Effect Of PingchuanGuben And Bufei Soup On The Immune Function Of COPD Patients With Lung And Kidney Deficiency Syndrome

Objective:To observe PingchuanGuben and Bufei Soup on the immune function of patients of Chronic Obstructive Pulmonary Disease with lung and kidney deficiency syndrome through dectection the body immune function markers as IgA, IgG, IgM, CD3, CD4, CD8and level of cytokine of IL-13.Background:Chronic Obstructive Pulmonary Disease (COPD) a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhance chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbation and comorbidities contribute to overall severity in individual patients. Its pathogenesis is not fully elucidatedThe occurrence, development and outcome of COPD is closely related to the function of the body’s immune system, one of the clinical characteristics of COPD is airway inflammation repeatedly, and such long-term airway infection will make the body’s immune function disorder and low and eventually lead to irreversible airway obstructive ventilation dysfunction.Therefore it can help rehabilitation and delay the occurence of airway dysfunction by enhancing immunity ability of body, regulating immunity and anti-infection ability in COPD patients.Traditional Chinese Medicine holds that COPD due to the lung qi consumption, qi deficiency, unconsolidation of the wei qi and evil invasion repeatedly because of repeated and unrecoverable cough, phlegm and asthma.There is a correlation with lung and kidney deficiency syndrome caused by cough and low immune function in patients with COPD.Patients with COPD accompanied abnormal immune function, not only the occurrence and development of COPD is closely related to the body’s immune system function, the outcome of COPD is also related to the immune status.Immunoglobulin (Immunoglobulin, Ig) refers to globulin with antibody or similar to antibody activity in chemical construction, glycoprotein molecules with antibody activity secreted by mature plasma cells which is activated, proliferated and differentiated under antigen stimulation from B cell, generally exist in blood, tissues and fluids. Immunoglobulin is important in the body’s defenses which not only directly against the corresponding pathogenic microorganisms but also can induce a variety of other functions, such as the complement activation and phagocytosis. According to the molecular structure of the heavy chain and different antigen specificity, the immunoglobulin is divided into five categories, IgA, IgM, IgG, IgE and IgD. The most of antibiotics with anti-microbial property and antiviral antibody belong to IgG, which is the main component serum immunoglobulin, plays a main role in resistance of infection. IgA is the main material against infection of organism mucosal defense, it can resist bacteria, fungi, viruses, respiratory and digestive tract infections with the surrounding immune systems. The effect of sterilization, lysis, on promoting phagocytosis and agglutination of the highly efficient biological antibody of IgM is500-1000times higher than the IgG, which plays an important role in the early stage of the body’s defense.T lymphocyte is the main immune cells in human body, playing a more important roles particularly in the immune systems.Both humoral immunity and cellular immunity cannot without the participation of T lymphocytes. The decreased immune function in the elderly is mainly of cells immune function, especially the T lymphocyte decrease with thymus cells reduced. The cellular immune function is damaged in COPD patients with respiratory failure or not.CD3is T cell count which specifically belongs to surface of the mature T cell. When immunity lowered, CD3also declineing. T cells have two main subgroup as CD4T cells and CD8T cells, which both maintain the balance of the immune system. When the immune function changes, CD4and CD8will changes too. When T cell activity is inhibiting the percentage of CD8cells also decreased, CD4/CD8ratio increased. When CD4cells reduce and the percentage of CD8cells increased or normal, CD4/CD8ratio declined. Thus, CD4/CD8ratio can be used as the important indicators of imrnunosuppression degree of the patient. When immune function decline, CD4/CD8ratio declined.Interleukin-13(IL-13) is a kind of newly discovered cytokine in1993which is one of the important molecules of cytokines net that many related to COPD. Excessive expressed of IL-13can make lung volume of rat increase, mucus gland metaplasia, mucus secretion increas, cause inflammation of the airway. At the same time, it also induce the production of variety of inflammatory factors. IL-13can lead to airway hyperresponsiveness by directly act on the airway structure cell. Chronic expression of IL-13can promote collagen material deposition and enhance collagen contraction under airway mucosa. IL-13may damage the structure of the lung through the above way, participate in the occurrence and development of COPD, the exact mechanism remains to be further studied.Traditional Chinese Medicine vest COPD to the "lung distension" category. COPD is chronic course of the disease, the main performance in stability stage are cough, asthma, cough up phlegm and chest tightness. Most of the clinical syndrome differentiation conforms to the characteristics of traditional Chinese medicine "lung and kidney-qi deficiency". Lung is the government of