李玮 刘自兵 潘娅玲 林先刚

〔摘要〕 目的 觀察电针“肺俞”“足三里”对慢性阻塞性肺疾病（chronic obstructive pulmonary disease， COPD）大鼠肺功能及转化生长因子-β（transforming growth factor-β， TGF-β）、肿瘤坏死因子-α（tumor necrosis factor， TNF-α）、白细胞介素-8（interleukin-8， IL-8）表达的影响，初步探讨针刺治疗COPD的效应机制。方法 60 只雄性SD大鼠随机分为正常组、模型组、针刺组，每组20 只，因模型复制和针刺干预过程中部分大鼠死亡，最终纳入统计为每组10 只。采用气管灌注脂多糖联合香烟烟熏法复制COPD大鼠模型。针刺组采用电针对大鼠双侧“肺俞”“足三里”穴进行干预治疗，每次20 min，1 次/d，共干预15 d，模型组和正常组大鼠不作干预。干预结束后测定各组大鼠肺通气功能，苏木精-伊红（hematine-eosine， HE）染色法观察各组大鼠肺组织病理学变化，酶联免疫吸附法（enzyme linked immunosorbent assay， ELISA）检测血清、肺泡灌洗液和肺组织中TNF-α、TGF-β、IL-8含量。结果 与正常组比较，模型组大鼠肺泡腔明显扩张伴肺组织间隙炎性浸润，肺活量、第0.1 秒用力呼气量占用力肺活量（forced vital capacity， FVC）比值以及第0.3 秒用力呼气量占FVC比值均显著降低（P<0.05或P<0.01），血清、肺泡灌洗液和肺组织中TNF-α、IL-8、TGF-β含量均升高（P<0.01）;与模型组比较，电针组大鼠肺泡腔扩张和肺组织炎性浸润减轻，肺活量、第0.1 秒用力呼气量占FVC比值以及第0.3秒用力呼气量占FVC比值均显著升高（P<0.05或P<0.01），血清、肺泡灌洗液和肺组织中TNF-α、TGF-β、IL-8水平明显降低（P<0.01）。结论 电针可以改善COPD气道通气受限情况，缓解肺泡扩张和肺组织炎性反应，降低机体炎性细胞因子水平。其中，抑制TNF-α、TGF-β、IL-8的高表达状态可能是针刺改善COPD呼吸道炎症和气道阻塞的效应机制之一。

〔关键词〕 慢性阻塞性肺疾病;针刺;肺功能;炎症;转化生长因子-β;肿瘤坏死因子-α;白细胞介素-8

〔中图分类号〕R245.97       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.009

〔Abstract〕 Objective To observe the effect of electroacupuncture "Feishu" （BL13） and "Zusanli" （ST36） on lung function and expression of transforming growth factor-β （TGF-β）， tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8） in rats with chronic obstructive pulmonary disease （COPD）， to explore the therapeutic effect of electroacupuncture on COPD. Methods 60 male SD rats were randomly divided into normal group， model group and acupuncture group， with 20 rats in each group. Some rats died in the process of model replication and acupuncture intervention， finally， 10 rats in each group were included. COPD rat model was established by tracheal injection of lipopolysaccharide combined with cigarette smoke. The rats in the acupuncture group were treated with electroacupuncture on both sides of "Feishu" （BL13） and "Zusanli" （ST36） for 20 minutes every time， once a day， 15 days in total. The rats in the model group and the normal group were not intervened. At the end of the intervention， the lung function indexes of each group were measured， the lung histopathological changes of each group were observed by HE staining， and the levels of TNF-α， TGF-β， IL-8 in serum， bronchoalveolar fluid and lung tissue were detected by enzyme-linked immunosorbent assay （ELISA）. Results Compared with the normal group， the alveolar cavity of the model group was obviously dilated with inflammatory infiltration in the lung tissue. The vital capacity， the ratio of forced expiratory volume at 0.1 second and forced expiratory volume at 0.3 second to forced vital capacity （FVC） were significantly decreased （P<0.05， P<0.01）， and the levels of TNF-α， IL-8 and TGF-β in serum， bronchoalveolar fluid and lung tissue were increased （P<0.01）; compared with the model group， the alveolar cavity and inflammatory infiltration in lung tissue were reduced， vital capacity and the ratio of forced expiratory volume at 0.1 second and forced expiratory volume at 0.3 second to FVC in electroacupuncture group were significantly increased （P<0.05， P<0.01）， and the levels of TNF-α， TGF-β and IL-8 in serum， bronchoalveolar fluid and lung tissue were significantly decreased （P<0.01）. Conclusion Electroacupuncture can improve COPD airway ventilation restriction， relieve alveolar dilation and inflammatory response of lung tissue， and reduce the level of inflammatory cytokines. Inhibition of TNF-α， TGF-β， IL-8 expression may be one of the mechanisms of electroacupuncture in improving airway inflammation and airway obstruction in COPD.

〔Keywords〕 chronic obstructive pulmonary disease; acupuncture; lung function; inflammation; transforming growth factor-β; tumor necrosis factor-α; interleukin-8

慢性阻塞性肺疾病（chronic obstructive pulmo-nary disease， COPD）是以喘咳、胸闷、呼吸困难等为主症的慢性肺病，伴随进行性的肺通气障碍和呼吸道炎症，其病理损伤不完全可逆，病程绵长难愈，COPD的病程进展和肺功能下降与呼吸道炎症有直接关系[1-2]。临床数据显示，COPD患者血清中转化生长因子-β（transforming growth factor-β， TGF-β）、肿瘤坏死因子-α（tumor necrosis factor， TNF-α）、白细胞介素-8（interleukin-8， IL-8）等参与介导炎症反应的细胞因子水平，与其病程发展及肺功能损伤具有密切相关性[3]。……