儿童特应性皮炎中医辨证分型特点及各证型的免疫表型研究  

Characteristics of Syndrome Differentiation and Immune Imbalance in Children with Atopic Dermatitis

作　　者：翟盼盼[1] 黄岩杰[1,2] 梅晓峰[1] 李佳佳 李秀敏 张霞[1] 翟文生[1] 任献青[1] 丁樱[1] 薛晨红 钱革 苗明三[2] Zhai Panpan;Huang Yanjie;Mei Xiaofeng;Li Jiajia;Li Xiumin;Zhang Xia;Zhai Wensheng;Ren Xianqing;Ding Ying;Xue Chenhong;Qian Ge;Miao Mingsan(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Henan University of Chinese Medicine,Zhengzhou 450000,China;Department of Microbiology and Immunology,New York Medical College,New York 10595,USA;Henan Provincial People’s Hospital,Zhengzhou 450000,China;Henan Children’s Hospital,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院,郑州450000 [2]河南中医药大学,郑州450000 [3]纽约医学院微生物学与免疫学系,纽约10595 [4]河南省人民医院,郑州450000 [5]河南省儿童医院,郑州450000

出　　处：《世界科学技术-中医药现代化》2023年第6期2168-2173,共6页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：河南中医药大学李秀敏团队课题(KYTQ2018003):河南省特应性皮炎患儿的临床特点及表观遗传学研究,负责人:黄岩杰;河南省中医药学科领军人才(豫卫中医函[2021]8号):中西医结合诊治儿童免疫系统疾病,负责人:黄岩杰;2022年度河南省卫生健康委国家中医临床研究基地科研专项(2022JDZX113):基于肠黏膜免疫稳态重建研究清心运脾方治疗ADFA小鼠皮炎的干预机制,负责人:翟盼盼。

摘　　要：目的探讨儿童特应性皮炎(Atopic dermatitis,AD)的中医辨证分型特点及不同证型AD儿童的免疫表型。方法共纳入159名AD儿童和100名正常对照组儿童。运用电阻抗法检测外周血嗜酸性粒细胞(Eosinophil,Eo)计数,免疫比浊法检测血清总免疫球蛋白E(Immunoglobulin E,IgE),多重微球流式免疫荧光法检测血清干扰素-γ(Interferon-gamma,IFN-γ)、白细胞介素4(Interleukin-4,IL-4)、白细胞介素5(Interleukin-5,IL-5)和白细胞介素17(Interleukin-17,IL-17)。结果159例AD儿童中,心火脾虚证占比最高,为38.4%,其次为血虚风燥证(22.0%)、心脾积热证(20.1%)、脾虚蕴湿证(19.5%)。与正常对照组比较,AD各证型间血清IFN-γ水平无明显差异。心火脾虚证AD外周血Eo、血清总IgE、Th2细胞因子IL-4和Th17细胞因子IL-17的水平显著升高(P<0.05);血虚风燥证AD外周血Eo以及血清Th2细胞因子IL-4、IL-5和Th17细胞因子IL-17的水平显著升高(P<0.05);心脾积热证AD血清Th2细胞因子IL-4、IL-5和Th17细胞因子IL-17的水平显著升高(P<0.05);脾虚蕴湿证AD外周血Eo和血清Th2细胞因子IL-4的水平显著升高(P<0.05)。结论心火脾虚证为儿童AD最常见的证型,但3岁以下以心脾积热证为主要证型。心火脾虚证、血虚风燥证和心脾积热证以Th2/Th17免疫失衡为主,脾虚蕴湿证以Th2免疫失衡为主。Objective To investigate the syndrome differentiation characteristics of children with atopic dermatitis(AD)and the immune imbalance status in children with different syndrome types of AD.Methods A total of 159 AD children and 100 normal control children were enrolled.The peripheral blood eosinophil(Eo)count was measured by impedance method,total serum immunoglobulin E(IgE)by immunoturbidimetric assay,and interferon-gamma(IFN-γ),interleukin-4(IL-4),interleukin-5(IL-5)and interleukin-17(IL-17)were measured by multiple microspheres flow immunofluorescence assay.Results Among 159 AD children,syndrome of heart-fire and spleen-deficiency was most commom,accounting for 38.4%,followed by syndrome of blood-deficiency and wind-dryness(22.0%),syndrome of heat accumulation in heart and spleen(20.1%)and syndrome of spleen-deficiency and dampness-accumulation(19.5%).Compared with normal control group,there was no significant difference in serum IFN-γ level among different syndrome types of AD.The levels of peripheral blood Eo,serum total IgE,IL-4 and IL-17 in AD with heart-fire and spleendeficiency syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo,IL-4,IL-5 and IL-17 in AD with blood-deficiency and wind-dryness syndrome were significantly increased(P<0.05).The levels of IL-4,IL-5 and IL-17 in AD with heat accumulation in heart and spleen syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo and serum IL-4 in AD with spleen-deficiency and dampness-accumulation syndrome were significantly increased(P<0.05).Conclusion Heart-fire and spleen-deficiency syndrome is the most common type in children with AD,however,the main type under 3 years old is heat accumulation in heart and spleen syndrome.Th2/Th17 immune imbalance are the main pathogenesis in heart-fire and spleen-deficiency syndrome,blood-deficiency and wind-dryness syndrome and heat accumulation in heart and spleen syndrome,and Th2 immune imbalance is the main pathogenesis of spleen-deficiency and dampness-accumulatio

关 键 词：特应性皮炎 儿童 辨证分型 细胞因子 

分 类 号：R275.9[医药卫生—中西医结合]