| Objective Bronchial asthma (BA), chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) are both inflammatory airway diseases with different characteristics and they often involved with kidney-yang deficiency (KYD) and depression. To evaluate changes of inflammatory airway features and hypothalamic-pituitary-adrenal (HPA) axis function in KYD-BA compared with KYD-COPD. Discuss thoroughly the syndrome differentiation relations between "disease" and "syndrome" of (Traditional Chinese Medicine) TCM, make comparative research on the same syndrome for different diseasesMethods Adults aged between18and65, BA, COPD and NSCLC were collected.41healthy individuals were enrolled as controls. We excluded subjects with other pulmonary diseases and patients using corticosteroids or operation or chemotherapy or radiotherapy or exacerbation or chest infection<4weeks prior to recruitment were excluded. Sputum was induced and blood samples were collected for measurement of cytokines and other inflammatory factors.24-hour collection of urine was performed and salivary samples of the diurnal rhythm profiles were obtained for assessment of the HPA axis activity.ResultsPart Ⅰ Airway inflammation and hypothalamic-pituitary-adrenal axis function in BA, COPD and NSCLC with different syndromes1. General informationThe study population consist36adults KYD-BA,37KYD-COPD and28KYD-NSCLC;30adults Non-KYD-BA and26Non-KYD-COPD and Non-KYD-NSCLC. There is no difference in demographic features including age, sex, BMI, smoking index, height and weight, the severity of diseases among the groups (P>0.05).2. Inflammatory factors in the same syndrome of different diseases.2.1Inflammatory factors in KYD syndrome of BA, COPD and NSCLC.Serum IgE and sputum ECP in KYD-BA group, Serum TGF-βin KYD-COPD group were higher than the other groups (P<0.05), serum ECP, sputum IgE in KYD-BA and KYD-COPD groups were higher than the control group (P<0.05) and sputum IFN-γ was decreased. Sputum TGF-βwas increased in KYD-COPD group.Serum IL-6, serum TNF-α in the KYD-NSCLC group were higher than the control group (P<0.05). 2.2Inflammatory factors in Non-KYD syndrome of BA, COPD and NSCLC.Sputum ECP in Non-KYD-BA group was higher than other groups. Serum ECP (P<0.05), serum and sputum tlgE were higher than the control group. Serum TGF-β was higher in Non-KYD-COPD than the other group (P<0.05), sputum tIgE and TGF-β were higher than the control group (P<0.05). Serum IFN-y was lower in the Non-KYD-NSCLC group than the control group (P<0.05).3. Inflammatory factors in the same disease with different syndromes3.1Inflammatory factors in KYD-BA and Non-KYD-BA:The serum and sputum ECP、tIgE were higher in the both BA groups than the control group(P<0.05), and the sputum IFN-y decreased in the KYD-BA group(P<0.05).3.2Inflammatory factors in KYD-COPD and Non-KYD-COPD:Serum ECP was increased in the KYD-COPD group (P<0.05).serum and sputum TGF-β and sputum tlgE were increased in both KYD-COPD and Non-KYD-COPD groups (P<0.05), serum and sputum IFN-y were decreased (P<0.05).3.3Inflammatory factors in KYD-NSCLC and Non-KYD-NSCLC:serum IL-6were higher in KYD-NSCLC than the other group, serum and sputum TNF-α、sputum TGF-β was higher than the control group (P<0.05), serum IFN-y was lower in the KYD-NSCLC and Non-KYD-NSCLC (P<0.05).4.24h urinary free cortisol/17-hydroxycorticosteroids/17-ketosteroids:24h urinary free cortisol/17-hydroxycorticosteroids/17-ketosteroids concentrations were lower in KYD groups than the control group (P<0.05). The peak level and baseline of the diurnal rhythm were also significantly lower in KYD-BA and KYD-COPD group compared to other groups (P<0.05).5. The diurnal rhythms of cortisol, ACTH and CRH concentrations in the same syndrome of different diseases. Serum cortisol concentrations were lower at8a.m. in KYD-NSCLC group than the other groups (P<0.05).6. The diurnal rhythms of cortisol, ACTH and CRH concentrations in the same disease of different syndromes.6.1The diurnal