摘要
目的：通过观察益气脱敏法治疗变应性鼻炎的临床疗效,探讨中医药治疗变应性鼻炎的机制,为变应性鼻炎患者寻找最适合、效果最好的个性化的治疗途径。
方法：理论研究：主要运用祖国医学和现代医学理论,论述了中医关于变应性鼻炎的病因病机和治疗法则,着重论述了变应性鼻炎的中医及现代医学的研究进展,以及从肺虚感寒论治变应性鼻炎的重要性和可行性,阐述益气脱敏方的组方原则。临床研究：本研究选择符合纳入标准病例60例,先填写肺虚感寒型变应性鼻炎临床观察表,分为2组,于治疗前抽取静脉血标本1份,分别服用中药益气脱敏汤及西药氯雷他定片治疗4周,采用症状及体征积分方法,定期每周观察患者病情变化情况,并于治疗4周后采集患者静脉血标本1份。所有静脉血标本经离心分装后均于-20℃冰箱中冷冻保存,最后检测所有标本IL-4和ECP,并将结果进行统计学分析,观察病例症状缓解情况。
结果：
从治疗前后积分比较来看,治疗组治疗前后有显著性差异,且病情有逐渐改善的趋势。中药组：显效23例,有效17例,无效0例,总有效率为100%,显效率为57.5%；全身症状畏寒、食少、便溏等明显好转。西药组：显效10例,有效10例,无效0例,总有效率为100%,显效率为50%；全身症状畏寒、食少、便溏改善不明显。本结果说明中、西药都有治疗作用,而且有效率都比较高,且全身症状的改善中药组亦比西药组明显。用药前,治疗组与正常组比较,IL-4、ECP浓度显著增高,用药后,治疗组血清中IL-4、ECP浓度较用药前下降明显(P<0.01),说明中药益气脱敏汤及西药氯雷他定均为有效药物,能降低血清IL-4、ECP值,改善免疫水平。而组间比较,中药组的血清IL-4值降幅大于西药组(P<0.01)，说明治疗变应性鼻炎,在改善变应性鼻炎发病免疫学基础Th1/Th2失衡上,益气脱敏方较氯雷他定有其优势。
观察结束后三个月对获效病例进行随访,益气脱敏方组复发率低于西药氯雷他定
结论：益气脱敏方能够治疗变应性鼻炎,而且在临床最常见的肺虚感寒证型疗效显著；中医药治疗的优势在于全身症状的改善,并且副作用少,值得临床推广。
Chinese medicine considers that allergic rhinitis is closely associated with deficiency of lung qi failing to consolidate the defensive qi. This rhinitis is termed as lung-deficiency-related cold type and treated mainly with the methods of warming the lung and eliminating cold. And for treating the root cause to prevent it from coming, it is crucial to improve the inner environment and increase immunologic function as it has been confirmed by the studies that deficiency syndromes are all based on lower immunologic functions. Recent development on study of immunology and molecular biology has proven that IL-4and ECP, the key factor of immunologic system, is closely related to the onset of allergic rhinitis. This research focuses on allergic rhinitis, involving its etiology, pathogenesis, treatment with modern and Chinses medicine as well as its correlation with IL-4and Ecp.
Objectives:To evaluate the effect of the compound prescription Yi Qi Tuo Min Tang(Benefiting Qi Against Allergy Decoction) to allergic rhinitis of LDC type; to probe the correlation between the allergic rhinitis of LDC type and IL-4and ECP so as to provide an objective criterion for supervising the therapeutic result of LDC type.
Approaches:Select 40 patiens in light with the criteria and divide them into two groups. They need to fill out the observation forms and take blood samples before the treatment.The two groups are given Yi Qi Tuo Min Tang and Loratadine respectively. After four weeks, they have another blood samples for cold preservation; and observe their condition by recording the accumulated points on their symptom and sign. Then 5 more healthy people are randomly selected to have blood samples as the control group. All the blood samples are centrifuged and maintained in the refrigerator at-20℃. IL-4and ECP is examined in all the samples at last and the data are analyzed statistically.
Results:The integral comparison before and after the treatment reveals pronounced difference between those before the treatment and 4 weeks later and shows the tendency of improvement. In the herbal group, there're 9 cases with pronounced effect,10 wih effect and one with no effect. The total effective rate is 95% and pronounced effective rate is 45%. General symptoms as aversion to wind cold and spontaneous sweating are greatly improved. In modern medicine group, there's one with pronounced effect,17 wih effect and 2 with no effect. The total effective rate is 90% and the pronounced effective rate is 5%. The general symptoms as aversion to wind cold and spontaneous sweating remain unchanged. but the pronounced effective rate and improvement of general symptoms are obviously higher in the herbal group. Before the treatment, the concentration of IL-4 and ECP is much higher in the treatment groups than in the control group. After the treatment,its concentration is greatly lowered in the treatment groups(P<0.01), which indicates both Yi Qi Tuo Min Tang and Loratadine are effective in decreasing IL-4 and ECP in the serum and improve the immunologic level, but the comparison between the groups shows higher decreasing amplitude in the herbal group (P<0.01), therefore the therapy of benefiting qi against allergy and its prescription, Yi Qi Tuo Min Tang are more advanced than Loratadine in treating allergic rhinitis, improving the imbalance between Th1 and Th2, which serves as the immunologic basis for occurrence of allergic rhinitis, and benefiting qi against allergy in terms of TCM.
Conclusion:IL-4 and ECPhas been found existing all through the immunologic process of allergic rhinitis and alterd quantity both before and after the treatment, which indicates Yi Qi Tuo Min Tang's function in restricting producing IL-4and ECP and its effect on this type of rhinitis.
引文
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