摘要
目的：
1．通过对课题组在中医、维吾尔医及西医理论指导下，针对新疆支气管哮喘基础与临床相关研究的分析，总结出新疆支气管哮喘的中、维、西医临床特点及生物学特性。找到三个医学对新疆支气管哮喘认识的“交互点”，阐明其生物学基础异常改变。
2．回顾性分析支气管哮喘临床病例，以探究新疆支气管哮喘的危险因素、临床特点、诊疗现状及中医证型分布规律。
3．对新疆支气管哮喘中医证素要点和基因多态性开展研究，归纳中医证素要点分布规律及其基因多态性特点，从而为形成新疆支气管哮喘“个性化”诊疗方案奠定基础。
方法：
1．在中国期刊网（CNKI）、中文科技期刊数据库（维普）、中国科技期刊全文数据库中，检索1989～2009年期间本课题组发表的西医、中医、维医方面有关哮喘的文献，并对其进行归纳与总结。
2．在医院HIS系统病案管理模块中的“综合查询”栏目，以“出院诊断”为“哮喘或支气管哮喘”，“入院时间”为2011年1月1日零时至2012年12月31日24时为检索条件进行查询，共检索出735例符合条件的住院患者，其中重复住院47例，故予以剔除。将688例支气管哮喘患者按照住院号由小到大的顺序排列，选定前305例进行分析。在灏翰电子病例系统中逐一输入选定病例住院号进行相关信息查询，同时填写信息采集表。
3．遵循流行病学的原理，采用流行病学横断面调查方法对哮喘患者进行中医证候要素调查，填写中医证候调查表。采用多聚酶链式反应-限制性片段长度多态性（PCR-RFLP）及等位基因特异性PCR（ASP）检测TNF-α-308及IL-13基因2100A/G突变位点多态性。统计学处理均采用SPSS17.0统计软件包进行。计量资料以均数±标准差表示，采用t检验，计数资料用χ2检验，先统计各组各位点基因型分布频率及等位基因频率，确认其符合Hardy-Weinberg平衡。基因型采用直接计数法。
结果：
1．新疆支气管哮喘的临床特点及生物学特性
西医临床特点发现新疆维吾尔族哮喘以感染性占优势，感染既是发病因素又是诱发因素，且在重度哮喘尤为明显；年龄越大，病程越长，越容易罹患重度哮喘；轻、中度哮喘如果控制不佳，反复发作，最终都会发展为重度哮喘。
中医临床特点发现新疆支气管哮喘病因以风寒为主，邪实以“痰”、“瘀”多见，正虚以“肾阳虚”为本，辨证分型以冷哮、肾虚痰瘀（虚哮）居多，各中医分型中均有“伏痰”之象。
维吾尔医临床特点发现借热损（咽喉、气道感染）、埃萨斯亚提（环境因素）等形成“乃孜来（伤风感冒或“过敏”时，头颅部或鼻腔产生的具有“腐蚀”性的液体）”，加之厄尔斯耶体（遗传因素）、“野力”刺激气道等因素引起机体体液的异常，导致气道“吾腐乃提”（炎症）产生、气道艾沙甫（神经纤维）敏感性增强而诱发哮喘。根据维医理论哮喘分为异常黑胆质、异常粘液质、异常血液质和异常胆液质四个类型，其中以异常黑胆质型哮喘为哮喘之重症。在各种类型的哮喘中异常黑胆质型哮喘的年龄最大，病情程度也最重，发病机理最为复杂，而且随着年龄的增长，更易患异常黑胆质型哮喘。
西医生物学特性发现新疆支气管哮喘患者CD4/CD8、CD11b、CD11b/CD18、CD62P的逐渐升高，淋巴细胞凋亡放缓及CS、ACTH、CRH逐渐下降；新疆维吾尔族支气管哮喘患者变应原特异性IgE抗体阳性率明显低于南方汉族，而血清ECP、T-IgE和S-IgE水平显著高于非哮喘患者，同时Gly16纯合子基因型频率明显高于健康对照组。重度哮喘与其他（轻度、中度）哮喘比较，淋巴细胞亚群及其介质、内源性皮质醇的异常变化更明显；重度哮喘与其他哮喘比较，血小板膜表面CD62P的表达、ET-1、PAI-1、FIB明显增高，APTT、PT时间缩短，t-PA含量及活性显著下降；新疆维吾尔族重度哮喘与其他哮喘比较，ECP值最高且S-ECP和IgE的异常变化更明显，同时β2-AR16位点基因多态性Gly/Gly基因型分布频率和IL-4基因启动子区多态性CT基因型分布频率明显增高。
