新型透皮吸收贴剂穴位贴敷治疗缓解期哮喘及对患者相关转录因子的影响

New percutaneous absorption herbal patch for asthma of paracmasis and its effect on the relative transcription factors of patients

目的:观察新型透皮吸收中药贴剂治疗哮喘的临床疗效及其治病机制,优化贴剂剂型。方法:将120例缓解期哮喘患者随机分为药贴组、天灸组及西药组,每组40例。药贴组以新型透皮吸收中药贴剂穴位贴敷,天灸组以本院传统天灸药饼穴位贴敷,两组均取肺俞、风门、大椎穴,每次贴6h,隔日1次;西药组用舒利迭吸入治疗,每次2吸,每天2次。分别于治疗前后及疗程结束半年后观察比较各组临床症状积分、哮喘发作次数及无喘息症状天数,同时观察比较治疗前后各组血浆免疫球蛋白E(IgE)、白细胞介素4(IL-4)、GATA结合蛋白3基因(GATA-3mRNA)、T-盒21基因(T-bet mRNA)表达水平。结果:治疗后,3组均能较好改善哮喘患者的临床症状积分(均P<0.01),3组在总有效率及哮喘发作次数、无喘息症状天数方面差异均无统计学意义(均P>0.05);但治疗结束随访半年后的远期疗效比较,药贴组总有效率为80.0%(32/40),天灸组为70.0%(28/40),均明显高于西药组的47.5%(19/40)(P<0.01,P<0.05),在控制哮喘发作次数及延长无喘息症状天数方面药贴组明显优于天灸组和西药组(P<0.05,P<0.01),治疗结束后3组IgE、IL-4水平均较治疗前明显降低(P<0.05,P<0.01),组间比较差异无统计学意义(均P>0.05),药贴组和天灸组尚能明显降低患者GATA-3mRNA水平,提高患者T-bet mRNA水平(P<0.05,P<0.01),且药贴组在提高T-bet mRNA水平方面明显优于西药组和天灸组(P<0.01,P<0.05)。结论:新型透皮吸收中药贴剂穴位贴敷治疗哮喘疗效确切,其治病机制可能是通过调节细胞因子及其特异性转录因子从而逆转Th1/Th2失衡而实现的。

Objective To observe the therapeutic effect and mechanism of new percutaneous absorption herbal patch for asthma of paracmasis,and to optimize the form of the patch.Methods One hundred and twenty cases of paracmasis asthma were randomly divided into medicine patch group,medicinal vesiculation group and western medication group with 40 cases for each.The new percutaneous absorption herbal patch was applied on medicine patch group.Traditional medicinal herbs cake of the hospital were applied on medicinal vesiculation group.Feishu（BL 13）,Fengmen（BL 12） and Dazhui（GV 14） were adopted for both groups.Each patch was applied for 6 hours and once every other day.Accuhaler was applied on the western medicine group with 2 inhalations a time and twice a day.Clinical symptom scores,number of attacks and asymtomatic days were observed right before,after and half a year after the treatment.Meanwhile,the expression level of IgE,IL-4,GATA-3 mRNA and T-bet mRNA were observed and compared before and after the treatment.Results Clinical symptom scores of all the 3 groups were improved（all P0.01）.The differences of the total effective rate,number of attacks and asymtomatic days of all the 3 groups are without statistical significance（all P0.05）.However,the long-term therapeutic effect in half a year after the treatment showed that the total effective rate of the medicine patch group was 80.0%（32/40）,and the medicinal vesiculation group was 70.0%（28/40）.Both of the them were obviously higher than 47.5%（19/40）of the western medicine group（P0.01,P0.05）.And the medicine patch group surpassed the other 2 groups in controlling the number of attacks and increasing the asymtomatic days（P0.05,P0.01）.The level of IgE and IL-4 of all the 3 groups decreased sharply after the treatment（P0.05,P0.01）.And there was no statistic significance in differences among groups（all P0.05）.The level of GATA-3 mRNA was obviously decreased,while the level of T-bet mRNA was obviouly increased in the medicine patch and medicinal vesiculation groups（P0.05,P0.01）.And the medicine patch group had obvious superiority on increasing the level of T-bet mRNA when compared with the medicinal vesiculation and western medicine groups（P0.01,P0.05）.Conclusion It is concluded that the new percutaneous absorption herbal patch has exact effect on asthma.The treatment may reverse the imbalance condition of Th1/Th2 through regulation on cell factor and its specific transcription factors.