银杏叶片联合常规疗法对激素依赖型哮喘患者HPA轴的影响

摘要

Objective:To investigate the effects of ginkgo biloba tablets plus relevant mechanism on HPA axis in patients with steroid-dependent asthma.Methods:80 patients with steroid-dependent asthma were divided into control group and experimental group at random,40 cases in every group.The control group were treated with pulmicort respules(1 mg/d) ,patients in the experiment group were given ginkgo biloba tablets in addition to routine treatment(120 mg/d).The therapeutic courses were both 12 weeks.The effective rate of reducing hormone,lung function,the plasma concentrations of ACTH and COR and the levels of PBMC GCR were deter mined before and after treatment.Results:The effective rate of reducing hormone was 89.47%in experimental group,which was 66.67%in control group.There were significant difference at the tows groups(P<0.01).There were no significant difference at lung function,the plasma concentrations of ACTH and COR and the levels of PBMC GCR at pre-treatment( P>0.05).After treatment,the lung function, the levels of plasma concentrations of COR and the levels of PBMC GCR were increased significantly than control group( P<0.01,P<0.05),the levels of plasma concentrations of ACTH was decreased significantly than control group(P<0.01).There was a significant positive correlation between the value of FEV1/FVC and the plasma concentrations of COR,the levels of PBMC GCR( r=0.724,0.632, P<0.01).There was a significant negaitive correlation between the value of FEV1/FVC and the plasma concentrations of ACTH( r=-0.668,P<0.01).Conclusion:Ginkgo biloba tablets combined with routine treatment therapy can increase the effective rate of reducing hormone in patients with steroid-dependent asthma,which can improve the lung function maybe by regulate the HPA axis and upgrade the levels of GCR.%目的：观察银杏叶片联合常规疗法对激素依赖型哮喘患者HPA轴的影响。方法：80例激素依赖型哮喘患者随机分成治疗组及对照组，每组40例。在逐渐撤减激素量的过程中，对照组每日给予吸入2次普米克令舒，每日剂量为1 mg；治疗组在此基础上加服银杏叶片40 mg每日3次，两组疗程均为12周。观察两组撤减激素有效率及治疗前后肺功能、血浆皮质醇（Cortisol，COR）、促肾上腺皮质激素（Adrenocor ticotropic hormone，ACTH）浓度、外周血单个核细胞（Peripheral blood mononuclear cell，PBMC）糖皮质激素受体（ Glucocorticoid receptor，GCR）水平变化。结果：治疗组撤减激素有效率为89．47％，对照组有效率为66．67％，两组有显著性差异（ P＜0．01）。治疗前，两组患者肺功能指标（ FEV1、FVC、FEV1占预计值％、FEV1／FVC％）、血浆COR、ACTH水平及PBMC GCR水平均无显著统计学意义（ P＞0．05）；治疗后，治疗组四项肺功能指标、血浆COR及PBMC GCR水平较对照组明显升高（P＜0．01，P＜0．05），而血浆ACTH水平较对照组显著下降（P＜0．01）。相关性分析表明，血浆COR水平及PBMC GCR水平与FEV1／FVC（％）值呈明显正相关（r分别为0．724、0．632，P＜0．01），血浆ACTH水平与FEV1／FVC（％）值明显负相关（r为－0．668，P＜0．01）。结论：银杏叶片联合常规疗法可提高激素依赖型哮喘患者撤减激素成功率，改善肺功能，其可能通过调控HPA轴，上调PBMC GCR水平发挥作用。