三伏天灸疗法与支气管哮喘患者可溶性细胞黏附分子的改变(英文)

Effect of dog-day moxibustion on chges of soluble cellular adhesion molecules in patients with bronchial asthma

背景:传统中医认为三伏天灸疗法对支气管哮喘有很好的临床疗效,认识该疗法对于支气管哮喘患者可溶性细胞黏附分子的影响有助于更好地了解其作用机制。目的:观察三伏天灸疗法对于支气管哮喘患者可溶性细胞黏附分子的影响。设计:前后对照,病例-对照观察。单位:广州中医药大学针灸推拿学院及第一附属医院针灸科门诊。对象:以2004-07/08在广州中医药大学第一附属医院针灸科门诊行三伏天灸治疗的哮喘缓解期患者28例为三伏灸组,同期体检健康自愿者10名为正常对照组。方法:根据“冬病夏治”原则,于初伏(7-20)、中伏(7-30)、末伏(8-09)分别将药(麻黄、细辛、甘遂、延胡、白芥子(生)等)贴于患者肺俞、定喘、风门、百劳、肾俞等穴,贴药时双侧取穴,用胶布将块状药膏贴于穴位上,贴药时间一般为成人3～6h,儿童约1～2h。主要观察指标:观察3个月后的近期疗效,于治疗前及治疗后10天分别检测血浆可溶性细胞黏附分子及IgE水平,并与正常对照组作对照;同时将治疗前患者各项指标进行Pearson相关分析。结果:28例患者和10名正常人全部进入结果分析。①细胞间黏附分子1水平:三伏灸组治疗前显著高于治疗后和正常对照组犤(281.39±64.58),(256.95±44.22),(194.30±39.05)μg/L,P<0.01犦。②血管细胞间黏附分子1水平:三伏灸组治疗前显著高于治疗后和正常对照组犤(234.79±89.75),(185.80±84.41),(128.85±51.28)μg/L,P<0.01犦。③IgE水平:三伏灸组治疗前显著高于治疗后和正常对照组犤(482.61±123.43),(418.96±134.18),(161.53±43.64)μg/L,P<0.01犦。④Pearson相关分析结果:细胞间黏附分子1水平与IgE和血管细胞间黏附分子1均呈显著正相关(r=0.641,0.449,P<0.01,0.05)。⑤疗效:三伏天灸治疗支气管哮喘的总有效率为93%(26/28),患者证型、有无灸疱、疗程长短及病情轻重对疗效无显著影响(均P>0.05)。结论:三伏天灸疗法可能通过抑制黏附分子的表达或直接抑制白细胞与内皮细胞的黏附,从而减少炎细胞的浸润,达到治疗效果。

BACKGROUND： It is thought in traditional Chinese medicine that dogday moxibustion （DDM） has good clinical effect in treating bronchial asthma. Study of its influence on soluble cellular adhesion molecules in patients with bronchial asthma can help to well understand its mechanism.OBJECTIVE： To observe the effect of dog-day on soluble cellular adhesion molecules in patients with bronchial asthmaDESIGN： Self-control, case-control observationSETTING： College of Acupuncture and Manipulation and Clinic of the Department of Acupuncture and Moxibustion of the First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine.PARTICIPANTS： Totally 28 patients with bronchial asthma receiving dog-day moxibustion in the Clinic of the Department of Acupuncture and Moxibustion, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July to August 2004 were set as dog-day moxibustion group, and 10 concurrent health volunteers were set as normal control group.METHODS： According to the principle of “treating winter diseases in summer”, the Chinese medicine which consists of such herbs as Baijiezi（Semen Sinapis Albae ）, Mahuang（Herba Ephedrae ）, Xixin （Herba Asari ）,Gans ui （Radix Kansui ）, Yanhu （Rhizoma Corydalis ） was stuck on the points such as Feishu, Dingchuan, Fengnen, Bailao, Shenshu. Point selection was at the two sides, and a lumpy salve was stuck on the point with adhesive tape. Three to six hours for adult and one to two hours for children in each sticking duration; and the operation was respectively done on the first （July20）, second （July 30） and third （August 9） dog-day.MAIN OUTCOME MEASURES： Short-term effect 3 months later was observed, the levels of soluble cellular adhesion molecules and IgE were assayed before and 10 days after treatment, and comparison with normal control group was performed. The indexes of the patients before treatment were performed Pearson correlation analysis.RESULTS： Twenty-eight patients and 10 healthy persons all entered result analysis. [1] Intercellular adhesion molecule-1 level was significantly higher before treatment in dog-day moxibustion group than that after treatment in the dog-day moxibustion group and that in the normal control group [（281.39±64.58 ）, （256.95±44.22）, （ 194.30±39.05 ） μg/L,P 〈 0.01].[2]Vaso-cellular adhesion molecule-1 level was significantly higher before treatment in the dog-day moxibustion group than that after treatment in the dog-day moxibustion group and that in the normal control group [（234.79±89.75）, （185.80±84.41）, （128.85±51.28）μg/L,P 〈 0.01]. [3]IgE level was significantly higher before treatment than that after treatment in the dog-day moxibustion group and that in the normal control group [（482.61±123.43）, （418.96±134.18）, （161.53±43.64）μg/L,P〈 0.01]. [4]Pearson correlation analysis result： Intercellular adhasion molecule-1 level is significantly positively correlated with IgE and vascular intercellular adhesion molecule-1 level （r =0.641,0.449 ,P 〈 0.01,0.05）. [5]Effect： Total effective rate was 93% （26/28）in the treatment of bronchial asthma with dogday moxibustion . The type of the symptoms, with blister or not, course of disease and condition of disease had no significant influence on effect （P〉 0.05）.CONCLUSION： Dog-day moxibustion may effect through inhibiting the expression of adhesion molecule or inhibiting leukocyte to adhere endothelial cell directly so as to reduce the infiltration of inflammatory cells.