| 中文摘要 |
由於近年來對過敏性氣喘致病機轉的了解，認為氣喘的發生與環境因子及多基因的遺傳有關。己有許多研究證實傳統中藥對免疫調節有一定的作用，但目前卻很少有中藥經過嚴謹的臨床試驗證實對氣喘病人有效，主要原因可能是臨床試驗並未加入中醫“ 辨證論治” 的精神。但中醫的“ 證” 到目前卻沒有明確的定義及量化的標準。因此本研究嘗試在過敏性氣喘的病人中，依據望、聞、問、切的原則，用八綱辨證之寒熱為主體，設計出熱證評分表來量化病人熱證的嚴重度，再利用微陣列的方法選取與氣喘相關的30 種基因，比較熱證程度不同的病人其各種基因表達之差異。結果發現guanylate binding protein 1 （GBP1） 與熱證評分的相關性最為顯著（P= 0.072 ），且為負相關。若將病人之熱證嚴重度分成明顯熱證（11-15 分）、微熱證（6-10 分）及非熱證（1-5 分）三型，再比較各種基因表現之差異，可以發現第二型輔助T 細胞類之細胞間白素4 、細胞間白素13 及RANTES 的基因表現在明顯熱證的病人高於非熱證型之病人。因此，我們認為臨床上過敏性氣喘的病人中，是否存在二群不同證型或體質的病人，在熱證明顯時，細胞間白素4 、細胞間白素13 及RANTES 的基因表現上升而GBP-1 基因的表現下降；相反的，在非熱證型中，GBP-1 基因的表現上升而細胞間白素4 、細胞間白素13 及RANTES 的基因表現下降，但是否能用這些基因表現之差異來完全解釋過敏性氣喘病人之寒熱證型，則需要做更大規模的研究並找尋更多可能與中醫證型有關的基因進一步研究。The prevalence and severity of allergic asthma had been increasing in recent decades. The pathogenesis of asthma was more clearly now. Asthma was a multiple genetic complex disease and related to environmental factors. There were many studies showed traditional Chinese medicines (TCM) work in immunomodulation. So far, TCM is not effective proven in clinical trials. The main reason is that we can not treat a patient by TCM without patterns (Zheng) identification. But the definition of “Zheng” is still not clear now and lack of scientific standards. Thus limited the use and developing of TCM. Therefore, our study tried to quantitate and score the “heat-Zheng” allergic asthma patients according to the principle of observation-inspection, listening-smelling, inquiry and pulsation. We selected 30 asthma related genes and tried to compare the difference of gene expression between different heat scoring patients. Our results showed that there was a negative correlation between guanylate binding protein 1(GBP-1) and heat-Zheng scoring (P = 0.072). If we stratified the heat-Zheng allergic asthma patients into three groups, obvious heat-Zheng (11-15), mild heat-Zheng (6-10) and not heat-Zheng (1-5), according to the severity of heat-Zheng scoring. The gene expression of Th-2 like cytokines (interleukin 4, interleukin 13) and chemotaxic factor (RANTES) were increased in obvious heat-Zheng patients compared with not heat-Zheng patients. Therefore, whether we can identify two kinds of different allergic asthma patients by the score of heat-Zheng. The gene expressions of IL-4, IL- 13, RANTES were up regulated in obvious heat-Zheng patients and down regulated in GBP-1. Oppositely, expression of GBP-1 gene was up regulated in not heat-Zheng patients and down regulation of IL-4, IL-13 and RANTES genes. We should search more and more genes to identified the relationship between “heat-Zheng” and genes expression in the future. |
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