皮质醇升高--自血穴位注射治疗哮喘的之一机理？

 

皮质醇升高--自血穴位注射治疗哮喘的之一机理？

 

摘要 目的 探讨自血穴位注射疗法对中重度皮质醇低下哮喘患者皮质醇的影响，观察穴位注射治疗前后哮喘患者的病情改善情况。广东省中西医结合医院呼吸科李俊雄

方法 临床选择20例中重度皮质醇低下哮喘患者，治疗期间给以西药表面激素、抗白三烯、β受体激动剂、茶碱、抗组胺等和中医自血穴位注射疗法。予自血穴位注射疗法3个疗程，每个疗程5次，每次隔一天，每个疗程之间隔10天，整个治疗共50天。治疗前后测定早上8时血浆皮质醇水平，并计算ACT和症状计分。

结果 治疗前哮喘患者皮质醇区间聚集在66±10nmol/L，治疗后皮质醇区间聚集在222±10 nmol/L，治疗前后平均升高156±10 nmol/L。ACT评分从17.8分升至22.3分；症状计分日间平均从2.26分降至0.32分；夜间平均从2.01分降至0.15分。

 

讨论 皮质醇通过①抑制炎性因子的合成，诱导炎性细胞的凋亡，收缩血管并抑制蛋白水解酶的释放，抑制单核细胞、中性白细胞和MΦ向炎症部位的募集和吞噬功能而达到抗炎作用；②通过促进淋巴细胞的破坏和解体达到抗过敏作用。哮喘是由多种细胞特别是肥大细胞、嗜酸性粒细胞和T淋巴细胞参与的慢性气道炎症。皮质醇通过抗炎、抗过敏而起到治疗哮喘的作用。

故本临床观察认为皮质醇水平低为长期哮喘反复发病难愈机理之一。林红伍认为夜间血浆皮质醇水平的降低及正常血浆皮质醇水平昼夜变化规律的紊乱是导致哮喘患者夜间发作的可能原因。临床观察20例哮喘患者治疗前均有长期大量服用或静脉使用激素病史，大量激素的长期使用可抑制下丘脑一垂体一肾上腺皮质轴(HPAA)、引起机体免疫力低下，黄益萍认为皮质醇水平低下可能为下丘脑一垂体一肾上腺皮质轴(HPAA)的功能受损有关。自血穴位注射疗法能起到部分激素样作用、改善HPAA轴功能紊乱，提高皮质醇水平，进而治疗哮喘。

 

结论  自血穴位注射可提高皮质醇，且哮喘患者皮质醇水平正常后，可继续起消炎、免疫抑制等作用，从而达到治疗哮喘的功效。这可能是自血穴注的机理之一。其它的临床和动物实验也已证实：自血穴注可提高干扰素水平，并有其它如炎症细胞因子等的变化，这需要我们进一步探讨。

 

关键词  哮喘 皮质醇  自血穴位注射

 

Cortisol Elevation( Rising up )??the Mechanism of the Theropy of

Self-blood Acupoint-jinjecting in Treatment of Asthma?

Abstract objective  To explore the influence of acupoint autohemotherapy to the asthma patient with moderate or serious extent of low level of cortisol and observe the improvement before and after the treatment.

Methods 20 cases of asthma patients with moderate or serious extent of low level of cortisol were assigned. During the treatments, Surface inhaled corticosteroids,antileukotriens, β receptor agonists,theophylline,anti-histamine and the influence of acupoint autohemotherapy were applied. The influence of acupoint autohemotherapy were applied for 3 sessions, with 5 treatments being a therapeutic session, once every other day, with an intervel of 10 days between two sessions and totally for 50 days. Before and after the treatments, the level of cortisol in the plasma at 8 o"clock were tested and the ACT and symptom scores were accounted.

Results The level of cortisol of the asthma patient were 66±10nmol/L before treatment and 222±10 nmol/L after treatment. On average it elevates 156±10 nmol/L after the treatment.The ACT scores elevate from 17.8 points to 22.3 points.Daytime symptom scores reduce averagely from 2.26 to 0.32, and at night the symptom scores reduce averagely 2.01 to 0.15.

Discussion The mechanisms of cortisol are as follows: First, by inhibiting the synthesis of inflammatory factors, inducing the apoptosis of inflammatory cells, contracting the vessels, inhibiting the release of proteolylic enzymes, inhibiting the collection of monocytes, neutrophile granulocytes to the inflammatory regions and the phagocytose, the cortisol performs the anti-inflammation effects. Second, by accelerating the damage and dissolution of the lymphocytes, the cortisol performs the anti-allergy effects. Asthma is a kind of chronic airway inflammation in which multiple cells such as mastocytes, eosinophile granulocytes and T lymphocytes participate. With the anti-inflammation and anti-allergy effects, the cortisol could be applied in the treatment of asthma.

This clinical study thinks(shows) that low level of cortisol could be the mechanism to the astmatic patients who were repeated onseted and difficultly to treat. HongWu Ling thinks(pointed out) that it could be the possible causedescription that it lead to asthma patient attack with low level of plasma cortisol at night and the disorders of diunal variation regularity of normal level of plasma cortisol .This 20 cases of asthma patients have long-term largely taken or intravenously injected hormone history. Taking largely hormone in a long-term can inhibit the hypothalamus-pituitary-adrenal cortical axis(HPAA) and cause low immunity. YiPing Huang thinkspp that the low level of cortisol could related to the impaired function of HPAA.. The influence of  acupoint autohemotherapy can play a part role of hormone ,imporve the dysfunction of HPAA, increase the level of cortisol.It explains to treat asthma.

Conclusion The influence of  acupoint autohemotherapy could increase the level of cortisol and the normal level of cortisol could go on performing the anti-inflammation and immune-inhibition effects hence treats asthma, which maybe is one of the mechanisms of the influence of  acupoint autohemotherapy. The other clinical and animal experiments have demostrated that the influence of  acupoint autohemotherapy could increase the content of interferon and have the changes such as inflammatory cytokines, which need to be further explored in the longer terms.

Keywords  asthma,cortisol, the influence of acupoint autohemotherapy

 

参考文献

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附：

作者：甘长朋               学校：广州中医药大学        

指导老师：李俊雄教授       专业：中医学七年制   

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