The Journal of Internal Korean Medicine (대한한방내과학회지)

The Society of Internal Korean Medicine (대한한방내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Comparative Analysis of Deficiency-Excess Pattern Identification with Sputum Cytokines and the Characteristics of Asthma Patients

천식환자 허실변증과 객담 cytokine 및 특성 비교분석

  • Do, Ha-yoon (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University) ;
  • Yu, Chang-hwan (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University) ;
  • Kang, Sung-woo (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University) ;
  • Kim, Kwan-il (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University) ;
  • Lee, Beom-joon (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University) ;
  • Jung, Hee-jae (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University)
  • 도하윤 (경희대학교대학원 임상한의학과 폐계내과학교실) ;
  • 유창환 (경희대학교대학원 임상한의학과 폐계내과학교실) ;
  • 강성우 (경희대학교대학원 임상한의학과 폐계내과학교실) ;
  • 김관일 (경희대학교대학원 임상한의학과 폐계내과학교실) ;
  • 이범준 (경희대학교대학원 임상한의학과 폐계내과학교실) ;
  • 정희재 (경희대학교대학원 임상한의학과 폐계내과학교실)
  • Received : 2019.08.09
  • Accepted : 2019.09.26
  • Published : 2019.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The aims of this study were to analyze the deficiency-excess pattern identification (虛實辨證) and compare it to the sputum cytokines of asthma patients. Method: 50 asthma patients who met the inclusion and exclusion criteria were included in this study. They were divided into two groups: deficiency and excess syndrome groups. Sputum examinations were performed including $TNF-{\alpha}$, Interleukin (IL)-4, IL-5, IL-10, and IL-13. The Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA), the Visual Analog Scale(VAS), and heart rate variability (HRV) were also measured. We also conducted laboratory tests, including the hematological indexes. Results: Based on the pattern identification, 50 asthma patients can be divided into two categories of groups: the deficiency syndrome group (N=24) and the excess syndrome group (N=26). In the analysis of sputum cytokines, although the $TNF-{\alpha}$, IL-4 and IL-13 were at a higher level in the deficient pattern group than in the excess pattern group, it was insignificantly different. There was a negative correlation in the analysis of QLQAKA and VAS. In the analysis of HRV, although the mean value of VLF, LF, and HF in the deficiency syndrome group was higher than in the excess syndrome group, it was insignificantly different. There was no significant difference in the hematological tests between the deficiency and the excess syndrome group. The mean value of the IgE in the blood tests was five times greater than the reference value. Conclusion: The cytokines of sputum including $TNF-{\alpha}$, IL-4, IL-5, IL-10, and IL-13 were indifferent statistically. Reinforcing the healthy and eliminating the pathogenic factors should be considered.

