A Study On The Pathognomic Pattern Of Infantile Pneumonia And The Influence Of Infantile Pneumonia Mixtura On The Release Of Chemotatic Factors Triggered By RSV Infected Epithelial Cell (A549)

ObjectiveClinical part: A study on the pathognomic pattern of infantile pneumonia. By studying distribution of traditional chinese medicine (TCM) pattern of syndrome in infantile pneumonia, its characteristics, TCM syndrome characteristics in infantile pneumonia due to different causative agents, disease index, syndrome differentiation index correlation, and the evolutionary rule in patterns of syndrome, a basis can be laid for a standardized diagnosis and treatment for infantile pneumonia.Experimental part.: The influence of Infantile Pneumonia Mixtura on the release of chemotatic factors, RANTES, MCP-1, triggered by RSV infected epithelial cell(A549). A discussion is carried out concerning the molecular mechanism of Infantile Pneumonia Mixtura treating RSV-LRTI.MethodClinical part: Observati on of symptoms is done on infantile pneumonia patients aged from one month to 14 years at the Second Hospital affiliated to the Traditional Chinese Medicine University of Guangzhou. The serum IgM antibody of frequently seen causative agents is detected, a form of Research Report on the rules governing the Patterns of Syndrome Regarding Infantile Pneumonia filled out, and a statistical analysis is conducted on the collected materials.Experimental part: After Hep-2 is infected by RSV, medicine-containing maintenance media of Infantile Pneumonia Mixtura and Ribavirin are respectively added to watch the suppressive effect of Infantile Pneumonia Mixtura on RSV. After A 549 cell is infected by RSV, medicine-containing maintenance media of Infantile Pneumonia Mixtura and Ribavirin are respectively added. ELISA is used to detect the content of chemotatic factors, RANTES, MCP-1 in the various cell groups.ResultClinical part: 1. Distribution of pattem of syndrome in infantile pneumonia: The most frequently seen pattern of syndrome is the type of Phlegm-Heat Obstructing the Lung, accounting for 69.5%; The next is the type of Wind-Heat Obstructing the Lung, taking up 20.5%; 19 cases belong to the type of Asthenia of Pulmonosplenic Qi, accounting for 10.0%; Neither the type of Wind-Cold Obstructing the Lung, nor the type of Toxin-Heat Obstructing the Lung, nor the type of Lingering of Pathogenic Factor due to Yin Asthenia has been found. Some cases belonging to the type of Phlegm-Heat Obstructing the Lung and the type of Wind-Heat Obstructing the Lung, in their midanaphase, evolve to the type of Asthenia of Pulmonosplenic Qi.2. The clinical characteristics of various patterns of syndrome:Comparatively speaking, there is a marked difference in the degree of blockage and nasal condition between the type of Wind-Heat Obstructing the Lung and the type of Phlegm-Heat Obstructing the Lung. The type of Wind-Heat Obstructing the Lung obstructs comparatively less, and nasal stuffiness and discharge are one of its exterior syndromes caused by exogenous pathogenic factors. There is no comparative difference in the aspects of fever, wheezing and coughing.Compared with the other two types, the type of Asthenia of Pulmonosplenic Qi has an obvious difference in the aspects of fever, coughing, complexion, and both of the lower eyelids. The type of Asthenia of Pulmonosplenic Qi is characterized by the absence of fever in most cases; The sound of coughing is characterized by its weakness; The complexion lacks luster, and is usually etiolated and pale; Both the lower eyelids are slightly swollen and vaguely livid. In the aspects of phlegm and coughing, this type has shows no difference from the other two types. Among the various types, there is a significant difference in the comparison of texture of tongue, coating, and pulse tracings (fingerprint).Among the various groups, major diagnosis indexes in western medicine, such as physical signs of the lung, the science of imaging, and etiological diagnosis, display no difference.3. The importance of Three elements: Although the distribution of TCM pattern of syndrome does not differ individually nor vary according to place, but vary according to time, and the change in the pattern of syndrome after the onset of the disease differs individually and is closely related to constitution.4. Clinical features of infantile pneumonia due to different causative agentsPneumonias of different causative agents manifested different TCM patterns of syndrome. Mycoplasmal pneumonia is characterized by a long duration of fever, while respiratory syncytial virus pneumonia has dyspnea with rapid and short breath as its major manifestations.Infantile pneumonias due to different causative agents will have different features in the physical signs of the lung. MP pneumonia and IV pneumonia have as its manifestations a small amount of rales in both lungs or no rales at all; RSV pneumonia is characterized by moderate amount of rales or widespread rales throughout the two lungs; concerning the comparison of stridor in the expiratory phase, RSV pneumonia is more likely to have stridor in the expiratory phase.5. Evolvement of pattern of syndrome: Both in the early and intermediate stages, pneumonia shows itself in the type of Phlegm-Heat Obstructing the Lung and the type of Wind-Heat Obstructing the Lung. After treatment, the change rate in the pattern of syndrome is 24.2% (46/190). 