| ObjectiveAs one of the common syndromes in clinical practice of Chinese Medicine, damp-heat syndrome is with high-rate occurrence in Lingnan (southern part of China) because of the climate and the life style of the local. In recent years, the incidence of this syndrome increased to some extent and featured by its wide spreading, prolonged course and recurrence.Located in Lingnan, Guangxi is in the climate zone characterized by its heat and humidity. The unique body constitution of local people, formed through the special geographical environment and distinctive features of life and diet, leads to their susceptibility and high frequency with damp-heat syndrome. Therefore, the study on damp-heat syndrome characteristics of local people and the relative factors to susceptibility have the high medical and sociological value.As known so far, Human Leukocyte Antigen (HLA) is the most complex system of genetic polymorphism. And it is a major genetic system for regulating individual specific immune response and determining individual differences of disease susceptibility. The distribution of HLA is characterized by distinctive differences of races, nationalities and geography. It is considered in traditional Chinese medicine (TCM) theory that the type, nature and the trend and prognosis of the pathogenesis development of the syndrome depend on two factors-etiology and constitution. And constitution, the internal factors, is the background and vital material basis for different syndromes and that the specificity of individual constitution usually determines his or her susceptibility to some certain pathogenic factors and the type tendency of the generated disorders. There are some similarities in polymorphism and Linkage Disequilibrium of HLA system and TCM constitution theory. Focusing on the relative stable constitution, this study chose the specific population to explore the immune genetic basis of susceptibility to damp-heat syndrome and discuss the geographic differences of susceptibility to damp-heat syndrome between Han people in Guangxi and those in Guangdong within Lingnan area from the perspective of Human Leucocyte Antigen (HLA) gene polymorphism.(type Ⅰ and type Ⅱ). It benefits in the deep research on the nature of the syndrome and provided the new perspective for the mechanical discussion of taking actions that suit local circumstances and the same syndrome of different diseases.Methods1. The literature research method was used in the study project to give a historical review on the theoretical origin of the damp-heat syndrome. The theoretical origin and the syndrome characteristic of the damp-heat syndrome could be sorted out through the research on ancient literature of the damp-heat syndrome, which laid a solid theoretical foundation for further study of damp-heat syndrome.2. In order to analyze the constitution of the Guangxi local people and consult and establish the damp-heat constitutional scale and the diagnostic standard, the method of cross sectional on-scene investigation was used to assess the TCM constitutional types after the questionnaire of322cases of adults. The questionnaire was implemented on166cases of Han people in Guangxi above18years old with72cases of damp-heat syndrome group and94cases of non damp-heat group. It is focused on understanding the living and diet habit of the damp-heat syndrome group and non damp-heat group and sociodemographic situation. The methods of one-factor ANOVA and multiple stepwise regression analysis were applied for some relevant factors.3. Sequence-based Genotyping Technology (PCR—SBT) was conducted to4group of Gaungxi and non Guangxi people with damp-heat and normal syndrome. HLA-A, B and DRB1genetic typing detections was conducted to18cases of each group. The method of direct counting was used in allele distribution. The gene frequency (GF) was calculated according to the balance of Hardy—Weinbergrule. The x2test or Fisher’s Exact Text was used for the comparison of the gene frequency for each group and two items comparison.Results1. The TCM constitutional types were assessed after the questionnaire of322cases of adults.94cases mild constitution account for29.2%;72cases damp-heat constitution account for22.4%;49cases phlegm-damp constitution account for15.2%;36cases qi-deficient constitution account for11.2%;23cases yin-deficient account for6.2%;15cases qi-stagnation constitution account for4.6%;7cases blood-stasis constitution account for2.2%;6cases the specific endowment constitution account for1.9%.2. The questionnaire was applied in166cases of Guangxi people with damp-heat constitution. Multiple stepwise regression analysis was used with P<0.10. According to the influenced extend of standardized regression coefficients modulus,7factors were selected, that are the like of sweet, irregular sleeping, sports habit, late sleeping and early getting up and the like of sour, viscera, cold food. The value for the damp-heat group people with the like of sweet, viscera, cold food, irregular sleeping, late sleeping and early getting up, less sports was relatively higher. But the value for damp-heat people with the like of early getting up and sleeping and the sour was relatively lower.3. The technology of PCR—SBT was used to conduct HLA-A, B and DRB1genetic typing detections. The allele phenotype frequency of HLA-A*0207in Guangxi damp-heat syndrome group was evidently higher than that of Guangxi normal group (P<0.05). And the allele phenotype frequency of HLA-DRB1*0301and HLA-DRB1*1602in Guangxi damp-heat syndrome group was evidently lower than that of Guangxi normal group (P<0.05). The difference was statistically significant.The allele phenotype frequency of HLA-A*0201in Guangxi damp-heat syndrome group was evidently lower than that of Non-Guangxi group. And the allele phenotype frequency of HLA-DRB1*1101and HLA-DRB1*1501in Guangxi damp-heat syndrome group was evidently higher than that of Non-Guangxi group. The difference was statistically significant (P<0.01or P<0.05). There were no significant differences between the four groups of HLA-B genotypes.ConelusionThe research results indicate that the damp-heat constitution is the most common constitutional type for adult in Guangxi, which meets the damp-heat climate characteristic in Guangxi. The formation of damp-heat constitution of Guangxi people is closely related with the postnatal factors of daily life and diet such as the appetite for sweet food, visceral, raw and cold food, irregular sleeping and lack of sports exercise. We need to focus on the guide for the diet and daily life habit and propagation for healthy education to advocate reasonable diet construction and habit, appropriate exercise and cultivate scientific life way in order to improve the damp-heat constitution, promote health and prevent diseases.The damp-heat patients in Guangxi was positively correlated with HLA-A*0207genotype, and negatively associated with HLA-DRB1*0301and HLA-DRB1*1602. The HLA-A*0207genotype could be the susceptible gene of the damp-heat syndrome. The HLA-DRB1*0301and HLA-DRB1*1602could be the protective gene of the damp-heat syndrome. Compared with the damp-heat patients of non-Guangxi group, the allele phenotype frequency of HLA-A*0201in Guangxi damp-heat syndrome group is evidently lower. While the allele phenotype frequency of HLA-DRB1*1101and HLA-DRB1*1501in Guangxi damp-heat syndrome group is evidently higher than that of non-Guangxi group. It is indicated that there may exist different immune genetic basis between the susceptible group to damp-heat syndrome of Guangxi and non-Guangxi group. It shows that there are immune genetic susceptible factors in the damp-heat group of Guangxi, which will easily cause the immune imbalance of the body."The weak of the earth spleen causes the failure for transformation and damp-qi accumulation." So the occurrence of damp-heat syndrome is caused by such internal factor and the invasion due to the damp-heat climate effect of Guangxi. |
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