rhythms of serum cortisol:Serum cortisol concentrations were lower at8a.m. next morning in KYD groups than the other groups (P<0.05).Serum cortisol concentrations were lower at8a.m. in KYD-COPD and KYD-NSCLC groups (P<0.05).6.2The diurnal rhythms of salivary cortisol:Salivary cortisol concentrations were lower at4p.m. in KYD-BA group than the other groups (P<0.05).6.3The diurnal rhythms of plasma ACTH:Plasma ACTH concentrations were lower at8a.m.,4p.m. and8a.m. next morning in KYD-BA group than the other groups (P<0.05). They were lower at8a.m.,4p.m. and.m. in KYD-COPD group than the other groups (P<0.05). They were lower at4p.m. and12a.m. in KYD-NSCLC group than the other groups (P<0.05).6.4The diurnal rhythms of salivary ACTH:Salivary ACTH concentrations were lower at.m. in KYD-COPD group than the other groups (P<0.05).6.5The diurnal rhythms of plasma CRH:Serum CRH concentrations were lower at8a.m. and8a.m. next morning in KYD-BA group than the other groups (P<0.05). They were lower at12a.m. and8a.m. next morning in KYD-COPD group than the other groups (P<0.05). They were lower at4p.m. and12a.m. in KYD-NSCLC group than the other groups (P<0.05).6.6The diurnal rhythms of salivary CRH:Salivary CRH concentrations were lower at8a.m. in KYD-COPD group than the other groups (P<0.05).Part II Airway inflammation and hypothalamic-pituitary-adrenal axis function in BA, COPD and NSCLC with depression1. General informationThe study population consist23adults BA with depression,28COPD with depression and25NSCLC with depression;41adults BA without depression,33COPD without depression and29NSCLC without depression. There is no difference in demographic features including age, sex, BMI, smoking index, height and weight, the severity of diseases among the groups (P>0.05).2. Inflammatory factors in different diseases with or without depression.2.1Inflammatory factors in BA, COPD and NSCLC with depression. Sputum ECP was significantly higher in BA with depression compared to other groups (P<0.05), serum TGF-β was increased in COPD with depression than the other groups(P<0.05). Serum ECP,TNF-a and serum and sputum tIgE were increased in BA with depression than the control group (P<0.05), and serum IFN-y decreased (P<0.05),serum ECP、sputum tlgE and TGF-β increased in COPD with depression and serum IFN-y decreased (P<0.05).Serum TNF-a increased in NSCLC with depression, and serum IFN-γ decreased (P<0.05).3. Inflammatory factors in the same disease with or without depression.3.1Inflammatory factors in BA with or without depression. Serum and sputum ECP and sputum CRP was significantly higher in BA with depression compared to other groups (P<0.05), serum and sputum tlgE was significantly higher in BA with depression compared to the control group(P<0.05), serum IFN-γdecreased (P<0.05).3.2Inflammatory factors in COPD with or without depression. Serum TGF-β was significantly higher in COPD with depression compared to other groups (P<0.05), serum ECP and sputum tlgE increased than the control group(P<0.05), serum IFN-γdecreased (P<0.05).3.3Inflammatory factors in NSCLC with or without depression. Serum TNF-α was significantly higher in NSCLC with depression compared to other groups (P<0.05), serum IFN-γdecreased than the control group (P<0.05).4.24h urinary free cortisol/17-hydroxycorticosteroids/17-ketosteroids:4.124h urinary free cortisol/17-hydroxycorticosteroids/17-ketosteroids in groups with depression24h urinary free cortisol were lower in groups with depression than the other groups (P<0.05), urinary17-ketosteroids decreased in BA with depression (P<0.05), urinary17-hydroxycorticosteroids increased in depression alone than the other groups (P<0.05).4.2.124h urinary free cortisol in groups with and without depression24h urinary free cortisol were lower in both BA with and without depression (P<0.05), COPD with and without depression groups than the other groups (P<0.05), it was lower in NSCLC with depression than the other groups (P<0.05).4.2.224h