中医生物学特性发现肾虚痰瘀哮喘与其他中医证型哮喘比较，淋巴细胞亚群及其介质、内源性皮质醇的异常变化更明显。
维吾尔医生物学特性发现异常黑胆质型哮喘与其他维医证型哮喘比较，淋巴细胞亚群及其介质、内源性皮质醇的异常变化更明显，同时血小板膜表面CD62P的表达、ET-1、PAI-1、FIB明显增高，APTT、PT时间缩短，t-PA含量及活性显著下降；IL-13intron3+1923位点基因多态性的变化可能增加异常黑胆质型哮喘病发生的危险性；IL-4基因589（C/T）位点多态性与异常黑胆质型哮喘有一定的相关性。
中、维、西医交互性发现重度哮喘、肾虚痰瘀型哮喘、异常黑胆质型哮喘，三者具有一定交互性，表现在它们均年龄大，病程长，病情易反复，发病机制（病机）复杂，三者症候症群重叠；三者均存在CD11b/CD18升高、淋巴细胞凋亡减慢及内源性皮质醇显著降低。
与肾虚痰瘀型哮喘、异常黑胆质型哮喘相比，其他分型哮喘患者虽无肾虚痰瘀或异常黑胆质的临床表现，但其免疫-内分泌网络系统功能紊乱等生物学基础有类似肾虚痰瘀或异常黑胆质的“隐潜性”变化，故其本质可能仍属肾虚痰瘀或异常黑胆质范畴。
2．回顾分析305例支气管哮喘病例，其中男性111例，女性194例，平均年龄52.90±16.93岁。汉族236例，维族38例，回族19例，其他民族12例。平均住院天数为11.41±4.80天。有78例在肺部可闻及哮鸣音，占25.57%。
在18岁以下男性9例，占81.81%，女性2例，占18.19%；在18～40岁男性21例，占47.73%，女性23例，占52.27%；40～60岁男性49例，占32.03%，女性104例，占67.97%；在≥60岁男性32例，占32.99%，女性65例，占67.01%。
有52例有明显致病因素，占17.05%，其中外源性因素（具体不详）16例，单纯遗传因素14例，刺激性气味8例，食物3例，遗传合并外源性因素、花粉、屋尘及粉尘各2例，遗传合并运动、遗传合并有机纤维、花粉及放疗、花粉及食物、劳累因素各1例。有明显诱因186例，占60.98%。其中外感162例次，占87.10%；精神心理因素16例次，占8.60%；刺激气味13例次，占6.99%；剧烈运动或劳累7例次，占3.76%；药物2例次，占1.08%；呼吸道感染1例次，占0.55%；饱食1例次，占0.55%。
有明确记录首发症状的有299例，其中咳嗽202例，胸闷54例，气急22例，喘息8例，心悸5例，咽痛2例，发热2例，咽痒、鼻塞、胸痛、呼吸困难各1例。有明确记录症状加重或发作时间的有152例，主要在活动后56例，占36.83%；夜间40例，占26.32%；闻刺激性气味26例，占17.11%；闻刺激性气味和活动后12例，占7.89%；晨起和活动后10例，占6.58%；活动后和夜间5例，占3.29%；饱餐后和活动后、晨起和冷空气、活动后和冷空气各1例，占0.66%。有吸烟史58例，占19.02%，无吸烟史242例，占79.34%，有4例未交待吸烟史，占1.64%。有过敏史者110例，占36.07%。有明确的哮喘家族史的19例，占6.23%。有明确记录合并疾病的有207例，占67.88%。行血气分析检查的有138例，占45.25%。行血常规检查的有296例，占97.05%。行凝血功能检查的有262例，占85.90%。行c反应蛋白检查的有89例，占29.18%。
有明确记录舌苔脉象的有265例，占86.89%。中医分型为燥邪伤肺型74例，占27.92%；冷哮型70例，占26.42%；风痰哮型48例，占18.11%；热哮型31例，占11.70%；肺肾两虚型19例，占7.17%；虚哮型13例，占4.91%；肺脾气虚型6例，占2.26%；寒包热哮型4例，占1.51%。
