三步序贯法对激素依赖型哮喘患者T辅助细胞亚群的影响

目的 揭示三步序贯法治疗激素依赖型哮喘（steroid—dependent asthma，SDA）的疗效机制。方法 将40例患者随机分为两组，每组各20例，对照组予普米克都保（布地奈德粉吸入剂，Pulmicort Turbuhaler，100μg／吸，AstraZeneca AB，瑞典），每次400μg，每日两次吸入；治疗组予中药三步序贯方煎剂，每次100ml，每日2次口服，同时给予普米克都保200μg，每日两次吸入。两组疗程均12～14周。观察治疗前后哮喘症状积分、口服激素用量以及肺功能变化；流式细胞仪技术检测治疗前后外周血CD4^＋胞内细胞因子IL-4和IFN-γ的阳性细胞表达率（即Th1％和Th2％）。结果 两组患者治疗前后哮喘症状积分、口服激素用量以及肺功能比较，差异均有显著性（P〈0．01）；两组治疗后Th2表达率均显著降低（P〈0．01，P〈0．05），Th1／Th2比值均显著升高（P〈0．01）；上述两组之间比较差异均有显著性（P〈0．01）；Th1表达率在治疗前后及组间比较差异均无显著性（P〉0．05）。结论 三步序贯法能够有效调节Th细胞亚群失衡，抑制炎性细胞因子的产生，减轻气道高反应性，从而改善了肺通气功能，减轻了哮喘症状，减少了患者对激素的依赖。

Effect of Three-step Sequential Method on Th1/Th2 in Patients with Corticosteroid-dependent Asthma

OBJECTIVE: To investigate the therapeutic mechanism of three-step sequential method (TSSM) on patients with corticosteroid-dependent asthma (SDA). METHODS: Forty patients with SDA were randomly assigned according to the randomizing number table to two groups equally, the treated group treated with three-step sequential recipes plus inhalation of Pulmicort Turbuhaler 200 microg, twice a day, and the control group treated with Pulmicort Turbuhaler alone. The therapeutic course for both groups was 12 - 14 weeks. Changes of the symptom score of asthma, the corticosteroid dosage used and the lung function were observed and the positive expression rate of IFN-gamma and IL-4 in peripheral CD4+ T cells were determined by flow cytometry before and after treatment. RESULTS: There was significant difference in the asthma symptom score, the oral corticosteroid dosage and the lung function between the treated group and the control group after treatment (P < 0.01). The expression rate of Th2 reduced, the ratio of Th1/Th2 increased significantly after treatment in both groups (P < 0.01, P < 0.05), but the changes were more remarkable in the treated group than those in the control group, showing significant difference between them (P < 0.01), while the expression rate of Th1 had no obvious change after treatment with no significant difference shown between the two groups (P > 0.05). CONCLUSION: TSSM can regulate imbalance of Th1/Th2, inhibit generation of inflammatory cytokines, decrease airway hyper-response, and therefore improve the pulmonary function, alleviate the asthmatic symptoms and reduce the patients' dependence on corticosteroid.