中医药调节Th1/Th2免疫平衡治疗慢性阻塞性肺疾病研究进展

Chinese Medicine Treatment of Chronic Obstructive Pulmonary Disease by Regulating Th1/Th2 Immune Balance:A Review

慢性阻塞性肺疾病(COPD)病程长且愈后较差,发病机制尚未完全阐明,多与气道及周围组织的非特异性炎症有关。辅助性T细胞1(Th1)与辅助性T细胞2(Th2)由CD4^(+)T细胞分化而来,机体正常时处于动态平衡状态,其调控的促炎细胞因子与抗炎细胞因子的平衡对维持呼吸道免疫稳态至关重要。慢性炎症状态改变了机体炎症细胞水平,COPD发病阶段存在T淋巴细胞免疫紊乱,Th1细胞在COPD稳定期优势表达,而Th2细胞在COPD急性加重期(AECOPD)优势表达,Th1/Th2免疫失衡使得炎症反应加剧,恢复二者的免疫平衡从而抑制炎症反应对COPD的治疗尤为关键。COPD的治疗目前尚无满意方案。中医药防治COPD历史悠久,疗效显著且不良反应较少,大量中医药干预COPD中Th1/Th2免疫平衡的动物实验及临床研究均显示Th1/Th2免疫平衡是中医药治疗COPD的重要潜在靶点,通过调节机体免疫紊乱从而纠正慢性炎症状态。研究表明Th1/Th2平衡在炎症反应中具有重要免疫调节机制,但在COPD发病过程中的具体机制尚未完全阐明,基于此,该文对Th1、Th2细胞生物学特性及其在COPD发病过程中的作用机制,以及单味中药或其有效成分、中药复方等对COPD中Th1/Th2免疫平衡的干预作用进行总结分析,进一步探究COPD发病机制及中医药干预COPD中Th1/Th2免疫平衡的潜在治疗靶点,为深入研究中医药防治COPD提供参考。

Chronic obstructive pulmonary disease(COPD) is characterized by long treatment course and poor prognosis.The pathogenesis has not been fully elucidated but is mostly related to the non-specific inflammation of the airway and surrounding tissues.T helper 1(Th1) and T helper 2(Th2) are generated by CD4^(+) T cell differentiation,and are in a dynamic equilibrium when the body is in normal state.The balance between pro-inflammatory cytokines and anti-inflammatory cytokines regulated by Th1/Th2 is vital for maintaining the immune homeostasis in respiratory tract.Chronic inflammatory state changes the level of inflammatory cells in the body,and there is immune disorder in T lymphocytes in the onset stage of COPD.Th1cells are predominantly expressed in the stable stage of COPD,while Th2 cells are predominantly expressed in the acute exacerbations of COPD(AECOPD).Th1/Th2 immune imbalance aggravates the inflammatory reaction,and thus restoring the immune balance between them and inhibiting the inflammatory reaction are critical for the treatment of COPD.At present,there has been no satisfactory treatment plan for COPD.Chinese medicine has a long history of preventing and treating COPD,with remarkable curative effect and few adverse reactions.A large number of animal experiments and clinical studies on Chinese medicine intervention of Th1/Th2 immune balance in COPD have indicated that Th1/Th2 immune balance is an important potential target for treating COPD by Chinese medicine,which can correct chronic inflammatory state by regulating the immune disorder of the body.It has also been found that Th1/Th2 balance plays an important immunoregulatory role in inflammatory response,but little is known about its specific mechanism in the pathogenesis of COPD.On this basis,this paper summarized and analyzed the biological characteristics of Th1/Th2 and their mechanism in the pathogenesis of COPD,as well as the intervention effect of single Chinese medicine or its effective components and Chinese medicine compound on Th1/Th2 immune balance in COPD.It further explored the pathogenesis of COPD and the potential therapeutic targets of Chinese medicine in interfering with Th1/Th2 immune balance in COPD,providing reference for further study on prevention and treatment of COPD with Chinese medicine.