支气管哮喘缓解期的控制是支气管哮喘治疗的核心内容近年来研究发现哮喘的 免疫学发病机制与辅助性T淋巴细胞的两个亚群)Thl和ThZ细胞亚群的反应失 衡有密切关系Thl细胞分泌的工L一2!工FN一丫等细胞因子,以及ThZ细胞分泌的 工L一3!工L一4!工L一5!工L一13!GM一CSF等细胞因子成为研究热点中医认为支气管哮喘 属/哮病0范畴/气阳虚弱,卫气不足0是哮喘发作的重要内因在缓解期治疗中, 中医药有着西医无可比拟的优势,故应重视中医药在哮喘缓解期的治疗桂枝汤辛甘 化阳以助卫!振奋卫气!祛邪外出,通过调和营卫以和气血阴阳而理脏腑的虚损,从 而达到预防哮喘反复发作的目的故桂枝汤可用于哮喘缓解期治疗 目的:本报告以中医对支气管哮喘的病机认识为基础,提出桂枝汤治疗支气管哮 喘缓解期可能具有良好的疗效本文主要的写作目的有两个,第一,论证桂枝汤应用 哮喘缓解期治疗的可行性第二,在此基础上设计出科学可行的研究方案使中医药 在提高支气管哮喘患者生存质量的有效性方面有了进一步的研究支持,从而为中医药 治疗支气管哮喘提供更有力的临床应用依据 方法:本报告主要采取综述的方式研究桂枝汤用于支气管哮喘缓解期治疗的可行 性和研究方案第一,对中国传统医学和西方现代医学的进行文献研究通过西医文 献论证Thl,ThZ细胞亚群反应失衡是哮喘缓解期的一个显著特征;通过中医文献论 证桂枝汤能调节Thl,ThZ细胞亚群反应失衡的原因在于桂枝汤具有调和营卫!和气血 阴阳而调理脏腑的功能从而论证桂枝汤用于支气管哮喘缓解期治疗的可行性第二, 根据以往对支气管哮喘缓解期免疫因子和桂枝汤的研究,从可行科学的角度设计动物 及临床试验 结果:研究综述表明:Thl,ThZ细胞亚群反应失衡是哮喘缓解期的一个显著特征, /气阳虚弱,卫气不足0是哮喘发作的重要内因桂枝汤调和营卫!和气血阴阳!理 脏腑虚损,其功用可以达到预防哮喘反复发作的目的支气管激发试验!哮喘控制测 试及相关动物实验是观察桂枝汤治疗哮喘缓解期疗效的良好评价工具 结论:本研究发现桂枝汤用于支气管哮喘缓解期治疗是切实可行的另外,在可 操作的基础上,本文设计出一套具体的研究实施方案:1.通过动物实验,观察桂枝 汤对哮喘小鼠肺泡灌洗液(BALF)中白介素一4(工L一4)!Y一干扰素(开N户Y)!工gE等水 平的变化,评价其对Thl汀h2细胞亚群反应的影响;2!通过支气管激发试验!哮喘ACT 评分,观察桂枝汤联合常规药物,对哮喘缓解期患者气道高反应性!临床症状的疗效 关键词:支气管哮喘;缓解期;桂枝汤;调和营卫Stud1esofFeas1b111tyofAPP1y1ngRamu11C1nnamom1Deeoet1on toBroneh1a1AsthmaPathogenesyTreatmentandDes1gnofthe ResearehP}an Spec1a1ty:1nterna1MediCineOfTraditionalCh.ineseMedieine Author:LuYuming Tutor:ProfessorLinMian ABSTRACT ManagementofParacmasisofBronchialAsthma15akeytreatment.Researchfindings inreeentyearsindieatethatthere15aeloserelationshiPbe勺刃eeninun切mtyPathogefiesis andreactionimbalanceoftwoeellsubsetsofT一HelPerCells,ThlandThZ.CellfaCtorsl议e IL一2and正N一丫seeretedbyThlandIL一3,IL一4,IL一5,IL一13andGM一CSFbyThZhave beeomethefoeusofstudies.lt,5saidthatweaknessofQiandYangandinsuffieieneyof Wei一Proteet15animPort孤intrinsiecauseforasthlna.lt.5believedthatChinesemedieine hasanineomParableadvantagethanwestemmedicineinthetreatinentofasth叮ad而ngthe Paracmasis.Therefore,ChinesemedieinedeservesmoreattentionforParaemasistreatment. R田nuliCinnamomiDeeoetionenablesacridnessandsweetuesstoactivateyang:therefore, itaidsandinsPiresWei一roteetandexPelsPathogen.BykeePingYingandWeiqiin balanceandh姗onizingQiandbloodtoregulateZangfu一organ,R田刀ullCinnamo而 Deeoetioneouldredueereeurrentasl知ma毗aeks.Therefore,RaJ刀uliCinnamonilDeeoetion canbeaPPliedinParaemasistreatmentofasthma. Objeetive BasedonChinesetraditionalunderstandingofPathogenesyofbronehialast知ma,而s dissertationPutsfo二ardthatRamuliCinnamomiDeeoctionmighthaveagoodeurative effeetinParacmasistreatmeni.TherearetwomajorPu印osesof而5study.First,面s dissertationaimstoillustratethefeasibilitytoaPPlyRaJ刀uliCinnamo而Deeoetioninthe Paracmasistreatmentofasthma.SeCond,thisdissertationProPosesafeasibleandseientifie researehPlanforthestudy.lt,5likelytogiveaeademieandeliniealsuPPortforfurther studyonlifequalityimProvemeniofasthmaPatienis.ftalsoProvidessomePowerful argumentsforcli正ealaPPlieationofChinesemedieineinast知ma. Methodology ThisdissertationillustratesthefeasibilityofaPPI外ngRamuliCinnamomiDecoetion 了tobronehialast知maPathogenesytreatinentandPutsforwardaresearchPlan廿irough literahirereview.First,reviewliteraturesofChinesemedieineandwesternmedieine. Westernlitera饥irereviewillustratesthatreactionimbalaneeofeellsubs改5ThlandThZ15 oneofthedistinctfeaturesofast知maPathogenesy.Chineseliteraturereviewshowsthat RaJ刀川iCinnamomiDeeoctioneanregU1atetheiir由alaneebeeauseit枷ctionstokeePYing andWeiqiinbalaneeandharmonizeQi一BlondYinandYang.