特异性免疫治疗联合中医药治疗小儿哮喘的临床和实验研究

发布时间：2018-06-05 20:18

本文选题：哮喘 + 特异性免疫治疗　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：1.通过回顾性研究473例寻求中医药治疗患儿的皮肤点刺结果,了解其过敏原分布特点,为开展中西医诊治过敏性疾病提供过敏原依据。2.跟师许尤佳教授,系统整理其治疗小儿哮喘恢复期的124个医案,分析其用药规律,论述“儿为虚寒”理论内涵及临床意义。3.通过前瞻性、随机对照研究,评价特异性免疫治疗联合中药干预哮喘患儿的临床疗效及对不良反应的影响。4.通过使用卵清蛋白诱导方法建立哮喘小鼠动物模型,使用中药膏方联合特异性免疫治疗,初步探索两者结合对哮喘小鼠的疗效及作用机制。方法：1.借助统计软件SPSS 17.0,系统整理、分析2008年4月至2013年2月广东省中医院儿科门诊的473例儿童皮肤点刺试验结果。2.借助中医传承辅助系统软件,选取许尤佳教授在广东省中医院儿科门诊治疗小儿哮喘恢复期的124例医案,对处方中应用的药物进行药物频次、四气五味、用药组合、药对、核心组合及新方发现等研究分析。3.采用前瞻性、随机对照方法,对儿童哮喘患者随机分为治疗组(特异性免疫治疗+中药)和对照组(特异性免疫治疗组),观察期为50周,分别在治疗前、第4周、第9周、第13周、第17周、第21周,第25周,第29周,第35周,第41周,第47周,第50周观察PEF、PEF变异率、不良反应的发生情况。4.20只6-8周龄SPF级BALB/c小鼠,随机分为空白对照组、哮喘模型组、特异性免疫治疗组、特异性免疫治疗联合中药膏方组,采用卵清蛋白腹腔注射及雾化激发构建支气管哮喘小鼠模型,给予特异性免疫治疗及中药膏方灌胃治疗,检测肺泡灌洗液细胞计数和分类,用ELISA法测定血清IgE,肺泡灌洗液IL-4、IFN-γ含量,用HE染色法检测小鼠肺组织病理学改变。结果：1.473例儿童中皮肤点刺试验阳性者共361例,阳性检出率为76.32%；过敏原阳性率较高的前3位依次为粉尘螨71.67%、屋尘螨68.71%、无爪热带螨37.21%；单一变应原阳性者占4.99%,2种以上变应原阳性者占95.01%；男童和女童阳性率差异无统计学意义(P0.05)；学龄前期阳性率低于学龄期,而学龄期与青春期阳性率无明显差别。2.许尤佳教授治疗小儿哮喘恢复期处方主要由补虚药、解表药、理气药、消食药和收涩药组成。124个处方的高频用药主要有：防风、白术、甘草、陈皮、五味子、炒稻芽、槟榔、柿蒂、太子参和佛手等。许尤佳教授治疗小儿哮喘恢复期以以温药为主,其次为平之品,少佐寒、凉性药物,亦少用热性药物。3.特异性免疫治疗联合中药组的PEF、PEF变异率在第17周开始出现明显改善,而对照组在21周左右才出现类似改变；治疗组的不良反应发生率低于对照组。4.中药膏方联合特异性免疫治疗组可改善鼠肺组织炎症细胞浸润,血清IgE水平较哮喘组下降(P0.05),中药膏方组联合SIT组较SIT下降更明显(P0.05)；SIT、中药膏方联合SIT组在肺泡灌洗液中白细胞总数及嗜酸性粒细胞总数均减少,肺泡灌洗液的IL-4下降、IFN-γ上升(P0.05),但两者差异无统计学意义(P0.05)。结论：1.寻求中医治疗儿童的变应原以粉尘螨、屋尘螨为主；单一变应原过敏者较少见；变应原阳性率与性别无关；学龄前期到学龄期,皮肤点刺试验阳性率随着年龄增长而增加。2.许尤佳教授治疗小儿哮喘恢复期以“儿为虚寒”为指导,常用补虚、理气、消食之品,重视饮食、生活调护指导。3.标准化特异性免疫治疗联合中药后,可缩短起效时间,减少全身不良反应的发生,起到减毒增效的作用。4.中药膏方联合特异性免疫治疗可以降低小鼠血清IgE水平,减轻肺部炎症。
[Abstract]:Objective: 1. through retrospective study of the results of 473 Cases of skin pricking in children seeking Chinese medicine, to understand the distribution characteristics of allergen, to provide the basis of.2. heel Xu Youjia to provide the basis for the diagnosis and treatment of allergic diseases between Chinese and Western medicine, to systematically organize the 124 medical cases in the recovery period of children's asthma and to analyze the law of drug use. The theoretical connotation and clinical significance of deficiency cold ".3. through prospective, randomized controlled study to evaluate the effect of specific immunotherapy combined with traditional Chinese medicine on the clinical efficacy and adverse effects of asthma in children.4. through the use of ovalbumin induction method to establish an animal model of asthma in mice and the combination of traditional Chinese Medicine ointment and specific immunotherapy. The effect and mechanism of the combination of the two groups on the asthma mice. 1. with the help of the statistical software SPSS 17, the results of the skin pricking test of 473 children in the outpatient department of Pediatrics of Guangdong Province Traditional Chinese Medical Hospital from April 2008 to February 2013 were analyzed with the help of the traditional Chinese Medicine Inheritance auxiliary system software, and Xu Youjia was selected in the pediatric door of the Department of Pediatrics. 124 cases of medical treatment in the recovery period of children's asthma were treated, and the drug frequency, four flavors, combination of drugs, drug pair, core combination and new discovery were analyzed and analyzed by.3.. The treatment group (specific immunotherapy + Chinese Medicine) and the control group were randomly divided into treatment group (specific immunotherapy + Chinese Medicine) and control group (specificity). Immunotherapy group), the observation period was 50 weeks, before treatment, fourth weeks, ninth weeks, thirteenth weeks, twenty-first weeks, twenty-fifth weeks, twenty-ninth weeks, thirty-fifth