urinary17-hydroxycorticosteroids in groups with and without depression24h urinary17-hydroxycorticosteroids were lower in both BA with and without depression (P<0.05), COPD with and without depression groups than the other groups (P<0.05), it was lower in NSCLC with depression than the other groups (P<0.05).4.2.324h urinary17-ketosteroids in groups with and without depression24h urinary17-ketosteroids were lower in both BA with and without depression (P<0.05), COPD with and without depression groups than the other groups (P<0.05), it was lower in NSCLC with depression than the other groups (P<0.05).5. The diurnal rhythms of cortisol, ACTH and CRH concentrations in patients with or without depression.5.1The diurnal rhythms of BA with or without depression:Salivary cortisol at8a.m. and4p.m.in BA with depression group decreased than the other groups (P<0.05), serum and salivary ACTH at8a.m. were lower than the other groups (P<0.05).5.2The diurnal rhythms of COPD with or without depression:Salivary cortisol at8a.m. and8a.m.next morning in COPD with depression group decreased than the other groups (P<0.05), serum and salivary ACTH at8a.m. were lower than the other groups (P<0.05).5.3The diurnal rhythms of NSCLC with or without depression:Salivary cortisol at8a.m. and8a.m.next morning in NSCLC with depression group decreased than the other groups (P<0.05), serum and salivary ACTH at8a.m. were lower than the other groups (P<0.05).6. The relationship between KYD syndrome and depression6.1The relationship between KYD syndrome and depression of BA group:16patients had KYD syndromes(44.4%) in BA without depression group (HAMD scores0-8points),4patients had KYD syndromes(50%) in BA with mild depression group (HAMD scores9-16points),5patients had KYD syndromes(55.6%) in BA with moderate depression group (HAMD scores17-24points),3patients had KYD syndromes(60%) in BA with severe depression (HAMD scores25-32points),1patients had KYD syndromes(100%) in BA with extremely severe depression group (HAMD scores≥33points)6.2The relationship between KYD syndrome and depression of COPD group:18patients had KYD syndromes(54.5%) in COPD without depression group (HAMD scores0-8points),6patients had KYD syndromes(54.5%) in COPD with mild depression group (HAMD scores9-16points),7patients had KYD syndromes(63.6%) in COPD with moderate depression group (HAMD scores17-24points),4patients had KYD syndromes(66.7%) in COPD with severe depression (HAMD scores25-32points)6.3The relationship between KYD syndrome and depression of NSCLC group:12patients had KYD syndromes(41.4%) in NSCLC without depression group (HAMD scores0-8points),3patients had KYD syndromes(42.9%) in NSCLC with mild depression group (HAMD scores9-16points),6patients had KYD syndromes(60%) in NSCLC with moderate depression group (HAMD scores17-24points),5patients had KYD syndromes(71.4%) in NSCLC with severe depression (HAMD scores25-32points),1patients had KYD syndromes(100%) in NSCLC with extremely severe depression group (HAMD scores≥33points)Conclusions1. In this study concerning BA, COPD and NSCLC, we found that the features of inflammation in KYD groups and depression groups seem to be exaggerated. The HPA axis functions in these groups have been disturbed or impaired more severely, which maybe involved in the pathogenesis of KYD and depression.2."Different diseases with same syndromes" has certain substance foundation, such as IFN-γ and HPA axis function were decreased in KYD BA, KYD-COPD and KYD-NSCLC.3. The substance foundation "Different diseases with same syndromes" might not be the same, such as serum tIgE、sputum ECP increased in KYD-BA group, serum and sputum TGF-β increased in KYD-COPD group, serum and sputum IL-6and TNF-a increased in KYD-NSCLC group, there might be differences in micropathology.4. KYD syndromes and depression is closely related. The percent of KYD patients increased significantly, according to the severity of depression. |
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