44 cases turn to the type of Asthenia of Pulmonosplenic Qi and 2 cases turn to the type of Yin Asthenia Generating Intrinsic Heat. The timing for the change in the pattern of syndrome is an average of 6.93 days after treatment.The logistic regression equation to predict the change in the pattern of syndrome is: logit(P)=-3.6939+0.9116 complexion+1.7141 slightly swollen and vaguely livid eyelids+1.5317 spontaneous perspiration6. A canonical correlation analysis on the four major symptoms of infantile pneumonia and principal diagnosis indexes in western medicine is done and the first canonical correlation variable is written as follows:V1=0.9898 (three depressions sign)+0.0246(physical signs in the lung)+0.0012( chest imaging change)01=0.9931(degree of breathlessness)－0.0042(degree of fever)- 0.0022(severity in coughing)+0.0236(degree in phlegm obstruction)The second canonical correlation variable is as follows:V2=－0.4615(three depressions sign)+1.0456(physical signs in the lung)－0.2368 (chest imaging change)W2=－0.1171 (degree of breathlessness)－0.4192(degree of fever)+0.7787 (degree in phlegm obstruction)+0.4091 (severity in coughing)Experimental part: In vitro tests research results suggest that Infantile Pneumonia Mlxtura has a direct effect on fighting against RSV, and shows some dose, effect relationship. Under the attack of the RSV, A549 cells will have more marked expression or release of RANTES, MCP-1. With the intervention of Infantile Pneumonia Mixtura, RANTES, MCP-1 drop drastically, although they are still far higher than the normal cell groups.ConclusionClinical part.1. The predominant pattern of syndrome of an infantile pneumonia is the type of Phlegm-Heat Obstructing the Lung. This can act as a guidance to improving syndrome differentiation. It is vitally important to certify that TCM has indeed intervened in the predominant pattern of syndrome.2. The characteristics of various patterns of syndrome are shown through differences in the features of four traditional methods of physical examinations in TCM. They do not display a definite relationship with the diagnosis indexes in western medicine, such as physical signs of the lung, science of imaging, and etiological diagnosis. This suggests that the establishment of patterns of syndrome in TCM still needs the cross-reference among the four traditional methods of physical examination and disease differentiation in western simply can't take the place of syndrome differentiation in TCM.Phlegm-Turbidity Obstructing the Lung is a new type arrived at by the research in question. It is distinguished from the type of Asthenia of Pulmonosplenic Qi in the textbook in that: both have the manifestation of Asthenia of Pulmonosplenic Qi. However, the former shows obvious shortness of breath and obstruction of phlegm.3. Nevertheless, the change in the pattern of syndrome differs individually and is closely associated with constitution. This shows that the holistic notion has an important value of guidance for syndrome differentiation in TCM.4. Detection Results of pathogenic microorganism probably reflect characteristics of some patterns of syndrome, but difference in some patterns of syndrome is not enough to determine what "pattern" it is. Through a comparison of physical sings in the lung due to infantile pneumonia caused by different etiological agents, it is suggested that air tube inflammation and air tube damage after RSV infection is relatively serious, and air tube spasm is more likely to occur.5. The evolvement of pattern of syndrome: The early and intermediate stages of pneumonia are characterized by the type of Wind-Heat Obstructing the Lung and the type of Phlegm-Heat Obstructing the Lung. The key moment for the change in the pattern of syndrome to take place is the end of the first week (11～16 days after the onset of the disease). The percentage for the change in pattern of syndrome is 24.2%. As for the cases observed in our hospital, the change in the pattern of syndrome shows obvious disproportion, that is to say, the majority of the cases (44) turn to the type of Asthenia of Pulmonosplenic Qi. What is more, it is closely related to the constitution of the diseased infants, and is not due to improper treatment and procrastination of the therapy. The three symptoms, an etiolated or pale complexion lacking luster, slightly swollen and vaguely livid eyelids, spontaneous sweating are important indexes to predict that the pattern of syndrome in infantile pneumonia has turned to the type of Asthenia of Pulmonosplenic Qi.6. A certain correlation exists between disease judgment index in infantile pneumonia and the principal judgment index of syndromes: There is an obvious positive correlation between degree of shormess of breath and three depressions sign; the degree of phlegm obstruction and coughing is affected by physical signs of the lung. The more obvious the physical signs in the lung, the more serious the degree of phlegm obstruction and coughing; the more obvious the three depressions sign in inhaling, the lighter the degree of coughing; the more serious the degree of fever, the less clearly-seen of physical signs in the lung. The analytical result of these indexes in statistical sense is in accordance with what we have observed in clinical practice.Experimental part: Modeling released by RSV-infected A549-cell-induced inflammatory factor is feasible, Infantile Pneumonia Mixtura can, to some extent, suppress RSV-infected A549-cell's release of RANTES, MCP-1, thus achieving the goal of reducing inflammatory reaction in the air tube.