma.(4) The Xuanfeihuatanhuoxue Chinese medicine showed no significant side effect, so this therapy is safe.2. Experimental Research PartObject ive:To observe the level of LTD4and NGF, as well as the pathological change in asthmatic rats, evaluating the effect of the method of Xuanfeihuatanhuoxue on the airway inflammation and airways remodeling in asthma.Methods:72SD male rats were randomly divided into6groups:control group(A);asthma model group(B); high(C), middle(D) and low(E) dosage Chinese medicine group, and dexamethasone group(F). Asthma rat model was established by intraperitoneal injection with the mix of OVA and aluminum hydroxide as well as by aerosol inhalation with OVA. Each rats were sensitized with the mix of10mg OVA in200mg aluminum hydroxide by intraperitoneal injection on days1,8except the control group rats. Each rats were induced by aerosol inhalation with OVA except the control group rats from daysl5, three times a week. Each time lasted20min and the whole course lasted8weeks. The concentration of OVA was as follow:1,2weeks with1%OVA,3and4weeks with1.5%OVA,5, and6weeks with2%OVA, and7,8weeks with2.5%OVA. The control group rats was administered physiological saline instead of OVA for sensitization and inducing. Rats in group C, D, and E were treated with Chinese medicine at the doses of40g/kg,20g/kg,10g/kg by intragastric administration, and rats in group F were treated with dexamethasone(0.5mg/kg) by intragastric administration half an hour before each ultrasonic aerosol inhalation. Rats in group A were replaced by physiological saline. Lung tissue were sliced and hematoxylin and eosin stained. Rats were sacrificed by drawing blood24hours in the last day, right lungs were perfused with4%paraformaldehyde to preserve pulmonary structure, fixed in4%paraformadehyde, and paraffin-embedded. Pathological change in the airway of rats were observed. The levels of LTD4and NGF in serum were measured by ELISA.Results:(1) Pathological change in the airway of rats:The pulmonary structure of the control group rats were nearly normal and little inflammatory cells gathered in airways. Bronchial epithelium of model group rats were necrosis. Obvious inflammatory cells gathered in airways. The thickness of airway wall and airway smooth muscle had increased. Pathological change in the airway of C, D, E, F group rats were similar with that of model group rats, but were more moderate.(2)The thickness of airway wall and airway smooth muscle of group A, C, D, E and F were lower than that of group B, and the change have significant difference (p<0.01). There are no significant difference among group C, D, E and F (P>0.05)(3)The levels of LTD4and NGF in group B were higher than that of group A, and the change have significant difference (p<0.01). The levels of LTD4and NGF in group C, D, E and F were lower than that of group B, and the change have significant difference(p<0.01). The levels of LTD4and NGF among group C, D, E and F have no significant difference (P>0.05)(4) Correlation analysis showed that there were positive correlation between the thickness of airway wall and the levels of LTD4and NGF(p<0.01). There were positive correlation between the thickness of airway smooth muscle and the levels of LTD4and NGF(p<0.01).Conclusions:(1)The Xuanfeihuatanhuoxue Chinese medicine can lower inflammatory cells gathering in airways, reduce the thickness of airway wall and airway smooth muscle, relieve airway inflammation and airways remodeling of asthmatic rats. This effect is similar with that of dexamethasone.There are no dose-effect differences in our study.(2)The Xuanfeihuatanhuoxue Chinese medicine can decrease the levels of LTD4and NGF.This effect is similar with that of dexamethasone. We consider that the Xuanfeihuatanhuoxue Chinese medicine may relieve asthma by decrease the levels of LTD4and NGF. This effect may be one of important factors of the Xuanfeihuatanhuoxue Chinese medicine in treating asthma.(3)There are close relation between the levels of LTD4and NGF and the airways remodeling. The Xuanfeihuatanhuoxue Chinese medicine may mitigate airways remodeling by decrease the levels of LTD4and NGF, and that may be the possible mechanism of this method in treating asthma.
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