weeks, forty-first weeks, forty-seventh weeks, the PEF, PEF variation, and the occurrence of adverse reactions.4.20 only ninth weeks of age SPF BALB/c mice, randomly divided into blank control group, asthma model group, specific immunotherapy The treatment group, specific immunotherapy combined with the cream prescription group, using ovalbumin intraperitoneal injection and atomization stimulation to construct the model of bronchial asthma mice, given specific immunotherapy and traditional Chinese medicine cream gavage treatment, detection of alveolar lavage liquid cell count and classification, ELISA method to determine serum IgE, alveolar lavage solution IL-4, IFN- gamma content, HE staining Results: the pathological changes in lung tissue of mice were detected. Results: 361 cases were positive for skin prick test in 1.473 children, the positive rate was 76.32%, the top 3 of the high positive rate of allergens were 71.67% dust mites, 68.71% of house dust mites, 37.21% of claw free tropical mites, 4.99% of the single strain and 2 kinds of allergen positive persons, and 95.01% There was no significant difference in the positive rate of boys and girls (P0.05), the positive rate of pre school age was lower than that of school age, but there was no significant difference between school age and puberty positive rate..2. Xu Youjia's prescription mainly consisted of supplementation of deficiency drugs, table medicine, physical medicine, digestion medicine and astringent medicine, which consisted of.124 prescriptions. There are: wind proof, Atractylodes, licorice, tangerine, Schisandra, fried rice sprouts, areca, persimmon, Diospyros, and Buddhist hands. Professor Xu Yu Jia is the main treatment in the recovery period of children's asthma, followed by a flat product, less cold, cold sex drugs, and less use of.3. specific immunotherapy for PEF in the Chinese medicine group, and the mutation rate of PEF begins to appear in seventeenth weeks. A similar change was found in the control group for about 21 weeks. The incidence of adverse reactions in the treatment group was lower than that of the control group.4. ointment combined with the specific immunotherapy group. The serum IgE level was lower than that of the asthma group (P0.05), and the combination of the ointment group and the SIT group decreased more significantly (P0.05) than the SIT group (P0.05); SIT, in SIT, The total number of white blood cells and eosinophils in the group of ointment combined with SIT in the alveolar lavage solution decreased, the IL-4 of the alveolar lavage fluid decreased and the IFN- gamma increased (P0.05), but there was no significant difference between the two groups (P0.05). Conclusion: 1. the allergen in the treatment of children with traditional Chinese medicine is mainly dust mite and house dust mites, and the single allergen allergy is rare. The positive rate of allergens was not related to sex; the positive rate of the skin prick test increased with the age of.2. in the early period of school age. Professor Xu Youjia treated the recovery period of children's asthma to "children's deficiency cold". It was commonly used to supplement deficiency, Qi, food, diet, and life care guidance in the.3. standardized specific immunotherapy. After medicine, it can shorten the onset time, reduce the occurrence of systemic adverse reaction, and play the role of reducing toxicity and increasing efficiency. The combination of.4. cream and specific immunotherapy can reduce the level of IgE in the serum of mice and reduce the lung inflammation.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R725.6

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