Keywords

References

  1. Sugita M, Kuribayashi K, Nakagomi T, Miyata S, Matsuyama T, Kitada O. Allergic bronchial asthma: airway inflammation and hyperresponsiveness. Intern Med 2003;42(8):636-43. https://doi.org/10.2169/internalmedicine.42.636
  2. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004;59(5):469-78. https://doi.org/10.1111/j.1398-9995.2004.00526.x
  3. WHO. Asthma fact sheet Updated April 2017.
  4. Hwang WS, Lee JS, Joo CY, Jung HJ, Lee HG, Jung SK. The Clinical Study on 1 Case of Hyperthyroid patient Treated with Yukmijihwangtang. The J of Oriental Chronic Diseases 2002;8(1):53-63.
  5. Gan HJ. Studies on Relationship Between Cold-heat Asthma at Stage of Attack of Bronchial Asthma and ET-1 and ANF. J of Shaanxi College of Traditional Chinese Medicine 2003;26(5):64-6. https://doi.org/10.3969/j.issn.1002-168X.2003.05.043
  6. LI ZY, LIU WW. Clinical Study on Immunity, Adrenocortical Function and Platelet Activation in Cold Heat Type of Attack Stage of Child Asthma. J of Fujian College of Traditional Chinese Medicine 2001-01.
  7. Cao YX, Dong JC, Du YJ. Biomarkers and inflammatory characteristics for microcosmic syndrome differentiation of cold-phlegm syndrome and heat-phlegm syndrome in patients with bronchial asthma. Zhongguo Zhong Xi Yi Jie He Za Zhi 2010;30(8):828-32.
  8. Bhang YH, Kim JH, Do HY, Kim MA, Kim KI, Jung HJ. Deficiency-excess and Cold-heat Pattern Identification and Analysis of the Characteristics of Asthma Patients. J Int Korean Med 2017;38(6):955-70. https://doi.org/10.22246/jikm.2017.38.6.955
  9. Park JW, Cho YS, Lee SY, Nahm DH, Kim YK, Kim DK, et al. Multi - center study for the utilization of quality of life questionnaire for adult Korean asthmatics (QLQAKA). J of asthma, allergy and clinical immunology 2000;20(23):467-79.
  10. Korean Society for Tuberculosis and Respiratory Diseases. Asthma medical guidelines 2014 revise. 2014:3.
  11. Ministry of Health and Welfare Centers for Disease Control and Prevention. 2015 National Health Statistics National Nutrition Survey 6th (2015). 2016:316-7.
  12. Kim BK. Korean Diagnostics. Seoul: Sungbosa; 1986, p. 25, 42.
  13. The National University of Dept. of Internal Medicine Pulmonary System. Internal Medicine Pulmonary System. Seoul: Nado; 2011, p. 273-81.
  14. Chlumsky J, Striz I, Terl M, Vondracek J. Strategy aimed at reduction of sputum eosinophils decreases exacerbation rate in patients with asthma. J Int Med Res 2006;34(2):129-39. https://doi.org/10.1177/147323000603400202
  15. Gibson PG, Fujimura M, Niimi A. Eosinophilic bronchitis: clinical manifestations and implications for treatment. Thorax 2002;57(2):178-82. https://doi.org/10.1136/thorax.57.2.178
  16. Jatakanon A, Uasuf C, Maziak W, Lim S, Chung KF, Barnes PJ. Neutrophilic inflammation in severe persistent asthma. Am J Respir Crit Care Med 1999;160(5 Pt 1):1532-9. https://doi.org/10.1164/ajrccm.160.5.9806170
  17. Haldar P, Pavord ID. Noneosinophilic asthma: a distinct clinical and pathologic phenotype. J Allergy Clin Immunol 2007;119(5):1043-52. https://doi.org/10.1016/j.jaci.2007.02.042
  18. Sim MK, Choi IS, Kim WJ. Change of Inflammatory Markers in Induced Sputum in Suspected Asthmatics by Asthma Treatment. The Korean Academy of Asthma, Allergy, Clinical Immunology 2012;32(3):159-68.
  19. Cazzola M, Polosa R. Anti-TNF-$\alpha$ and Th1 cytokine-directed therapies for the treatment of asthma. Curr Opin Allergy Clin Immunol 2006;6(1):43-50. https://doi.org/10.1097/01.all.0000199798.10047.74
  20. Thomas PS, Heywood G. Effects of inhaled tumor necrosis factor alpha in subjects with mild asthma. Thorax 2002;57(9):774-8. https://doi.org/10.1136/thorax.57.9.774
  21. Cho SH, Stanciu LA, Holgate ST, Johnston SL. Increased interleukin-4, interleukin-5 and interferon-$\gamma$ in airway CD4+ and CD8+ T cells in atopic asthma. Am J Respir Crit Care Med 2005;171(3):224-30. https://doi.org/10.1164/rccm.200310-1416OC
  22. Commins SP, Borish L, Steinke JW. Immunologic messenger molecules: cytokines, interferons, and chemokines. J Allergy Clin Immunol 2010;125 (2 Suppl 2):S53-72. https://doi.org/10.1016/j.jaci.2009.07.008
  23. Ownby DR, Johnson CC. Factors underlying the increasing incidence and prevalence of allergic diseases. In: Adkinson NF Jr, Busse WW, Bochner BS, Holgate ST, Simons FER, Lemanske RF Jr. Middleton's allergy: principles and practice. 7th ed. Philadelphia: Mosby Elsevier; 2009, p. 769-78.
  24. Fiorentino DF, Bond MW, Mosmann TR. Two types of mouse T helper cell. IV. Th2 clones secrete a factor that inhibits cytokine production by Th1 clones. J Exp Med 1989;170(6):2081-95. https://doi.org/10.1084/jem.170.6.2081
  25. Borish L. IL-10: evolving concepts. J Allergy Clin Immunol 1998;101(3):293-7. https://doi.org/10.1016/S0091-6749(98)70238-6