治疗状况，71.48%的患者应用了糖皮质激素，65.57%的患者应用吸入性糖皮质激素+长效β受体激动剂（ICS+LABA），62.62%的患者应用氨茶碱类药物，50.16%的患者应用了白三烯受体调节剂，46.56%的患者应用抗生素，41.97%的患者应用了抗胆碱能药物，33.77%的患者应用了抗组胺类药物，32.46%的患者应用速效β2受体激动剂（SABA），17.70%的患者应用了抑酸药物。在给药途径上，糖皮质激素在雾化吸入、口服给药和静脉给药分别占45.57%、4.92%和28.20%；吸入速效β2受体激动剂占32.46%，吸入抗胆碱能药物占41.64%，吸入ICS+LABA占65.25%；口服和静脉茶碱分别占4.92%和58.36%；口服和静脉抗生素分别占15.08%和46.23%；口服抗组胺药及白三烯调节剂分别占33.11%和54.75%；口服和静脉使用抑酸药分别占9.84%和17.70%；口服中药治疗占86.23%；使用有创呼吸机治疗占0.33%，使用无创呼吸机治疗占1.64%。联合用药占95.09%。单纯服用中药汤剂的有50例，占16.39%，服用中药汤剂加膏方的有140例，占45.90%，服用中药汤剂加免煎剂加膏方的有31例，占10.16%。72.46%的患者应用了中药治疗，42.95%的患者应用了中药贴敷治疗。
3．支气管哮喘中医证素文献研究显示：构成支气管哮喘的证候要素有19种，但主要以痰（42.89%）、热（34.53%）、气虚（27.64%）、阴虚（15.31%）为主；作用靶点以肺（82.84%）、肾（22.22%）为主。临床调查显示：新疆支气管哮喘发作期出现频次前三位的病性要素是痰、阳虚和寒；病位要素是肺、表和心。
4．哮喘组与正常对照组比较、维吾尔族哮喘组与维吾尔族正常对照组比较、汉族哮喘组与汉族正常对照组比较、维吾尔族正常对照组与汉族正常对照组比较TNF-α-308两种基因型（野生型和突变型）及等位基因在分布上有差异均无统计学意义（P＞0.05）。哮喘组与正常对照组、维吾尔族哮喘组与维吾尔族正常对照组比较IL-13基因2100A/G突变位点基因型频率有差异有统计学意义而等位基因频率无统计学意义。汉族哮喘组与汉族正常对照组比较、维吾尔族正常对照组与汉族正常对照组比较IL-13基因2100A/G突变位点基因型及等位基因在分布上有差异均无统计学意义（P＞0.05）。
结论：
1．新疆支气管哮喘的中、维、西医临床特点
（1）西医研究发现感染与新疆支气管哮喘发病关系密切，感染既是发病因素又是诱发因素，且在重度哮喘尤为明显；年龄越大，病程越长，越容易罹患重度哮喘。
（2）中医研究发现新疆支气管哮喘病因以风寒为主，邪实以“痰”、“瘀”多见，正虚以“肾阳虚”为本，辨证分型以冷哮、肾虚痰瘀（虚哮）居多，各中医分型中均有“伏痰”之象。
（3）维吾尔医研究发现借热损（咽喉、气道感染）、埃萨斯亚提（环境因素）等形成“乃孜来（伤风感冒或“过敏”时，头颅部或鼻腔产生的具有“腐蚀”性的液体）”，加之厄尔斯耶体（遗传因素）、“野力”刺激气道等因素引起机体体液的异常，导致气道“吾腐乃提”（炎症）产生、气道艾沙甫（神经纤维）敏感性增强而诱发哮喘。其分型以异常黑胆质型为哮喘之重症，且年龄最大，病情最重，发病机理最为复杂。
2．本次调查哮喘患者女性多于男性，且40～60岁年龄段患者最多。首发症状为咳嗽的比例最高，其次为胸闷、气急。临床症状加重以活动后多见，夜间及闻刺激性气味次之。过敏性鼻炎与哮喘的发病密切相关，其中哮喘合并过敏性鼻炎30例次，占9.84%。六淫之邪是哮喘发病重要原因之一，其中风寒及燥邪为新疆支气管哮喘主要病因。中医证型中发作期以燥邪伤肺最多，冷哮次之。虚哮型及肺肾两虚型患者均年龄大。18岁以下哮喘患者以热哮为主。18～60岁哮喘患者以燥邪伤肺多见，60岁以上患者则以冷哮居多。支气管哮喘的西医诊疗基本符合指南要求，但仍存在联合用药种类数偏多，抗生素使用和激素静脉给药比例偏高的问题。中医治疗以温肺散寒、滋阴润燥、益气固表、补肾活血化痰为主，具体包括中药汤剂、免煎剂、中药膏方及贴敷疗法“内外同治”的综合诊疗方案。
