氣喘病人服用中藥前後血中ECP、IgE及T細胞變化

　　　　　氣喘是一種慢性的呼吸道疾病，也是目前影響國人健康的主要疾病之 一，兒童尤其為甚。雖然西方醫學已對此疾病有許多深入的研究，且發展出不少 治療方式，但常無法根治或有副作用。本研究主要配合中醫臨床診斷和辨證，篩 選出寒、熱哮病人，評估用於治療寒哮的小青龍湯與熱哮的定喘湯兩種科學中 藥，對病人體內免疫反應、發炎物質及主導氣喘過敏反應的T輔助細胞，在治療 前後的變化。其中因血清中IgE及嗜酸性白血球之eosinophil cationic protein (ECP) 的濃度，常和急性發作有關，而由西方醫學近年的研究又得知，第二型Ｔ 輔助細胞所分泌之細胞素又和嗜酸性白血球的分化、成熟相關。所以我們檢視病 人在發作時及緩解期回診時，其血中ECP及IgE的濃度和中醫臨床辨證診斷出寒 哮或熱哮間的相關性。結果顯示，熱哮病人血清中total IgE和Der PI-specific IgE濃度較寒哮病人為高，但緩解期則無明顯下降趨勢。而寒哮病人的ECP濃度 在緩解期則有顯著下降。另外，使用細胞內染色配合細胞流式儀的方法，來檢測 T輔助細胞中Th1/Th2的比例。結果顯示，氣喘的病人IFN-g+ (Th1) 細胞在緩 解期均略升高，尤以服用小青龍湯的病人較明顯。而IL-4+ (Th2) 細胞則在熱 哮病人中有明顯下降，所以Th1/Th2之比例於熱哮之病人有明顯上升。IgE和寒、 熱哮辨證間的相關及ECP和Th2細胞在哮喘病人服藥期間的變化，或許可輔助中 醫辨證給藥或作為中西醫結合時的參考。
　　　　　Traditional Chinese medicine (TCM) has been used in the treatment of airway diseases including bronchial asthma. According to TCM practice, acute asthma symptoms are usually divided into many types and require different combination of herbs to treat the patients. Two popular Chinese medicines, Hsiou Ching Long Tang (HCLT, for cold pattern) and Din Chung Tang (DCT, for heat pattern), have been used to treat cold and heat types of acute asthma symptoms. The immune responses in the patients with these two types were analyzed before and after TCM treatment. A number of cytokines and inflammatory mediators were demonstrated to play roles in the initiation of airway hypersensitivity. Eosinophil cationic protein (ECP) and serum total and Der p I-specific IgE are the main inflammatory factors related to the onset of asthma. Recent reports indicated that the Th2-type cytokines enhanced IgE production, and promoted differentiation, maturation, survival, and recruitment of eosinophils to the airway. The results indicated that the patients diagnosed with heat-pattern asthma had higher serum total and Der p I-specific IgE levels. Din Chung Tang showed less efficacy in patients who had low levels of IgE. On the other hand, significantly decreased ECP levels were detected in patients with cold-pattern and treated with HCLT. The percentage of IFN-g+ (represent Th1) cells, determined using intracellular staining technique in combination with flow cytometry technique, was slightly increased in patients who received both concentrated TCM herbal extracts, particularly in those with cold-pattern asthma. However, the percentage of IL-4+ (represent Th2) cells decreased significantly in patients with heat pattern asthma treated with DCT. Thus, the ratio of Th1/Th2 increased in this group. Further studies are required to explain the observations in this study. However, this study provides some scientific substantiation at the molecular level for the use of Traditional Chinese medicine in the treatment of asthma.