中医药调节免疫平衡治疗咳嗽变异性哮喘研究进展

Regulation of Immune Balance by Traditional Chinese Medicine in Treatment of Cough Variant Asthma:A Review

咳嗽变异性哮喘(CVA)是以咳嗽为主要症状的慢性呼吸系统疾病。CVA的发生与非特异性气道炎症密切相关,发病机制涉及环境、遗传、免疫等因素。近年来,中医药在CVA治疗中的优势得到国内外专家学者的关注,尤其在调节免疫平衡缓解CVA患者咳嗽症状、减少复发次数等方面具有突出作用。辅助性T细胞(Th)1、Th2、Th17、调节性T细胞(Treg)由CD4+T细胞分化而来,Th1/Th2、Th17/Treg免疫失衡是CVA发病机制研究中的新热点,也是中医药治疗CVA的潜在关键靶标。Th细胞亚群生理情况下处于动态平衡,维持促炎细胞因子与抑炎细胞因子平衡的呼吸道免疫稳态。CVA发病阶段,未成熟的辅助T细胞(Th0)受微环境中细胞因子类型影响分化为Th1、Th2、Th17、Treg等细胞亚群,Th2细胞增殖引发嗜酸性粒细胞性气道炎症,Th17细胞过度分化诱发中性粒细胞性气道炎症的产生。Th1/Th2、Th17/Treg细胞在数量及功能上相互制约,Th1/Th2、Th17/Treg免疫失衡易加剧炎症反应的产生,恢复免疫平衡对CVA的气道抗炎治疗尤为重要。该文对Th1/Th2、Th17/Treg失衡与CVA发病机制进行系统阐述,同时对中药复方、单味中药及其有效成分调控免疫失衡治疗CVA的最新研究进行梳理,为揭示中医药调节免疫平衡治疗CVA的科学内涵及CVA临床治疗和基础研究的开展提供思路和借鉴。

Cough variant asthma(CVA)is a chronic respiratory disease with cough as its main symptom.The occurrence of CVA is closely related to non-specific airway inflammation,and its pathogenesis involves environmental,genetic,immune,and other factors.In recent years,the advantages of traditional Chinese medicine(TCM)in the treatment of CVA have attracted the attention of experts and scholars in China and abroad,especially its prominent role in regulating immune balance,relieving cough symptoms in CVA patients,and reducing recurrence.T Helper cells 1(Th1),T helper cells 2(Th2),T helper cells 17(Th17),and regulatory T cells(Treg)are derived from CD4+T cells.Immune imbalance of Th1/Th2 and Th17/Treg is a new hotspot in the pathogenesis of CVA and a potential key target in the treatment of CVA by TCM.Th cell subsets are in dynamic balance under physiological conditions,maintaining respiratory immune homeostasis in which pro-inflammatory cytokines and anti-inflammatory cytokines are balanced.Immature helper T cells(Th0)can be differentiated into Th1,Th2,Th17,Treg,and other cell subsets due to cytokine types in the microenvironment in the stage of CVA maturation.The proliferation of Th2 cells leads to eosinophilic airway inflammation.Excessive differentiation of Th17 cells induces neutrophil airway inflammation.Th1/Th2 and Th17/Treg cells are mutually restricted in number and function,and the immune imbalance of Th1/Th2 and Th17/Treg is easy to aggravate the generation of inflammatory response.Restoring immune balance is particularly important for the airway anti-inflammatory therapy of CVA.In this paper,the imbalance of Th1/Th2 and Th17/Treg and the pathogenesis of CVA were systematically expounded.Meanwhile,the latest research on the regulation of immune imbalance by TCM compound,single TCM,and its effective ingredients in the treatment of CVA was reviewed.It provides ideas and references for revealing the scientific connotation of TCM regulating immune balance therapy of CVA,as well as the development of clinical treatment and basic research of CVA.