芪丹复感颗粒对反复呼吸道感染患儿及免疫低下小鼠T细胞的影响

发布时间：2018-04-30 12:32

本文选题：芪丹复感颗粒 + 反复呼吸道感染　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的及意义:据不完全统计,在我国儿科门诊病人中,呼吸道感染占患儿的70%左右,其中30%为反复呼吸道感染,且发病率呈居高不下之态。特别是在季节更替、气候变化异常,或家长对儿童衣物增减不及时,都易让患儿出现反复的感冒、发热、咳嗽等病证,病程缠绵,每年发病几次或十几次,且易并发肺炎、哮喘、心肌炎、急性肾炎等严重疾患,更加增加患儿成年后患其他慢性呼吸系统疾病的可能性。对儿童无论从身体上还是心灵上都易造成严重损害,也令家人和亲人担忧。因此反复呼吸道感染虽然不能称为一个独立的疾病,但作为儿科常见的临床现象,其形势严峻己经引起全社会的广泛关注。现代医学对RRTI确切的发病原因尚未所知,研究提示RRTI的发生可能与小儿的解剖特点、免疫功能异常、微量元素缺乏、遗传易感性与基因突变等因素有关。而随着黏膜免疫系统研究的深入,我们发现RRTI患儿的体液免疫及细胞免疫功能均有不同程度的降低,尤以细胞免疫功能改变明显,而在胃肠道黏膜集合淋巴结中抗原诱导的淋巴细胞会经循环而分布到呼吸道和消化道及各处外分泌腺黏膜的淋巴组织中,使机体获得抗体。因此肺、脾同免疫功能的关系显得密不可分。在以往的中医治疗上,多以解表扶正为大法。王俊宏教授则突破固有的传统思路,在"肺脾同调"的基础上提出"久病必瘀",以益气活血运脾为其治疗原则,更加深入探究小儿反复呼吸道感染的中医病机。本次研究主要观察芪丹复感颗粒就对气虚血瘀型反复呼吸道感染患儿治疗前后中医证候的改变及T细胞亚群的影响以及制备免疫低下小鼠模型,观察并检测芪丹复感颗粒对免疫功能低下模型小鼠T细胞亚群的影响,同时从临床和实验两方面阐述芪丹复感颗粒对RRTI患儿免疫系统的改善效果。研究方法临床研究:本研究全部病例来自2015年8月至2016年12月就诊于北京中医药大学东直门医院儿科门诊的患儿,共计31例患儿进入临床试验。予口服芪丹复感颗粒(黄芪,白术,太子参,丹参,赤芍,川考,鸡内金等),根据患儿临床病情的不同,随证加减,若鼻塞流涕者加辛夷、苍耳子,痰盛加浙贝(燥邪偏盛增加川贝起润肺作用),咽喉肿痛加玄参、板蓝根,咳嗽加炙百部、炙杷叶;湿重者加生白术、生苍术,大便干者加瓜萎、炒枳实,治疗3个月。口服剂量依患儿年龄不同而调整。急性感染者应暂停试验,对症处理。3个月后进行治疗前后临床表现、中医证候积分以及血清T细胞亚群含量对比。动物实验:雄性昆明小鼠70只随机分成7组,分辨为模型组、空白对照组、芪丹复感颗粒高、中、低剂量组,匹多莫德组,槐杞黄组。每组10只,对照组生理盐水,其余各组按照50mg/kg的剂量连续注射环磷酰胺溶液3d;同时各组连续给药10天。观测免疫低下模型小鼠治疗前后,胸腺、脾等脏器指数以及T细胞亚群免疫指标的变化。统计方法:以上数据均采用Excel录入,SPSS20.0统计,统计方法为正态数据采用配对t检验,组间分析采用单因素方差分析及方差齐性检验,方差齐性数据使用Tukey和REGWQ检验,方差不齐数据使用Dunnett' st检验。研究结果1、经过统计,CD3+治疗前为65.77±6.70,治疗后为66.27±4.42,P0.05无统计学意义。CD3+CD4+、CD3+CD8+、CD4+/CD8+在治疗前分别为40.78±5.77、22.17±3.46、1.37±0.66,经过治疗后均呈升高分别为 45.78±3.73、25.13±4.27、1.71±0.11,均P0.05有统计学意义。提示芪丹复感颗粒对于RRTI患儿免疫力有提升作用。治疗前后呼吸道症状对比可见鼻塞流涕症状缓解率为84%,咽痛充血缓解率为88%,咳嗽咳痰缓解率为71%,腹胀频率缓解率为67%。治疗前后鼻塞流涕症状积分、咽痛充血症状积分、咳嗽咳痰症状积分、腹胀频率症状积分经统计后P0.05,均有统计学意义。提示芪丹复感颗粒对于RRTI患儿鼻塞流涕、咽痛充血、咳嗽咳痰、腹胀频率症状有改善作用。2、治疗前后中医症状积分对比得出自汗、面色少华、纳呆食少、倦怠乏力、面色晦暗、眼眶色黑经过治疗后各症状积分均较前下降,且均P0.05有统计学意义。提示芪丹复感颗粒在中医症状改善方面有显著疗效。3、脾/胸腺指数,经组间分析后得出,造模后的小鼠脾指数和胸腺指数明显低于空白对照组,均P0.01,差异具有统计学意义,模型组同匹多莫德组、槐杞黄组及芪丹复感(高中剂量)组在脾指数及胸腺指数上均无明显差异,均P0.05。芪丹复感颗粒低剂量的小鼠脾指数和胸腺指数有一定的降低,各组间P0.059,差异具有统计学意义。T细胞亚群含量:经统计后得出,CD3+T细胞占淋巴细胞比例的各组均较空白组呈升高,均P0.05。模型组与各治疗组之间分别比较后无统计学意义,P0.05。在CD3+CD4+T细胞占T细胞比例中,各组均较空白组呈升高,均P0.05。模型组与各治疗组组间比较中仅槐杞黄较要明显低于模型组,P0.05。CD3+CD8+T细胞占T细胞比例方面,各组均较空白组呈降低,均P0.05,而模型组与各治疗组间比较中,芪丹复感低剂量组要明显低于模型组(P0.05),同时芪丹复感中剂量组要低于匹多莫德治疗组(P0.05)匹多莫德组、槐杞黄和芪丹复感高剂量组与模型组间无统计学差异(均P0.05)。研究结论芪丹复感颗粒对于气虚血瘀证反复呼吸道感染患儿症状及中医证候有改善作用;芪丹复感颗粒(低剂量)对于免疫低下型小鼠血清T细胞亚群水平有提高作用、对小鼠免疫力增强。
[Abstract]:The purpose and significance of the study: according to incomplete statistics, respiratory tract infection accounts for about 70% of the children in the outpatient department of Pediatrics in China, of which 30% are recurrent respiratory infections, and the incidence is high. Fever, cough and other diseases, the course of disease is lingering, a few times a year or more than a dozen times, and it is easy to be complicated with pneumonia, asthma, myocarditis, acute nephritis and other serious diseases. It is more likely to increase the possibility of other chronic respiratory diseases in children. It is easy to cause serious damage to children, both in body and in mind, and to worry about family and relatives. Therefore, although recurrent respiratory infection can not be called an independent disease, as a common clinical phenomenon in pediatrics, the severe situation has attracted wide attention of the whole society. The exact cause of RRTI is not known by modern medicine. The study suggests that the occurrence of