川1thesearetoilfustratethe feasibilityofaPPI灿9RamuliCinnamo而DecoetiontoasthimaParaemasis.Seeond,design afeasibleandscientifieresearchPlanof耐malexPerimentsalldeliniealtestsonthebasis ofstudiesofR田刀uliCinn田nomiDeeoetionandinlrnunefactors. ResultS Thelltera权irereviewhasshownthefollowingfindings.First,thereaetionimbalanceof twoeellsubsetsofT一HelPerCells15oneofthemostdistinctiefea仅iresofParaemasisof BronehialAst知rna.Seeond,weaknessofQiandYangandinefficieneyofwei币roteetisan 加portantintrinsiecanseforast知ma.Third,bykeePingYingandWeiqiinbalaneeand hanno垃zingQiandbloodtoregulateZangfu一organ,RamuliCinnamomiDeeoetioneould redueeree皿entast知maattacks.Fourth,BPT一brinchialProvoeationtest,managemenitest ofashma,andrelatedanimalexPeriementsaregnodassessmenttoolstoobservethe eUlativeeffeetofRamuliCinnamomiDeeoetioninParacmasisofBronehialAsthma. Conclusion 伽5dissertationfindsthataPPI外ngRamuliCinnamomiDecoetioninbronChialasthma Pathogenesytreatlllent15feasible.Also,itdesignsadetailedresearchPlan.First,eaJ丁yout 耐maleXPeriments.APPlyRaJ卫uliCitmamo而Deeoetiontoasthmamiee,5re印iratory atriuxns.ObserveehangesinIL一4,正N.YandIgElevelsinB几Fofthemandearefully assessR出刀ullCinnaxnomiDecoetion,5effeetonreaetionofThlandTh2.Seeond,eariy outBPT一brinehialProvoeationtestandgettheACTscore.Observetheeurativeeffeeton thecl而cals丫mPtomofAHR一ai柳ayh即erreaetivityandothersofast知maPatienis. Keywords:Bronehia}Asthma,Pathogenesy,Ramu11C1nnamomiDeeoetion, keeP1ngY1ngandWei一q11nba}anee目录 ,土,工,l唯占十如叭甘占卜,7k丁却加匀刀川刀川刀川划!八洲入U几山袱只比以曰日q比氏q曰氏陌比-汉限比丰尹q-浅十产q 一一一一一一一一一一一一一一一一一一一一一一一一一一一一一一一一 ...............................................,....................................................................................,.......,..,..............................冲.................................................................................................................................................................,....................................................,:........................................................................................................................,...........................0............................................................................... qnqnqqqqqqqqqqqqqqnqqqqqqqqqnnqq ....................................................引言........................文献综述........................1.现代医学对支气管哮喘的研究.. 1.1哮喘的流行病学.......... 1.2哮喘的发病机制及其研究.. 1.3支气管哮喘治疗的研究进展 2.中医学对支气管哮喘的研究.... 2.1历代对哮喘的研究........ 2.2历代证治方药............ 2.3古代对哮喘病因病机研究.. 2.4辨证论治研究............ 2.5外治法研究.............. 3.支气管哮喘缓解期的相关研究. 4.小结....................... 研究思路及研究工具.............. 1.研究思路................. 2.研究工具.................. 2.1桂枝汤的研究............ 2.2肺功能与哮喘之间的关系.. 2.3ACT量表与哮喘之间的关系 2.4动物实验:.............. 3.研究思路及方案设计的可行性研究. 研究方案设计.................... 1.研究目标及方法................ 2.拟行研究方案.................. 2.1病例选择................... 2.2研究方法................... 2.3动物实验方案............... 3.技术路线................. 4.研究过程中可能遇到的问题及解决方案二 4.1解决患者的依从性........... 4.2支气管激发试验的安全性问题. 沁5.统计处理......................................................46 6.拟解决的关键问题..............................................46 7.科学价值..................,.............................47 8.社会!经济效益分析..............................!.......47 结论与展望.......................................................48 1.研究结论.......................................................48 2.前景展望.................................,...............48 3.存在问题..................................,..............49 结语.........................................................50