寒熱中醫處方對氣喘鼠模型體質之基因體差異

高尚德
中國醫藥學院中國醫學研究所
氣喘是全球性的重大公共衛生問題，研究指出，引發氣喘最重要的因子乃是過敏反應，其罹患率與致死率在過去二十年中持續增加，由此可見氣喘治療與預防的重要性。氣喘致病機轉中，T-淋巴球對氣喘之形成、調控及氣喘呼吸道慢性發炎反應均扮演重要角色。成熟之輔助性T淋巴球 (T helper lymphocyte)依所分泌的淋巴激素不同可分成Th1及Th2細胞，Th1-參與遲發型過敏反應 (delayed type hypersensitivity)而Th2-參與過敏性發炎反應 (allergic inflammation)。Th2分泌IL-4、IL-13能抑制Th1之活性，相對的，Th1產生的IFN-γ、IL-10對Th2細胞亦具有負迴饋反應。研究顯示氣喘患者呈現Th2細胞增多的趨勢，Th2細胞可經由IL-4、IL-5協助IgE的形成及活化肥大細胞與嗜酸性白血球。因此，在暴露於過敏原後，過敏性氣喘之呼吸道中Th2細胞在調節慢性發炎反應、維持呼吸道過度反應性和控制特異性IgE生成上扮演關鍵角色。最近幾年，影響特異性免疫反應來調控Th1或Th2路徑的因子已廣泛被發現，Th1及Th2細胞是由T輔助性前驅細胞(Th0)於抗原呈現時受其環境與遺傳雙重因素影響下發展而來。研究證據顯示Th1和Th2反應在體內是互相調節的，調節Th1/Th2平衡並使之趨向Th1優勢化，對以因Th2細胞為主的氣喘之治療是合理的策略，亦提供了免疫調節劑發展之方向。
關鍵字：寒藥；熱藥；體質；小青龍湯；麻杏石甘湯；塵蟎；氣喘；細胞激素

Differentail Genomic Expression of Asthma Animal Model in Heat-TCM or Cold-TCM

Asthma is a major public health problem worldwide, and asthma morbidity and mortality have increased over the last two decades. Although the reason for this increased incidence is unknown, there is a clear association between atopy and asthma. Antigen-induced IgE production, airway inflammation, and airway hyperresponsiveness have been well documented in patients with allergic asthma and in animal models. Increasing evidence suggests that the Th2-type cytokines IL-4, IL-5, and IL-13, produced by activated CD4+ T cell, play a central role in the pathogenesis of allergic asthma.With the increased understanding of the pathogenesis of asthma, anti-inflammatory therapies have become important therapeutic strategies for asthma treatment. The representative cytokines of Th2 cells are IL-4 and IL-5. IL-4 is the major inducer of class switching to IgE biosynthesis in B lymphocyte; IL-5 is the principal eosinophil-activating factor. IFN-g, which is a representative cytokine of Th1 cells, is known to suppress the development of Th2 cells. Since evidence suggested that the Th1 and Th2 types of reactions are reciprocally regulated in vivo, the modulation of Th1/Th2 balance, namely shifting the balance from Th2 to Th1 dominance, should be a rational strategy for the therapy of allergic asthma.
關鍵字：Ma-Xing-Gan-Shi-Tang；Xiao-Qing-Long-Tang；Asthma；Th1/Th2 modulation；Cytokine；Chemokine；Adhesion molecule