Study On Immune And Endocrine Disturbance Of Bronchial Asthma By Traditional Chinese Medicine, Uygur Medicine And Western Medicine

Bronchial asthma(brief in asthma)has been one of the complex diseases that we are facing,and the severe public health problem that is attracting great attention from all countries of the world.The etiological factors of asthma are various with complicated nosogenesis.Although there are deep studies on the etiological factors and nosogenesis, the pathogenesis of asthma has been fully understood.Our project group studied the pathogenesis of asthma and found that eosinophil cationic protein(ECP)and IgE can reflect the activity of airway inflammation of asthma and prognosticate the attack of severe asthma.β2-AR16 site gene polymorphism in Gly/Gly genotype frequency distribution of severe group was significantly higher than that of slight and moderate group.Polymorphism of IL-4 promoter gene in CT genotype frequency distribution of severe group was significantly higher than that of slight and moderate group.The severity of asthma was related toβ2AR 16 site genetype.The proportion of patients with Gly 16 homozygote increased significantly in the severe asthma.In this study,we studied the relationship between asthma and immunity,endocrinium,and changing regulation in traditional Chinese medicine,Uygur medicine and western medicine.Discovered the rule of immune and endocrine system disturbance in patients with asthma(especially the severe asthma),explained pathogenesis of asthma,summarized the regulation between the changes of immune and endocrine systems in deficiency asthma,abnormal sewda asthma;searched the biological expression in the classification by traditional Chinese medicine and Uygur medicine and relative indices of microcosmic syndrome differentiation,discriminate the concordance and reciprocation relationship among severe asthma,deficiency asthma and abnormal sewda asthma,and provide rationale basis for the diagnosis,prediction and treatment of asthma.1 Material and MethodDuring the period of January 2006 to January.2007,156 cases of bronchial asthma patients were collected.All cases were analyzed by severity classification,differentiation of symptoms and signs for classification of syndrome by traditional Chinese medicine and Uygur medicine.PEF%Pred,FEV₁%Pred and FEV₁%were detected in asthma patients by Pulmonary function testing machine(JAEGER PET)made in Germany.IL-1,IL-6, TNF-α,ACTH,CS and GH were detected with radio immunoassay while CRH with ELISA.Lymphocyte apoptosis,CD₃CD₄CD₈,CD_11b,CD₁₈and CD_62Pwere determined with flow cytometry.All data were analyzed by Statistical software SPSS12.0. Measurement data were described with mean and standard deviation,and multiple mean comparisons were dealt with single factor analysis of variance or group t test. Discriminant function was calculated with Fisher method.The size of test wasα=0.05.2 ResultsThe course was long in patients with severe asthma,and compared with the patients with asthma of other types,the mean age of severe asthma was older.Compared with other types of asthma classified by traditional Chinese medicine classification,the mean age of patients with deficiency asthma was older.Compared with the other types of classified by Uygur medicine classification,the mean age of patients with abnormal sewda asthma was obviously older.There was significant statistical difference(P＜0.05). Lymphocyte subgroup and its mediatior of CD₄,CD₈,CD₄/CD₈,CD_11b,CD_11b/CD₁₈, CD_62Pand TNF-αheightened gradually in accordance with the exacerbation of the disease.Those were the highest in severe asthma,while lymphocyte apoptosis decreased along with the aggravation of the disease.The apoptosis was not obvious in the severe asthma.CD₄/CD₈,CD_11b,CD_11b/CD₁₈and CD_62Pwere the highest and lymphocyte apoptosis the slowest in the group of deficiency asthma.CD_11bincreased and lymphocyte apoptosis decreased obviously in the abnormal sewda asthma group.The results mentioned above had statistical significance(P＜0.05).CS,ACTH and CRH decreased gradually in accordance with the exacerbation of the disease,and were the lowest in the severe asthma.CS,ACTH and CRH were the lowest in the deficiency asthma with differentiation of symptoms and signs for classification of syndrome by traditional Chinese medicine and in the abnormal sewda asthma with differentiation of symptoms and signs for classification of syndrome by Uygur medicine.The results mentioned above had statistical significance(P＜0.05).The lymphocyte subgroup and endogenous cortisol were usually affected by medicine.Among them,CD₄/CD₈, CD_11b,CD_11b/CD₁₈and CD_62Pheightened