RRTI may be related to the anatomical characteristics of children, the abnormal immune function, and the lack of trace elements. Deficiency, genetic susceptibility is related to factors such as gene mutation. With the in-depth study of the mucosal immune system, we found that the humoral immunity and cellular immune function of children with RRTI are reduced in varying degrees, especially the cellular immune function changes obviously. The relationship between the lung, the spleen and the immune function appears to be inseparable. In the past Chinese medicine treatment, most of the traditional Chinese medicine, Professor Wang Jun Hong, broke through the inherent traditional ideas and put forward "long illness" on the basis of "lung and spleen homology". This study mainly observed the changes of TCM syndrome and the influence of T cell subsets before and after the treatment of qi deficiency and blood stasis type of recurrent respiratory infection and the preparation of the immunosuppressive mice model. The effect of Qidan compound granule on T cell subsets in immunocompromised model mice was detected and examined. At the same time, the effect of Qidan complex Granule on the immune system of children with RRTI was discussed from two aspects of clinical and experimental. The clinical study of the study methods: all cases from August 2015 to December 2016 were from the east of Beijing University of Chinese Medicine A total of 31 children in the outpatient department of Pediatrics in the hospital of gate hospital were enrolled in the clinical trials. They were given oral Qidan Fu Kang Granules (Huang Qi, Rhizoma Atractylodes, Radix radix ginseng, radix salviae miltiorrhizae, Radix Paeoniae Radix Paeoniae, kagao, chicken inner gold etc.). Sore throat, Radix Isatidis, Radix Isatis Root, coughing with 100 parts, broiled quat leaves; wet heavy people with Atractylodes, cacoatractylodes, cacoatractylodes, cacoatractylodes, fry Fructus aurantii Immaturus for 3 months. The oral dose is adjusted according to the age of children. The patients with acute infection should suspend the experiment for.3 months after treatment, TCM syndrome score and serum T fine. Animal experiment: 70 male Kunming mice were randomly divided into 7 groups, identified as model group, blank control group, Qidan compound granule high, middle and low dose group, pidodoodo group, Huai Qi Huang group. 10 rats in each group, control group physiological saline, and the other groups were injected cyclophosphamide solution 3D continuously according to the dose of 50mg/ kg; meanwhile the groups were continuous in each group. After 10 days of administration, the changes in the index of the thymus and spleen and the immune index of T cell subsets were observed before and after the treatment of the immunocompromised model mice. The statistical methods: the above data were recorded by Excel, SPSS20.0, and the statistical method was positive for normal data by paired t test, and the analysis of the inter group analysis was carried out by single factor analysis of variance and variance homogeneity test, Fang Chaqi The data were tested with Tukey and REGWQ, and the data of variance uneven use Dunnett'st test. Results 1, the results were 65.77 + 6.70 before CD3+ treatment, 66.27 + 4.42 after treatment, P0.05 without statistical.CD3+CD4+, CD3+CD8+ and CD4+/CD8+ were 40.78 + 5.77,22.17 + 3.46,1.37 + 0.66 