3．发现西医重度哮喘、中医肾虚痰瘀型哮喘、维医异常黑胆质哮喘具有一定的交互性，表现在三者病情重、病程长、年龄大、症候症群重叠、免疫及内分泌紊乱更加明显。
4．新疆支气管哮喘发作期证候病位主要涉及肺、表、心；病性要素以痰、阳虚、寒为总体特征。其发病与TNF-α-308多态性无关，而与IL-13基因2100A/G突变位点多态性有关。
5．提出“哮喘中、维医其他证型的生物学特性有类似中医肾虚痰瘀型哮喘、维医异常黑胆质型哮喘的‘隐潜性’变化”的新观点。提出为防止哮喘向肾虚痰瘀型或异常黑胆质型发展，应将治疗“前移”，做到“未病先防，既病早治，已病防变”，从而有效控制哮喘复发或/和病情恶化。
Objectives:
1. To summarize clinical features and biological characteristics of Chinese, Uygurand Western medicines of bronchial asthma in Xinjiang through the analysis of theresearch group on basis of bronchial asthma in Xinjiang and relevant clinical researchesunder the theoretical guidance of Chinese, Uygur and Western medicines; find “crosspoints” of three medicines in the understanding of bronchial asthma in Xinjiang andclarify abnormal changes of its biological foundation.
2. To conduct retrospective analysis on clinical cases of bronchial asthma andexplore risk factors, clinical features, diagnosis and treatment status and TCM syndromedistribution law.
3. To carry out research on key points of TCM syndrome elements and genepolymorphism of bronchial asthma in Xinjiang, summarize the distribution law of keypoints of TCM syndrome elements and characteristics of gene polymorphism and thus laya foundation for developing an “individual” diagnosis and treatment program ofbronchial asthma in Xinjiang.
Methods:
1. Literatures related to asthma and regarding Western, Chinese and Uygur medicinespublished by this research group from1989to2009were searched in CNKI, SWIC (VIP) and CJFD and summarized.