gradually and lymphocyte apoptosis slowed down along with the application of hormone.CS,ACTH and CRH decreased gradually according to the application of hormone.The results mentioned above had statistical significance(P＜0.05).The research result that,all types had the insidous phlegm syndromes as follows: stethocatharsis,sticky and greasy tongue coating,such as white and greasy fur,thick fur, yellowish and greasy tongue fur,smooth pulse,wiry pulse,deep pulse and so on.Besides the general symptoms of asthma,patients with deficiency asthma followed with renal deficiency syndrome such as mental exhaustion,cold body and limbs or sultriness, lassitude in loin and legs,tinnitus and loss of memory,clear abundant urine,increased nycturia and so on,stagnation of phlegm syndrome such as feeling of stuffiness in the chest,heaviness in head and body,numbness of the limbs,hydroadipsia,abundant expectoration and difficult to hawk and so on,stasis syndrome such as chest gas pains or twinge,scaly skin,pale purple tongue or dark purple tongue with ecchymosis and so on. There was reciprocity of the three types in the severity.It was shown in the severity of asthma,mean age,symptoms and syndromes,immune and endocrine system disturbance, and so on.Discrimination of patients with severe asthma,deficiency asthma and abnormal sewda asthma was carried out with Fisher method.The veracity rate was 84.1%of severe asthma,74.1%of deficiency asthma and 66.7%of abnormal sewda asthma.3 Conclusion3.1 It was found that the immunity and endocrine of patients with asthma are indiscriminate.In severe asthma,lymphocyte subgroup and the value of its mediators such as CD₄,CD₈,CD₄/CD₈,CD_62P,CD_11b,CD_11b/CD₁₈and TNF increases obviously. That shows negative correlation with pulmonary function.CS,ACTH and CRH decrease obviously,but the lymphocyte apoptosis is not evidently.Therefore,in combination with the previous study,besides clinical manifestation and pulmonary function,lymphocyte subgroup and its mediators,lymphocyte apoptosis,endogenous cortisol and change of IgE and ECP should be monitored dynamically when severe asthma is judged.3.2 It was found that the effect of hormone therapy on immunity and endocrine is obvious.Long use of hormone will result in side-effect that it is disadvantage for the treatment on asthma.The material basis might be the gradually increase of CD₄/CD₈, CD_11b,CD_11b/CD₁₈and CD_62P,slow lymphocyte apoptosis,and gradual decrease of CS, ACTH and CRH as well.3.3 The change of CD_11band CD_11b/CD₁₈as the relative index of infection was obvious in the onset of asthma(especially the severe asthma).It indicates that infection closely relate to the onset of asthma.3.4 There is syndrome of "insidous phlegm" in all differentiations of symptoms and signs for classification of syndrome of asthma.No matter asthma belongs to sthenia syndrome,deficiency syndrome or combination of sthenia syndrome and deficiency syndrome,"phlegm" exists from the beginning to the end of asthma."Phlegm" plays important role in the persistence and aggravation of asthma."No phlegm could induce asthma"."Phlegm is the key to asthma".Therefore,we suggest that the classification of onset period of asthma,such as cold asthma,heat asthma,frigiopyretic asthma and anemophlegmatic asthma,changes to be the classification of cold phlegm,heat phlegm, frigiopyretic phlegm and anemophlegmatic phlegm.3.5 In patients with deficiency asthma,there is syndrome of kidney deficiency and stagnation of phlegm.So we propose that deficiency asthma is really asthma of phlegm stagnancy because of deficiency of kidney.It needs further research.3.6 We discovered that there is certain reciprocity among severe asthma,deficiency asthma and abnormal sewda asthma,which is shown by the severe condition,old mean age,overlapping of syndrome and symptom,indiscriminate immunity and endocrine,and so on.The study explained the relationship among immune and endocrine system disturbance,severe asthma classified by western medicine,deficiency asthma classified by traditional Chinese medicine,abnormal sewda asthma classified by Uygur medicine.3.7 On basis of that,we suggest that,in the treatment on asthma,we should not only think highly of the diagnosis of asthma by western medicine and the evaluation on patients' condition,but also combine with differentiation of symptoms and signs and differential diagnosis of disease,and put the entire conception of traditional medicine,the thought of "man,as a microcosm,is connected with the macrocosm" into the whole process of diagnosis,therapy,prognosis judgment of asthma to improve the diagnosis and treatment on asthma.The research is undertaking.