before treatment, and all were increased after treatment, respectively. It was 45.78 + 3.73,25.13 + 4.27,1.71 + 0.11, all P0.05 had statistical significance. It was suggested that Qidan Fu Qing granule had a promotion effect on the immunity of children with RRTI. The respiratory symptoms before and after treatment showed that the remission rate of nasal congestion was 84%, the remission rate of sore pain was 88%, the rate of cough expectoration remission was 71%, and the rate of abdominal distention frequency relieved before and after 67%. treatment. The symptom score of nasal congestion, the integral of the symptoms of sore pain, the integral of cough and expectoration, the integral of the symptoms of abdominal distention were statistically significant after the statistical P0.05. It suggested that the Qidan Fu Qing granule had the effect of improving the symptoms of nasal congestion, sore throat, coughing and phlegm and abdominal distention in children with RRTI. The symptoms of abdominal distension were improved by.2, and the scores of TCM symptoms before and after the treatment were compared from before and after the treatment. There was a significant effect on the symptom improvement of traditional Chinese medicine.3, the spleen / thymus index, after the analysis of the spleen / thymus index, the spleen index and thymus index of the mice after the model were obtained, and the spleen index and thymus index after the model were obtained. Obviously lower than the blank control group, all P0.01, the difference was statistically significant. There was no significant difference between the model group and the Pi do Maude group, the Huai Qi Huang group and the Qidan complex (high school dose) group in the spleen index and the thymus index. The spleen index and thymus index of the mice in the low dose of P0.05. Qidan complex granules were reduced, and the difference was P0.059 in each group. The content of.T cell subgroup was statistically significant: after statistics, it was found that the proportion of CD3+T cells in the proportion of lymphocytes was higher than that in the blank group, and there was no statistical significance between the P0.05. model group and the treatment groups. P0.05. was higher in the proportion of T cells in CD3+CD4+T cells than in the blank group, all P0.05. model groups and each treatment group were treated with each treatment. Compared with the model group, the ratio of P0.05.CD3+CD8+T cells to T cells was lower than that in the blank group, which was lower than that of the model group. In the comparison between the model group and the treatment group, the low dose group of Qidan complex was significantly lower than that of the model group (P0.05), and the dose group in the Qidan complex was lower than the Pi do Maude treatment group. Group (P0.05) pidodo group, Huai Qi Huang and Qidan complex high dose group had no statistical difference between the model group and the model group (P0.05). Conclusion Qidan complex granule could improve the symptoms and TCM Syndromes of children with recurrent respiratory infection of qi deficiency and blood stasis syndrome, and Qidan complex granule (low dose) was used in the subgroup of serum T cells in immunocompromised mice. It has an enhanced effect and enhances immunity in mice.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

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