目的 探讨支气管哮喘的神经心理发病机制,为支气管哮喘的防治提供有利的干预措施.方法 将诊断为支气管哮喘的患儿220例随机分为常规GINA方案吸入治疗1组(116例)和常规GINA方案吸入治疗加脑电生物反馈治疗2组(104例),同时选择保健门诊同性别,同年龄,家族中无精神病、癫疒间及智力低下儿童80例为对照组.三组儿童(哮喘患儿一经诊断明确后在未治疗前)均检测血清皮质醇(8 am和4 pm)、神经生长因子(NGF)、脑电波θ/β比值;哮喘患儿经过6个月的治疗后再次复查对上述指标.结果 哮喘患儿与对照组儿童的脑电波θ/β比值在治疗前比较差异有统计学意义,经过6个月的治疗后治疗2组θ/β比值接近正常对照组儿童.哮喘患儿在治疗前,8 am和4 pm皮质醇数值均较对照组儿童低,差别有统计学意义,治疗1组治疗前后变化差异无统计学意义,治疗2组6个月后皮质醇8 am测定值较未治疗前明显上升,下午则无明显变化;哮喘组患儿治疗前的NGF数值明显较对照组儿童高,差异有统计学意义,治疗1组治疗后NGF有所下降但差异无统计学意义,治疗2组NGF数值较对照组明显降低,差异有统计学意义.结论 适度的神经心理调节可协调下丘脑-垂体-肾上腺轴反应,提高哮喘患儿体内早上皮质醇浓度,降低神经生长因子浓度,进而达到平衡机体细胞免疫,有效全面防治哮喘的作用.%Objective To explore the neuropsychological pathogenesis of bronchial asthma in order to improve the prevention and treatment of bronchial asthma. Methods Two hundred and twenty pediatric patients diagnosed with bronchial asthma were randomly divided into the therapy group one (116 patients) and the therapy group two (104 patients ). All asthmatic patients received routine inhalation treatment according to the GINA program. In addition, therapy group two received additional electric biofeedback therapy. Eighty healthy children with the same distribution of gender and age and without familial history of mental illness, epilepsy and mental retardation were selected as the control group. All subjects were measured serum cortisol at 8 am and 4 pm, serum nerve growth factor ( NGF ) and 8/(3 ratio of the brain waves before and after 6 months of treatment in asthmatic patients. Results The 8/(3 ratios of the brain waves of children were significantly different between control group and asthmatic groups before treatment. After 6 months of treatment, the 8/(3 ratio of the brain waves of children of therapy group two was close to control group. The serum cortisol was significantly lower in asthmatic groups than in control group. After 6 months of treatment, no significant difference of the serum cortisol was showed in therapy group one. However, 8 am serum cortisol was significantly increased and 4 pm serum cortisol was not significantly different in therapy group two after 6 months of treatment. The NFG was significantly higher in asthmatic groups than in control group before treatment. The NFG was decreased but difference was not statistically significant in therapy group one after treatment, and it was significantly decreased in therapy group two. Conclusions Moderate neuropsychological adjustment might coordinate the response of the hypothalamus-pituitary-adrenal axis to increase the serum cortisol in the morning, decrease the NFG and then balance the cellular immunity, in order to effectively control asthma.
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