基于NF-κB信号通路探讨宣肺解痉方对支气管哮喘免疫失衡和炎症反应的影响

Effects of decoction for diffusing the lung and releasing convulsion on immune imbalance and inflammatory response in bronchial asthma based on NF-κB signaling pathway

目的观察宣肺解痉方对支气管哮喘患者免疫失衡、炎症反应及核转录因子-κB(NF-κB)信号通路的影响,探讨其治疗支气管哮喘的分子机制。方法选择2021年3月—2022年3月河北省中医院诊治的80例支气管哮喘患者作为研究对象,按照随机数字表法分为对照组与观察组各40例。对照组予布地奈德福莫特罗粉吸入剂(160μg/4.5μg)治疗,观察组在对照组治疗基础上联合宣肺解痉方治疗,2组连续治疗28 d。观察2组治疗前后临床症状体征积分、哮喘控制水平(ACT评分)、肺功能指标[第一秒用力呼气容积占预计值百分比(FEV_(1)%)、呼气峰值流速(PEF)]、气道炎症指标[呼气一氧化氮(FeNO)水平及血清嗜酸性粒细胞(EOS)计数、总免疫球蛋白E(IgE)水平]、免疫失衡指标[白细胞介素-4(IL-4)、γ干扰素(IFN-γ)]、通路相关指标[NF-κB p65、核转录因子-κB抑制蛋白α(IκBα)]的变化,比较2组临床疗效。结果与治疗前比较,2组患者治疗后临床症状体征积分、FeNO水平、EOS计数及血清IgE、IL-4、NF-κBp65水平均明显降低,ACT评分、FEV_(1)%、PEF及血清IFN-γ、IκBα水平均明显升高,差异均有统计学意义(P均<0.05);治疗后组间比较,观察组患者临床症状体征积分、FeNO水平、EOS计数及血清IgE、IL-4、NF-κBp65水平均明显低于对照组,ACT评分、FEV_(1)%、PEF及血清IFN-γ、IκBα水平均明显高于对照组,差异均有统计学意义(P均<0.05)。观察组总有效率明显高于对照组[90.0%(36/40)vs 77.5%(31/40)](P<0.05)。结论宣肺解痉方能够有效控制支气管哮喘患者的临床症状,提高肺功能,纠正免疫失衡,降低炎症反应,其作用机制可能与抑制NF-κB信号通路相关。

Objective It is to observe the effects of decoction for diffusing the lung and releasing convulsion on immune imbalance,inflammatory response and nuclear transcription factor-κB(NF-κB)signaling pathway in bronchial asthma patients,and to explore the molecular mechanism of this decotion in the treatment of bronchial asthma.Methods Eighty patients with bronchial asthma treated in Hebei Provincial Hospital of Traditional Chinese Medicine from March 2021 to March 2022 were selected as the study subjects,and were divided into control group and observation group according to the method of randomized numerical table,with 40 cases in each group.The control group was treated with budesonide formoterol powder inhaler(160μg/4.5μg),and the observation group was treated with decoction for diffusing the lung and releasing convulsion combined with the therapy of the control group,both groups were continuously treated for 28 days.The changes in the scores of clinical signs and symptoms,scores of asthma control test(ACT),the lung function indicators[first second force expiratory volume as a percentage of predicted value(FEV_(1)%),peak expiratory flow(PEF)],airway inflammation(exhaled nitric oxide(FeNO),serum eosinophil(EOS)count,total immunoglobulin E(IgE),immunoimmune imbalance indicators[interleukin-4(IL-4),interferon gamma(IFN-γ)],and pathway-related indexes(NF-κB p65,inhibitor of nuclear transcription factor-κB alpha(IκBα)before and after treatment were observed in the two groups,and the clinical effects of the two groups were compared.Results Compared with before treatment,the scores of clinical symptoms and signs,the levels of FeNO,EOS counts,and the levels of serum IgE,IL-4,and NF-κBp65 were significantly reduced,and ACT scores,FEV_(1)%,PEF,and the levels of serum IFN-γ,and IκBαwere significantly increased in the patients of the two groups after treatment,and the differences were all statistically significant(all P<0.05).After treatment,the scores of clinical symptoms and signs,the levels of FeNO,EOS counts,and the levels of serum IgE,IL-4,and NF-κBp65 of patients in the observation group were significantly lower than those of patients in the control group,and ACT scores,FEV_(1)%,PEF,and the levels of serum IFN-γ,and IκBαwere significantly higher than those in the control group,the differences were all statistically significant(all P<0.05).The total effective rate of the observation group was significantly higher than that of the control group[90.0%(36/40)vs.77.5%(31/40)](P<0.05).Conclusion Decoction for diffusing the lung and releasing convulsion can effectively control the clinical symptoms of patients with bronchial asthma,improve lung function,correct immune imbalance,and relieve inflammatory response,and its mechanism of action may be related to the inhibition of NF-κB signaling pathway.