支气管哮喘“寒痰”与“热痰”证型微观辨证指标及其炎症特点

目的探讨支气管哮喘"寒痰"、"热痰"证型的微观辨证指标及其炎症特点。方法将支气管哮喘慢性持续期按中医辨证分为寒痰证组(27例)、热痰证组(32例)和非寒痰热痰证组(31例),并以健康人作为正常组(33名)。通过诱导痰技术使之咳出痰液,痰涂片计数嗜酸性粒细胞(Eosinophil,EOS)百分比、中性粒细胞(Neutrophils,NEU)百分比;血常规测EOS和NEU百分比;ELISA方法检测痰上清液和血清中白介素(IL)-8、IL-4、IL-5、干扰素(IFN)-γ、嗜酸性粒细胞阳离子蛋白(ECP)、白三烯(LT)B4、C-反应蛋白(CRP)水平。结果寒痰证组血和痰EOS均明显高于正常组、非寒痰热痰证组和热痰证组(均P0.01),热痰证组痰NEU高于正常组、非寒痰热痰证组和寒痰证组(P0.05);与EOS密切相关的ECP在寒痰证中较正常组明显升高,与NEU密切相关的IL-8各组间比较,差异无统计学意义(P0.05)。寒痰证组血清IL-4水平高于非寒痰热痰证组(P0.05),IFN-γ/IL-4值明显低于非寒痰热痰证组(P0.01)。结论中医哮病之宿根——"痰"可能与现代医学的"炎症"相关。哮喘寒痰证型的炎症特点部分表现为EOS升高,可能有Th2优势的趋势,与嗜酸性粒细胞哮喘表现有类似之处。热痰证表现为气道局部NEU升高。EOS、ECP可能是哮喘寒痰证微观辨证的重要指标之一,NEU可能是热痰证微观辨证的重要指标之一。

Biomarkers and Inflammatory Characteristics for Microcosmic Syndrome Differentiation of Cold-phlegm Syndrome and Heat-phlegm Syndrome in Patients with Bronchial Asthma

Objective To explore the biomarkers and inflammatory characteristics for microcosmic syndrome differentiation of cold-phlegm syndrome（CPS） and heat-phlegm syndrome（HPS） in patients with bronchial asthma.Methods Patients with bronchial asthma of chronic persistent condition were distributed into three groups according syndrome differentiation,the CPS group（27 patients）,the HPS group（32 patients） and the non-cold/heat-phlegm syndrome group（NP group,31 patients）,besides,a control group was setup with 33 healthy persons.Percentages of neutrophils and eosinophils（NEU,EOS） in sputum sample（collected by induction） and peripheral blood were counted;and levels of interleukin-8,-5,and-4（IL-8,IL-5 and IL-4）,interferon-γ（IFN-γ）,leukotriene B4（LT-B4）,eosinophil cationic protein（ECP）,and C-reactive protein（CRP） in sputum supernatant and serum were determined by enzyme-linked immunosorbent assay.Results Percentage of NEU in sputum of HPS group was higher than that in the other three groups（P 0.05）;while percentages of EOS in serum and sputum of CPS group were higher than that in the other three groups（all P 0.01） .Level of ECP（a parameter closely associated with EOS） also was high in the CPS group,but IL-8（a parameter closely associated with NEU） showed no significant difference in various groups（P 0.05） .Moreover,the CPS group showed a higher serum IL-4（P 0.05） but a lower IFN-γ/IL-4 level as compared with those in the NP group（P 0.01） .Conclusion Phlegm,which is considered by Chinese medicine as an inveterate root of asthma,might be closely related with the inflammation in modern medicine.The inflammatory characteristics of asthma inpatients with CPS partially present as increase of EOS,possibly show Th2 dominant trend,similar to that presented in eosinophilic asthma.Asthma with HPS embodies increase of NEU in respiratory tract.EOS and ECP might be the important markers for microcosmic syndrome differentiation of CPS,and NEU might be that for HPS.