the qi, kidney is the root of the qi, the normal breathing function should maintain by dominantion fuction of lung and kidney and internal coordination.PingchuanGuben Soup and Bufei Soup both can strengthen lung, benefit kidney, reduce phlegm and stop asthma. PingchuanGuben Soup (constitution:codonopsis15g, fructus6g schisandrae6g, cordyceps sinensis12g, walnut meat magnet18g, aloes15g,umbilical15g, perilla15g, coltsfoot flower12g, the pinellia12g, orange6g) to benefit lung qi.Bufei Soup(constitution:astragalus30g, licorice12g, stalactite12g, ginseng12g, cassia heart15g, dried rehmannia root15g, tuckahoe15g, white quartz15g, magnolia bark15g, mulberry bark15g, dried ginger15g, phlegm15g, orange peel15g, angelica15g, mixed taro15g, polygala15g, ophiopogon15g, jujube20g) to benefit kidney-qi. Party of dangshen, astragalus membranaceus fill spleen lung, centralizer thrift, temper is enough, im wei qi, can improve immunity, enhance the ability of resistance, rehmannia glutinosa nourishing liver and kidney Yin, phlegm, coltsfoot flower, Perilla, pinellia, orange cough phlegm, ti and asthma, white mulberry root-bark, purging lung magnet, aloes, and asthma, walnut meat, kidney temperature lungs, fructus schisandrae folding of the lung cough, licorice to reconcile the medicine, the two sides share, altogether plays lung, kidney, centralizer thrift. Modern research has shown that astragalus polysaccharide dangshen, astragalus polysaccharides, saponins, licorice polysaccharide, liquorice saponin and all has the immune adjustment.Although many scholars have a lot of research in the pathogenesis of COPD on the immune function, but due to the complexity pathogenesis and immune function of COPD, its specific mechanism needs further exploration. Deng used PingchuanGuben and Bufei Soup in the treatment of lung and kidney-qi deficiency syndrome of lung distension received very good curative effect, but lack of observation of clinical indicators and further studying of the mechanism.This study use PingchuanGuben Soup and Bufei Soup for the treatment of patients with COPD with lung and kidney-qi deficiency syndrome, observe on the influence of the IgA, IgG, IgM, CD3, CD4, CD8, IL-13, lung function and blood gas analysis, further investigate the relationship between the COPD and immune function, and the therapeutic effect and possible mechanism of COPD patients and provide theoretical basis for clinical application.Methods:The prospectie, randomized and controlled study method is applied to divided30 cases of healthy people as normal control group,30cases of COPD patients as COPD observation group which treated with PingchuanGuben and Bufei Soap and routine treatment of Western medicine, and30cases of COPD patients as COPD control group which only treated with routine treatment of Western medicine, unlimited with sex ratio and by the method of random numbers table.COPD control group treated with routine treatment of Western medicine for three months. COPD observation group which treated with PingchuanGuben and Bufei Soap and routine treatment of Western medicine, a daily dose, conventional water decoction, divide into twice for drinking, three months for one course of treatment. Selected cases should doing lung function test forced expiratory volume in1second predicted value (FEVlpied), forced expiratory volume in1second (FEVl)/forced vital capacity (FVC), and other clinical indicators, both before treatment and after treatment detection. Extract venous blood10ml in the center of the suction elbow, before and after treatment respectively, take serum and preservated into low temperature-30℃for uniform testing, using immune turbidimetric method to detect the immune globulin IgA, IgG, IgM, using flow cytometry instrument determination of CD3, CD4, CD8, using enzyme-linked immunosorbent (ELISA) determination of IL-13. After the completion of research, using SPSS11.5software to test statistics the data and deviate with average±standard, using ONEWAY single factor analysis of variance and t test, P<0.05for the difference of statistically significant.Results:The lung function of COPD patients is decreased obviously than healthy people (P<0.01). FEV1and FEV1/FVC of control group of COPD had no difference before and after treatment (P>0.05), while improved in observation group of COPD. IL-13of COPD significantly increased than healthy people (P<0.01). Both control group and observation group decreased after treatment, and the latter resulted more significantly (P<0.01).The immune function of COPD significantly decreased obviously than healthy people (P<0.05). IGA, IGG, IGM, CD3, CD4, CD4/CD8of control group of COPD had no difference before and after treatment, while improved in observation group of COPD (P>0.05).IGA, IGG, IGM, CD3, CD4, CD4/CD8of observation group of COPD improved than the control group after treatment (P<0.05).Conclusions:(1) Most patients with COPD exist abnormal immune function, the outcome of disease is also related to immune status.(2) PingchuanGuben and Bufei Soap has a certain clinical significance and value, can effectively improve the immune function of COPD patients with lung and kidney-qi deficiency syndrome, also improve lung function and reduce the level of inflammation factor IL-13.(3) The curative effect of combined Chinese and Western medicine treatment of COPD is value of popularization and application.