2. A query was made in the “comprehensive inquiry” column in case managementmodule in HIS system of the hospital with the following search conditions:“dischargediagnosis”=“asthma or bronchial asthma” and “admission time”=from00:00, January1,2011to24:00, December31,2012.735cases of inpatients meeting these conditionswere inquired, including47cases of repeated hospitalization which were therebyeliminated.688cases of patients of bronchial asthma were arranged according to theascending order of admission number and the former305cases were selected for analysis.Admission numbers of selected cases were input one by one in Haohan electronic casesystem for relevant information inquiry and meanwhile the information collection formwas filled in.
3. A survey of TCM syndrome elements was conducted on patients of asthma withthe method of cross-section survey of epidemiology according to the principle ofepidemiology and TCM syndrome questionnaire was filled in. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and allele-specific PCR (ASP)were used to test TNF-α-308and IL-13gene2100A/G mutation site polymorphism.Statistical treatment was conducted with SPSS17.0statistical package. Measurement datawere expressed as mean±standard deviations and used t test. Enumeration data used x2test. The genotype distribution frequency and allele frequency at each site in each groupwere first counted and its conformance to Hardy-Weinberg balance was confirmed. Forgenotype, direct counting method was used.
Results:
1．Clinical features and biological characteristics of bronchial asthma in Xinjiang
Clinical features of Western medicine show that asthma in Xinjiang Uygur isdominated by infectivity; infection is both pathogenic factor and inducing factor andespecially obvious in severe asthma; the older, the longer the course of disease and theeasier to suffer from severe asthma; with poor control and repeated attack, mild andmoderate asthma will finally develop into severe asthma.
Clinical features of Chinese medicine show that the pathogenesis of bronchialasthma in Xinjiang is mainly cold; pathogenic excess is mainly “phlegm” and “stasis”;weakened body resistance is mainly caused by “deficiency of kidney-yang”;differentiation of symptoms and signs for classification of syndrome is mainly asthmadue to cold and phlegm stasis due to deficiency of kidney (asthma due to deficiency). Each Chinese medicine classification has “long-standing phlegm”.
Clinical features of Uygur medicine show that,“corrosive” liquid produced in heador nasal cavity during cold or “allergy”, which is caused by throat and airway infectionand environmental factor etc., plus abnormity of body fluid caused by genetic factor andairway stimulation etc., cause airway inflammation and increased sensitivity of airwaynerve fiber, thus inducing asthma. According to the theory of Uygur medicine, asthmahas four types-abnormal savda, abnormal phlegmatic temperament, abnormal bloodquality and abnormal bile quality. Abnormal savda asthma is severe. Among all types ofasthma, abnormal savda asthma occurs at the maximum age with the severest state ofillness and the most complicated pathogenesis. With the increase of age, people are easierto suffer from abnormal savda asthma.
Biological characteristics of Western medicine show that, in patients of bronchialasthma in Xinjiang, CD4/CD8, CD11b, CD11b/CD18and CD62Pgradually increase,activation-induced cell death slows down and CS, ACTH and CRH gradually decrease;allergen specific IgE antibody positive rate of Uygur patients of bronchial asthma inXinjiang is significantly lower than the Han nationality in the south and their serum ECP,T-IgE and S-IgE levels are significantly higher than non-asthma patients; meanwhile,their Gly16homozygote genotype frequency is significantly higher than the healthycontrol group. Compared to other (mild and moderate) asthmas, in severe asthma,anomalous changes of lymphocyte subpopulation, medium and endogenous cortisol aremore obvious; expression of CD62Pon the surface of platelet membrane, ET-1, PAI-1andFIB significantly increase, APTT and PT time decreases and t-PA content and activitygreatly reduce. Compared to other asthmas, in severe asthma in Xinjiang Uygur, ECPvalue is the highest and anomalous changes of S-ECP and IgE are more obvious;meanwhile, gene polymorphic Gly/Gly genotype distribution frequency at β2-AR16siteand polymorphic CT genotype distribution frequency in IL-4gene promoter regionsignificantly increase.
Biological characteristics of Chinese medicine show that, compared to other TCMsyndrome asthma, in phlegm stasis asthma due to deficiency of kidney, anomalouschanges of lymphocyte subpopulation, medium and endogenous cortisol are moreobvious.
