| ObjectivesTraditional Chinese Medicine (TCM) holds a theory that the lungs and large intestine share an interior-exterior relation. Clinical observations both home and abroad have come to confirm this speculation. A recent hypothetic term of "lung-intestine interference" has further illustrated the close connection between lung and the large intestine. Yet little is known about its specific mechanism. This study aimed to study the correlation between the lung function damage and the immune imbalance between Thl7/Treg in patients with ulcerative colitis (UC) so as to add substantial data to biomedical mechanism of the interior-exterior relation between the lungs and large intestine.Methods90patients matching UC diagnostic criteria and30healthy volunteers were recruited. Demographic data together with endoscopic evaluation, clinical activity index and lung function were collected. Related inflammatory cytokines in Th17/Treg immune balance, including serum IL-17and TGF-β1level, the expression of IL-17, TGF-β1in colonic mucosa and the percentage of Th17and Treg in peripheral blood were measured. Correlation between all measurements and between those and lung function were studied as well. We concluded teacher’s experience about the treatment of UC and its basic prescription, and reviewd systematically the effectiveness and safety of this prescription on treating UC patients.Results1Pulmonary function abnormalities in UC patients compared with normal groupIn UC group, pulmonary function abnormalities were present in62of90patients the percentage was68.89%. In UC group, FEV1/FVC,FEF75, MMEF and DLCO were lower compared with those of the control group,showing statistical significance (P<0.05). In UC group, RV/TLC was higher compared with those of the control group, showing statistical significance (P<0.05).2Characterizes of pulmonary function abnormalitiesDLCO/VA in the moderate-severe group was lowerer than in the mild roup, showing statistical significance (P<0.05). RV/TLC was higher in the the moderate-severe group than in mild group, showing statistical significance (P<0.05). FEV1、PEF75in patients whose course of disease>5years were lower than those in the patients whose course of disease≤5years, showing statistical significance(P<0.05). FEV1FEF50. DLCO in patients whose recurrence rate>5times were lower than those in the patients whose recurrence rate≤5times, showing statistical significance (P<0.05).3Correlation between clinical activity index, endoscopic evaluation and lung function in UC patientsThere was a negative linear correlation between DLCO/VA and clinical activity index (P<0.05,r<0), and there was a negative linear correlation between DLCO/VA and endoscopic evaluation (P<0.05, r<0).4Serum IL-17, TGF-β1level in UC patientsSerum IL-17level in UC group increased significantly compared with healthy control group, serum TGF-β1level in UC group decreased significantly compared with healthy control group. Serum IL-17level of patients in moderate-severe group was significantly higher than that of patients in mild group in UC group. Compared with patients with the duration of less than five years, serum TGF-β1level decreased significantly in patients with longer term.5Correlationbetween serum IL-17, TGF-β1and lung function in UC patientsIn UC group, there was a negative linear correlation between serum IL-17level and DLCO/VA and there was a positive linear correlation between serum IL-17level and RV/TLC; there was a positive linear correlation between serum TGF-β1level and DLCO/VA.6IL-17, TGF-β1in colonic mucosa in UC patientsCompared with healthy control group, IL-17、TGF-β1level in colonic mucosa of UC group increased significantly. TGF-β llevel in colonic mucosa in moderate-severe group was significantly higher than that of mild group in UC group. TGF-β1in colonic mucosa among patients≤5times decreased significantly, compared with patients>5times,7Correlation between the level of IL-17, TGF-β1in colonic mucosa and lung functionThere was a linear negative correlation between the level of IL-17in colonic mucosa and FEV1/FVC; and there was a linear negative correlation between the level of TGF-β1in colonic mucosa and DLCO/VA.8percentage of Th17and Treg in peripheral blood in UC patientsCompared with healthy control group, percentage of Th17in peripheral blood increased significantly in UC group,however,percentage of Treg decreased markedly. Percentage of Th17in moderate-severe group was significantly higher than that of patients in mild group in UC group, however, percentage of Treg in moderate-severe group decreased markedly. Compared with patients≤5times, percentage of Treg decreased significantly in patients>5times. There was a linear positive correlation between percentage of Th17in peripheral blood and clinical activity index, endoscopic evaluation in UC group; there was a linear negative correlation between percentage of Treg in peripheral blood and clinical activity index, endoscopic evaluation in UC group.9Correlation between percentage of Th17and Treg in peripheral blood and lung functionThere was a linear negative correlation between the percentage of Th17in peripheral blood and DLCO/VA and there was a linearpositive correlation between the level of Th17in colonic mucosa and RV/TLC. There was a linear negative correlation between percentage of Treg in peripheral blood and DLCO/VA.10Correlation between serum IL-17, TGF-β1and IL-17、TGF-β1in colonic mucosa and percentage of Th17and Treg in peripheral blood.The percentage of Th17in peripheral blood was positively related with IL-17in serum level and the level of IL-17in colonic mucosa of patients in UC group. There was a positive relation between the percentage of Treg in peripheral blood and serum TGF-β1level, however, and there was a negative relation between the percentage of Treg in peripheral blood and the level of TGF-β1in colonic mucosa.11Systematic Review and Meta-analysis of effectiveness of sishenwanin treating Ulcerative ColitisTeacher’s experience about the treatment of UC is warming kidney, tonifying spleen, resolving toxin, activating blood and treating zang and fu at the same time, the basic prescription of which is Sishen Formula, so we systematically review the effectiveness and safety of the prescription based on Sishen Formula on treating UC patients, This meta-analysis indicated the overall effect was significantly better in patients receiving Chinese medicine based on Sishen Formula group compared with other therapy group, the adverse effect was significantly decreased in Sishen Formula group compared with other therapy group.Conclusion1Characterized pulmonary function in UC:This article proves that one of the main complications of ulcerative colitis is pulmonary dysfunction.2Th17/Treg immunologic balance in UC:Th17and IL-17were both prmoting inflammation in UC; Treg and TGF-β1were both prohibiting inflammation in UC. Immunologic balance Th17/Treg in UC may be abnormal.3Lung lesions in ulcerative colitis may be associated with unbalanced immune Thl7/Treg.4The Sishen Formula is the representive formula of the Chinese medicine method of warming kidney and tonifying spleen,it was proved that the effect of Chinese herbal medicine based on the Sishen Formula for UC seemed significant over using SASP and other Chinese medicine, Chinese herbal medicine based on the Sishen Formula for UC was less adverse things. So the Sishen Formula might be used broadly in clinic and researched with animal experiments in the future. |
PDF Full Text Request