月经期哮喘患者肺肾阳虚证与生殖激素、免疫相关性临床研究

Clinical research on correlativity between lung-kidney yang-deficiency and reproductive hormone,immunity of patient with menstrual asthma

目的:观察月经期哮喘(PMA)患者生殖激素、T淋巴细胞与呼气峰流速的变化,探讨其相关性及在中医证型肺肾阳虚证(虚寒证)、非肺肾阳虚(非虚寒证)的表达。方法:选择PMA患者161例为研究对象、正常健康女性50例为对照;采用免疫荧光抗体标记和流式细胞仪检测外周血Ⅰ/Ⅱ型T淋巴细胞水平;放射免疫分析法测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E_2)、睾酮(T)、孕酮(P)的含量;采用GD微型峰流速仪测定气道峰流速(PEF)及变异率。结果:(1)PMA患者在月经前、月经期PEF值明显降低(P<0.05、P<0.01),PEF变异率≧20%例数显著增多(P<0.05);(2)与正常组比较:虚寒证组患者血清T、FSH激素水平的降低(P<0.05),E2激素水平降低则有显著性(P<0.01)。非虚寒证组患者血清P激素水平显著升高(P<0.01),T、LH激素水平亦升高,有统计学意义(P<0.05);(4)与正常组相比,虚寒证组患者外周血中CD_3^+T、CD_3^+CD_8^+T、Th_2、Th_2/Th_1、Tc_2、Tc_1细胞的含量显著降低(P<0.01),Tc_2/Tc_1降低(P<0.05);CD_3^+CD_4^+T细胞含量升高(P<0.05),CD_3^+CD_4^+T/CD_3^+CD_8^+T、Th_1升高(P<0.01)。非虚寒证组患者外周血中CD_3^+T、CD_3^+CD_8^+T、Tc_1细胞的含量降低(P<0.01),CD_3^+CD_4^+T、Th_1细胞含量降低(P<0.05);Th_2/Th_1、Tc_2升高(P<0.05),Tc_2/Tc_1升高(P<0.01)。CD_3^+CD_4^+T/CD_3^+CD_8^+T、Th_2有升高趋势,但无统计学意义(P>0.05)。(4)PMA虚寒证患者T淋巴细胞Th_2、Tc_2、Th_1、Tc_1细胞与血清生殖激素中E_2、P、T、FSH等水平变化相关,与PRL、LH水平变化无明显相关性。Th_1细胞与E_2呈负相关(r=-0.551,P<0.05),Th_2、Tc_2细胞、Th_2/Th_1与T呈正相关(r=0.549,P<0.01;r=0.619,P<0.01;r=0.382,P<0.05),Th1细胞与P、FSH呈负相关(r=-0.353,P<0.05)。结论:PMA患者围月经期存在生殖激素的波动,尤其是E_2和(或)P水平激素水平的异常,对气道呼气峰流速有影响,且与虚寒证的发生相关。

Objective ： To observe the changes of reproductive hormone, T lymphocytes and peak expiratory flow in patient with menstrual asthma（PMA） , and to explore its correlativity and the expressions of lung and kidney yang-deficiency （deficiency-cold syndrome） and non lung and kidney yang-deficiency （non deficiency-old syndrome）. Methods： 161 cases of PMA patients were chosen as the research objects,50 cases of normal healthy women as controls; Ⅰ/Ⅱ type T lymphocyte levels in peripheral blood were detected by imnmnofluorescent antibody labeling and flow cytometry; The contents of follicle stimulating hormone （FSH）, luteinizing-hormone （LH）, estradiol（E2）, testosterone （T） and progesterone （P） in serum were determined by radioimmunoassay; the peak expiratory flow（PEF） and the variation rate were determined by GD mini peak flow meter. Results：（ 1 ） PEF values of PMA patients were obviously decreased before the menstruation and during the menstrual period （P 〈 0.05, P 〈0. 01 ）, PEF variation rates≥20% the number of cases were obviously increased （ P 〈 0.05 ）. （2） Compared with normal group： T, FSH hormone levels in serum of patients with deficiency-cold syndrome were decreased （P 〈 0. 05 ） , E2 hormone levels were obviously decreased （ P 〈 0. 01 ）. P hormone levels in serum of patients with non deficiency-cold syndrome were obviously increased （P 〈 0. 01 ）, T, LH hormone levels were also increased, there was statistical significance （P 〈 0. 05）. （3） Compared with the normal group： CD3 T, CD3 CDs T, Th2,Th2/ThI ,Tc2,TcI cell contents in pe- ripheral blood of patients with deficiency-cold syndrome were obviously decreased（P 〈0. 01 ）, Tc2/Tc1 were decreased （P 〈 0. 05）,while CD3＋ CD4 T cell contents were increased （P 〈 0. 05 ）, CD3 CD4 T / CD3 CDs T, Th, were increased （P 〈0.01 ）. CD3＋T, CD3 CD8 T, Tc1 cell contents in peripheral blood of patients with non deficiency-cold syndrome were decreased P 〈0. 01 ）, CD3 CD4 T, Th1 cells contents were decreased （P 〈 0. 05） ; Th2/Thl, Tc2 were increased （P 〈0. 05）, Tc2/Tc1 were increased （P 〈0. 01 ）. CD3 CD4 T / CD3＋ CDs T, Th2 tended to increase, but there was not statistical significance （ P 〉 0. 05 ）. （4） In PMA patients with deficiency-cold syndrome, Th2, Tc2, Th1, Tc1 cells of T lymphocytes were correlative to levels changes of E2, P, T, FSH, etc. of reproductive hormone in serum, not obviously correlative to levels changes of PRL,LH. Thl ceils were negatively correlative to E2 （r = -0. 551, P 〈 0. 05 ） ; Th2, Tc2 cells, Th2/Th1 were positively correlative to T （r = 0. 549, P 〈0. 01 ; r =0. 619, P 〈0. 01 ; r =0. 382, P 〈0.05） ; Th1 cells was negatively correlative to P, FSH （r = - 0. 353, P 〈 0.05 ）. Conclusion ： Reproductive hormones fluctuations exist in PMA patients during the menstrual period. Especially, the abnormal of hormone levels of E2 and （or） P levels has influence on peak expiratory flow of airway, and is correlative to the occurrence of deficiency-cold syndrome.