Biological characteristics of Uygur medicine show that, compared to other Uygurmedicine syndrome asthmas, in abnormal savda asthma, anomalous changes oflymphocyte subpopulation, medium and endogenous cortisol are more obvious; expression of CD62Pon the surface of platelet membrane, ET-1, PAI-1and FIBsignificantly increase, APTT and PT time decreases and t-PA content and activity greatlyreduce; the variation of gene polymorphism at IL-13intron3+1923site might increase theoccurrence risk of abnormal savda asthma; IL-4gene589(C/T) site polymorphism andabnormal savda asthma have certain correlation.
The interaction of Chinese, Uygur and Western medicines shows that severe asthma,phlegm stasis asthma due to deficiency of kidney and abnormal savda asthma havecertain interaction, manifested in old age, long course of disease, relapse of illness andcomplicated pathogenesis. Their syndromes are overlapped. All of them have increasedCD11b/CD18, slowed-down activation-induced cell death and CS, ACTH and significantlyreduced endogenous cortisol.
Compared to phlegm stasis due to deficiency of kidney and abnormal savda asthma,though patients of other types of asthma do not have clinical manifestations of phlegmstasis due to deficiency of kidney or abnormal savda, their biological foundations such asimmuno-endocrine network system dysfunction have “latent” change similar to phlegmstasis due to deficiency of kidney and abnormal savda asthma. Therefore, its essencemight still belong to the scope of phlegm stasis due to deficiency of kidney or abnormalsavda.
2．Retrospective analysis was conducted on305cases of bronchial asthma,including111male cases and194female cases, and236cases of Han nationality,38cases of Uygur,19cases of Hui nationality and12cases of other nationalities, with anaverage age of52.90±16.93and average length of stay of11.41±4.80days. In78cases,wheezing could be heard in lung, accounting for25.57%.
There were9cases of male and2cases of female below18, respectively accountingfor81.81%and18.19%;21cases of male and23cases of female between18and40,respectively accounting for47.73%and52.27%;49cases of male and104cases offemale between40and60, respectively accounting for32.03%and67.97%;32cases ofmale and65cases of female≥60, respectively accounting for32.99%and67.01%.
52cases had an obvious pathogenic factor, accounting for17.05%, including16cases of exogenous factor (unknown specifically),14cases of simple genetic factor,8cases of pungent smell,3cases of food, respectively2cases of heredity accompanied byexogenous factor, pollen, house dust and dust and respectively1case of heredityaccompanied by exercise, heredity accompanied by organic fiber, pollen and radiotherapy,pollen and food and tiredness.186cases had an obvious incentive, accounting for60.98%, including162cases of external infection accounting for87.10%,16cases ofpsychological factor accounting for8.60%,13cases of pungent odor accounting for6.99%,7cases of strenuous exercise or tiredness accounting for3.76%,2cases ofmedicine accounting for1.08%,1case of RTI accounting for0.55%and1case ofsatiation accounting for0.55%.
299cases had an explicitly recorded initial symptom, including202cases of cough,54cases of choking sensation in chest,22cases of dyspnea,8cases of gasp,5cases ofpalpitation,2cases of pharyngalgia,2cases of fever and respectively1case ofpharyngeal itching, nasal obstruction, chest pain and dyspnea.152cases had explicitlyrecorded symptom increase or onset time, including56cases after exercise accountingfor36.83%,40cases at night accounting for26.32%,26cases after pungent smellaccounting for17.11%,12cases after pungent smell and exercise accounting for7.89%,10cases after getting up in the morning and exercising accounting for6.58%,5casesafter exercise and at night accounting for3.29%and respectively1case after satiationand exercise, after getting up in the morning and in cold air, and after exercising and incold air accounting for0.66%;58cases with the history of smoking accounting for19.02%,242cases without the history of smoking accounting for79.34%and4caseswithout telling the history of smoking accounting for1.64%;110cases with the history ofallergy accounting for36.07%;19cases with specific family history of asthmaaccounting for6.23%;207cases with explicitly recorded complication accounting for67.88%;138cases experiencing blood gas analysis test accounting for45.25%;296casesexperiencing blood routine examination accounting for97.05%;262cases experiencingcoagulation function examination accounting for85.90%; and89cases experiencingc-reactive protein examination accounting for29.18%.
