【作者】 旺建伟；

【导师】 李冀；

【作者基本信息】 黑龙江中医药大学 ， 方剂学， 2004， 博士

【摘要】 支气管哮喘是当前世界范围内严重威胁公众健康的重要慢性疾病之一。其病因繁多，发病机制复杂，以气道非特异性炎症和气道高反应性(AHR)为特征。 本课题通过祖国医学及现代医学文献对哮喘的病因、病机及治疗现状进行了较为完整、全面的综述和总结。其中，嗜酸性粒细胞(EOS)浸润、募集及Th 1／Th2细胞因子失衡在哮喘发病、发展及持续起着关键性作用。 苏子降气汤是临床治疗哮喘的有效方剂，取其降气化痰，温肾纳气之功。本课题旨在通过复制哮喘模型，选择与气道变应性炎症密切相关的多项指标，对苏子降气汤的作用机制进行较为深入的研讨，并通过拆方配伍研究，观察降气化痰法、温肾纳气法对哮喘模型的作用机制，以切入二者在治疗哮喘中的配伍意义。 实验通过药理、病理、放射免疫、免疫组化等方法，从整体、细胞因子、炎性介质、组织形态、基因表达等水平探讨苏子降气汤对哮喘模型的作用机制及降气化痰法与温肾纳气法的配伍意义。结果表明，苏子降气汤能明显提高哮喘模型的呼吸功能；明显控制哮喘模型的气道炎症，作用机制与抑制EOS趋化、促进EOS凋亡、调节Th1／Th2细胞因子平衡有关，并与对TNF、NF-κB、ICAM-1、ET调控有关；能明显改善气道重塑，作用机制可能与对TNF、ET调控有关；能明显降低AHR，作用机制与抑制炎症有关。说明苏子降气汤具有明显抗炎、调节免疫反应、降低气道高反应性作用，通过多途径、多环节、多靶点阻断气道炎症的发生、发展过程，降低气道高反应性，改善气道重塑。降气化痰法与温肾纳气法均有一定抗炎、调节免疫反应的作用，但降气化痰法抗炎作用较温肾纳气法明显，温肾纳气则偏于调节免疫反应。炎症与免疫失调在哮喘病机中是互为促进，互为影响的，因而降气化痰法通过抗炎作用加强温肾纳气法的调节免疫反应，反之，温肾纳气法通过调节免疫反应而增强降气化痰法的抗炎作用。提示，降气化痰法与温肾纳气法的黑龙江中医药大学博士学位论文之间配伍意义体现在抗炎与调节免疫功能方面更多还原

【Abstract】 Bronchial asthma is one of the important chronic diseases that seriously harmed the healthy of public in the world at present.Its etiological factor is various,pathogenesis is complicated.Airway nonspecific inflammation and air hyperreactivity(AHR) are the main character of this disease.The dissertation presents the research summarize progressed on the etiological fators,pathogenesis,and the most recent treatments of bronchial asthma from the TCM documents and the medicine documents.The infiltration of EOS and the imbalance of Th1/Th2 cytokines have the key action to the episode ,pathogenesis and persistent of bronchial asthma.Suzi Jiangqi decoction,a effective prescription to bronchial asthma in clinic,could keep the inspired air going downward and dispell phlegm,and warm the kidney to help inspiration to relieve asthma.By establishing asthma model and selecting some indexes closely related to airway allergic inflammation, studying and discussing deeply the action and mechanism of Suzi Jiangqi decoction.By the decomposition and compatibility’s study,reseaching the action and mechanism of the method of keeing the inspired air going downward and dispelling phlegm and the method of warming the kidney to help inspiration to relieve asthma to asthma model and studying deeply the sence of compatibility of the two methods in the therapy of bronchial asthma.In the experimental studies,on the level of entirety,cytokine,inflammatory factor,histomor and gene,by means of pharmacology,pathlolgy,immunoradiometry andimmunohistochemistry,studying the action and mechanism of Suzi Jiangqi decoction to asthma model and the significance of compatibility of the two methods.Results:Suzi Jiangqi decoction can improve obviously the respiratory function of the asthma model and control obviously the airway inflammation.The mechanisms relate to restraint EOS’chemotaxis,promoting EOS’apoptosis and Th1/Th2 cytokines’ regulation,and TNF, NF-B, ICAM-1 and ET’s regulation.It could control obviously the passage recombination.The mechanisms probably relate to TNF- , ET’s regulation.It could reduce AHR. The mechanisms relate to control the airway inflammation.Conclusion: Suzi Jiangqi decoction has the actions ofanti-mflarnrnatory,immunoregulation,reeducing AHR and control the passage recombination. The two methods all have the action of anti-inflammatory and immunoregulation.But, the method of keeing the inspked ak going downward and dispelling phlegm is more obviously than the method of warming the kidney to help inspiration to relieve asthma on the action of anti-inflammatory.The latter is obviously on the action of immunoregulation.In the pathogenesis of bronchial asthma, the airway inflammation and immunologic imbalance influence each other.So,by the action of anti-inflammatory,the method of keeing the inspked ak going downward and dispelling phlegm enhances the action of immunoregulation of the method of warming the kidney to help inspkation to relieve asthma. By the action of immunoregulation,the method of warming the kidney to help inspkation to relieve asthma can enhances the action of anti-inflammatory of the method of keeing the inspked ak going downward and dispelling phlegm. Suggestion: the significance of compatibility of the two methods reflects on the action of anti-inflammatory and the action of immunoregulation.更多还原