基于气机升降理论探讨哮喘共病焦虑/抑郁免疫失衡和肠道内稳态失调

Discussion on Asthma Comorbid Anxiety/Depression Immune Imbalance and Intestinal Homeostasis Disorder Based on Theory of Ascending and Descending of Qi Movement

目的:从气机升降理论探讨哮喘共病焦虑/抑郁的CD4^(+)T淋巴细胞、胃肠道症状评分(GSRS评分)、哮喘控制情况(ACT评分)与无焦虑/抑郁的差异及三阴三阳体质的分布情况,从而为改善哮喘控制情况提供新方向。方法:选取2020年9月至2021年12月哮喘患者101例,收集完整的临床资料,记录外周血免疫细胞辅助性T细胞1(Th1)、辅助性T细胞2(Th2),辅助性T细胞17(Th17)、调节性T细胞(Treg)的数量和比例,以及ACT评分、GSRS评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、三阴三阳体质量表评分,根据SAS、SDS评分分为有焦虑/抑郁组(观察组)49例和无焦虑/抑郁组(对照组)52例,分析两组患者的各项指标及体质有何差异。结果:观察组Th1、Th17、Th17/Treg、GSRS评分高于对照组(P<0.05),ACT评分低于对照组(P<0.05)。GSRS评分与Th1、Th1/Th2、Th17、Th17/Treg呈正相关(P<0.05),与ACT评分呈负相关(P<0.05)。体质分布:厥阴体质57例(观察组30例),少阳体质23例(观察组14例),阳明体质19例(观察组5例),太阳体质1例(观察组0例),少阴体质1例(观察组0例)。厥阴、少阳、阳明三组体质患者焦虑/抑郁比例差异无统计学意义(P>0.05),而女性哮喘患者以少阳体质多见(P<0.05)。结论:气机升降失调与哮喘、焦虑/抑郁的发病、肠道内稳态及免疫失衡密切相关,哮喘患者焦虑/抑郁状态高发,厥阴、少阳、阳明体质为好发体质,伴有焦虑/抑郁及胃肠道症状突出者免疫失衡更为严重,哮喘控制情况更差。调节气机应成为提高哮喘控制水平、缓解焦虑/抑郁状态、维持肠道内稳态的重要内容。

Objective:To investigate the differences of CD4+T lymphocytes,gastrointestinal symptoms(GSRS score),asthma control(ACT score)between asthmatic patients with comorbid anxiety/depression and those without anxiety/depression based on the theory of ascending and descending of qi movement,and the distribution of three yin and three yang constitution,so as to provide a new direction for improving asthma control.Methods:A total of 101 patients with asthma from September 2020 to December 2021 were included.Clinical data were collected,and quantity and proportion of perimeter blood immune cell helper T cell-1(Th1),helper T cell-2(Th2),helper T cells 17(Th17),regulatory T cells(Tregs)were record,and ACT score,GSRS score,self-evaluation of anxiety scale(SAS),self-evaluation of depression scale(SDS)and three yin and three yang constitution scale score were measured for the study.According to SAS and SDS scores,patients were divided into anxiety/depression group(observation group,49 patients)and non-anxiety/depression group(control group,52 patients),to analyze the differences of each index and constitution between the two groups.Results:The scores of Th1,Th17,Th17/Treg and GSRS in the observation group were higher than those in the control group(P<0.05),ACT score was lower in the observation group than that of the control group(P<0.05).GSRS score was positively correlated with Th1,Th1/Th2,Th17 and Th17/Treg(P<0.05),while GSRS score was negatively correlated with ACT score(P<0.05).On body constitution distribution,there were 57 patients with jueyin constitution(30 patients in observation group),23 patients with shaoyang constitution(14 patients in observation group),19 patients with yangming constitution(5 patients in observation group),1 patients with taiyang constitution(0 patient in observation group)and 1 patients with shaoyin constitution(0 patients in observation group).There was no significant difference in the ratio of anxiety/depression among 3 groups of jueyin shaoyang and yangming(P>0.05),while the female patients with asthma usually showed shaoyang constitution(P<0.05).Conclusions:Disorder of qi’s ascending and descending was closely related to the incidence of asthma,anxiety/depression,intestinal homeostasis and immune imbalance.Patients with asthma had a high incidence of anxiety/depression,with high incidence in constitutions of jueyin,shaoyang and yangming.The immune imbalance was more serious and the treatment effect for asthma was worse in patients with anxiety/depression and severe gastrointestinal symptoms.Regulating qi movement should be an important part of relieving asthma symptoms and anxiety/depression to maintain intestinal homeostasis.