265cases had explicitly recorded coated tongue pulse manifestation, accounting for86.89%. According to Chinese tradition medicine type, there were74cases of lungimpairment due to dryness evil accounting for27.92%,70cases of asthma due to coldaccounting for26.42%,48cases of wind-phlegm asthma accounting for18.11%,31casesof asthma due to heat accounting for11.70%,19cases of deficiency of lung and kidneyaccounting for7.17%,13cases of asthma due to deficiency accounting for4.91%,6cases of deficiency of lung, spleen and vital energy accounting for2.26%and4cases offrigiopyretic asthma accounting for1.51%.
In terms of the therapeutic status,71.48%patients used glucocorticoid,65.57%patients used inhaled glucocorticoid+long-acting beta receptor agonist (ICS+LABA), 62.62%patients used aminophylline drugs,50.16%patients used LTRA,46.56%patientsused antibiotics,41.97%patients used anticholinergic drug,33.77%patients usedantihistamine drug,32.46%patients used short-acting β2receptor agonist (SABA) and17.70%patients used acid suppression drug. In terms of drug delivery route, aerosolinhalation, oral medication and intravenous administration of glucocorticoid respectivelyaccounted for45.57%,4.92%and28.20%; inhalation of short-acting β2receptor agonistaccounted for32.46%; inhalation of anticholinergic drug accounted for41.64%;inhalation of ICS+LABA accounted for65.25%; oral and intravenous administration oftheophylline respectively accounted for4.92%and58.36%; oral and intravenousadministration of antibiotics respectively accounted for15.08%and46.23%; oraladministration of antihistamine drug and LTRA respectively accounted for33.11%and54.75%; oral and intravenous administration of acid suppression drug respectivelyaccounted for9.84%and17.70%; oral administration of traditional Chinese medicineaccounted for86.23%; treatment with invasive breathing machine accounted for0.33%;treatment with noninvasive breathing machine accounted for1.64%; drug combinationaccounted for95.09%;50cases simply taking traditional Chinese medicine decoctionaccounted for16.39%;140cases taking traditional Chinese medicine decoction pluscream formula accounted for45.90%;31cases taking traditional Chinese medicinedecoction plus free decoction and cream formula accounted for10.16%;72.46%patientswere subject to treatment by Chinese herbs and42.95%patients were subject to thetreatment of application of Chinese herbs.
3．Document research on TCM syndrome elements of bronchial asthma shows that19syndrome elements constitute bronchial asthma, mainly including phlegm (42.89%),fever (34.53%), deficiency of vital energy (27.64%) and deficiency of yin (15.31%) andaction targets are mainly lungs (82.84%) and kidney (22.22%). Clinical survey shows that,for the period of onset of bronchial asthma in Xinjiang, the frequency of occurrence ofwhich ranks among the top three, disease factors are phlegm, deficiency of yin and coldand disease locations are lungs, surface and heart.
4. By comparison between asthma group and normal control group, Uygur asthmagroup and Uygur normal control group, Han asthma group and Han normal control group,Uygur normal control group and Han normal control group, two genotypes (wild type andmutant type) of TNF-α-308and allelic genes had differences in distribution withoutstatistical significance (P＞0.05). By comparison between asthma group and normalcontrol group, Uygur asthma group and Uygur normal control group, IL-13gene 2100A/G mutation site genotype frequency had differences with statistical significance,but allelic gene frequency had no statistical significance. By comparison between Hanasthma group and Han normal control group, Uygur normal control group and Hannormal control group, IL-13gene2100A/G mutation site genotype and allelic gene haddifferences in distribution without statistical significance (P＞0.05).
Conclusions:
1．Clinical characteristics of bronchial asthma in Xinjiang in Chinese, Uygur andWestern medicines
1.1Western medicine research shows that infection is closely related to themorbidity of bronchial asthma in Xinjiang. Infection is both pathogenic factor andinducing factor and especially obvious in severe asthma; the older, the longer the courseof disease and the easier to suffer from severe asthma.
1.2Chinese medicine research shows that the pathogenesis of bronchial asthma inXinjiang is mainly cold; pathogenic excess is mainly “phlegm” and “stasis”; weakenedbody resistance is mainly caused by “deficiency of kidney-yang”; differentiation ofsymptoms and signs for classification of syndrome is mainly asthma due to cold andphlegm stasis due to deficiency of kidney (asthma due to deficiency). Each Chinesemedicine classification has “long-standing phlegm”.
1.3Uygur medicine research shows that “corrosive” liquid produced in head ornasal cavity during cold or “allergy”, which is caused by throat and airway infection andenvironmental factor etc., plus abnormity of body fluid caused by genetic factor andairway stimulation etc., cause airway inflammation and increased sensitivity of airwaynerve fiber, thus inducing asthma. According to the classification, abnormal savda asthmais severe, which occurs at the maximum age with the severest state of illness and the mostcomplicated pathogenesis.
2．In this survey, there were more female asthma patients than male patients andthere were most patients between40and60. The initial symptom cough has the highestproportion, followed by chocking sensation in chest and dyspnea. Clinical symptomincrease is commonly seen after exercise, followed by at night and pungent smell.Allergic rhinitis is closely related to the morbidity of asthma. There were30cases ofasthma accompanied by allergic rhinitis, accounting for9.84%. Evil among the sixexternal factors which cause diseases is one of the important reasons for onset of asthma.Cold and dryness evil are main causes of bronchial asthma in Xinjiang. In TCM syndrome, the period of onset mainly involves lung impairment due to dryness evil,followed by asthma due to cold. Patients of asthma due to deficiency and deficiency oflung and kidney are old. Patients of asthma below18generally have asthma due to heat.Patients of asthma between18and60mostly have lung impairment due to dryness evil.Patients above60mostly have asthma due to cold. Western medicine diagnosis andtreatment of bronchial asthma basically meet requirements of the guideline, but there arestill problems such as excessive types of drug combination and higher proportions ofantibiotics and intravenous administration of hormone. Chinese medicine treatmentmainly involves warming lung for dispelling cold, nourishing Yin and moistening dryness,tonifying qi and strengthening exterior and tonifying kidney, invigorating the circulationof blood and reducing phlegm, specifically including the comprehensive diagnosis andtreatment program of simultaneous internal and external treatment-traditional Chinesemedicine decoction, free decoction, traditional Chinese medicine cream formula andapplication.
3. It is found that Western medicine of severe asthma, Chinese medicine of phlegmstasis asthma due to deficiency of kidney and Uygur medicine of abnormal savda asthmahave certain interaction, manifested in severe state of illness, long course of disease, oldage, overlapped syndrome and more obvious immune and endocrine disorder.
4. Disease locations of syndrome in the period of onset of bronchial asthma inXinjiang mainly involve lungs, surface and heart; disease factors are mainly phlegm,deficiency of yang and cold. Its onset is irrelevant with TNF-α-308polymorphism butrelated to IL-13gene2100A/G mutation site polymorphism.
5. A new idea is put forward, i.e. biological characteristics of Chinese and Uygurmedicines and other syndrome types of asthma have “latent” change similar to phlegmstasis asthma due to deficiency of kidney in Chinese medicine and abnormal savdaasthma in Uygur medicine. To prevent the development of asthma into phlegm stasisasthma due to deficiency of kidney or abnormal savda asthma, the treatment should beshifted forward to realize “prevention first, early treatment and prevention of pathologicalchanges” and thus effectively control recurrence of asthma and/or exacerbation.
引文
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