参地颗粒对慢性肾小球肾炎脾肾亏虚证患者细胞毒T淋巴细胞相关抗原-4/外周单个核细胞B7-1介导的免疫炎症紊乱的影响  

Effect of Shendi Granules on Immune and Inflammatory Disorder Mediated by CTLA-4/B7-1 in Chronic Glomerulonephritis Patients with Spleen-kidney Insufficiency Syndrome

作　　者：茅燕萍[1] 王亿平[1] 陈成 张磊[1] 魏玲[1] 任克军[1] 金华[1] 王东[1] 章雪莲[1] MAO Yah-Ping;WANG Yi-Ping;CHEN Cheng;ZHANG Lei;WEI Ling;REN Ke-Jun;JIN Hua;WANG Dong;ZHANG Xue-Lian(Dept.of Nephrology,the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031 Anhui,China)

机构地区：[1]安徽中医药大学第一附属医院肾病科,安徽合肥230031

出　　处：《广州中医药大学学报》2019年第2期165-170,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：安徽省卫生厅中医药科研项目(编号:2012ZY13);安徽省卫计委中医药科研项目(编号:2016ZY13)

摘　　要：【目的】观察参地颗粒对于脾肾亏虚型慢性肾小球肾炎(CGN)患者外周细胞毒T淋巴细胞相关抗原-4(CTLA-4)、外周单个核细胞B7-1(CD80)水平和血清白细胞介素2(IL-2)、白细胞介素6(IL-6)、干扰素γ(IFN-γ)的影响,探讨参地颗粒对CGN患者的CTLA-4/B7-1介导的免疫炎症紊乱的干预作用。【方法】将60例脾肾亏虚型CGN患者随机分为治疗组和对照组,每组各30例;另选择20例同期健康体检者作为正常组。2组患者均给予西医常规治疗,治疗组同时给予参地颗粒治疗,对照组同时给予缬沙坦胶囊治疗,疗程12周。观察2组治疗前后24 h尿蛋白定量(24hUPr),外周血B7-1、IL-2、IL-6、IFN-γ及尿B7-1水平的变化情况,并评价2组的疗效。【结果】(1)治疗组剔除2例,对照组剔除3例,最终治疗组28例、对照组27例完成试验。(2)治疗后,2组患者的中医证候积分均较治疗前下降(P<0.05),且治疗组的降低作用明显优于对照组(P<0.05)。(3)治疗组和对照组的中医证候疗效总有效率分别为92.86%、55.56%,临床疾病疗效总有效率分别为89.29%、62.96%,治疗组的中医证候疗效和临床疾病疗效均优于对照组(P<0.05)。(4)治疗后各个时点,对照组的24hUPr含量与治疗前比较均无统计学差异(P> 0.05);治疗组在治疗8周、12周后的24hUPr含量均较治疗前明显降低(P <0.05),且其降低作用明显优于对照组(P <0.05)。(5)治疗前,2组患者血清IL-2水平均较正常组下降,IL-6、IFN-γ水平均较正常组升高(P <0.05)。治疗后,2组患者血清IL-2水平均较治疗前升高(P <0.05),IL-6、IFN-γ水平均较治疗前下降(P <0.05);组间比较,治疗组对血清IL-6、IFN-γ表达水平的降低作用优于对照组(P <0.05)。(6)治疗后,2组患者血清和尿B7-1表达水平均较治疗前下降(P <0.05),但治疗后组间比较,差异均无统计学意义(P> 0.05)。【结论】CGN患者体内CTLA-4/B7-1信号系统存在紊乱,引起Th1/Th2细胞失衡,造成炎症因子�Objective To observe the effect of Shendi Granules on the levels of cytotoxic T lymphocyte associated antigen-4(CTLA-4)and B7-1(CD80)in peripheral blood mononuclear cells(PBMC),and serum levels of interleukin(IL)-2,IL-6,interferon gamma(IFN-γ)of chronic glomerulonephritis(CGN)patients with insufficiency of spleen and kidney,thus to investigate the intervention effect of Shendi Granules on CTLA-4/B7-1mediated immune and inflammatory disorder in patients with CGN.Methods Sixty CGN patients with spleen kidney insufficiency were randomly divided into treatment group and control group,30 cases in each group.And another 20 healthy physical examiners at the same period were chosen as the normal group.The treatment group was treated with Shendi Granules orally combined with routine western medicine,and the control group was treated with Valsartan Capsules orally combined with routine western medicine,the treatment for the two groups lasting for12 weeks.Before and after treatment,24-hour urine protein quantification(24hUPr),peripheral blood B7-1,IL-2,IL-6,and IFN-γ(IFN-γ)levels,and urinary B7-1 level in the two groups were observed.After treatment,the therapeutic effect in the two groups was evaluated.Results(1)For 2 cases from the treatment group and 3 cases from the control group were excluded,finally 28 in the treatment group and 27 in the control group completed the trial.(2)After treatment,traditional Chinese medicine(TCM)symptom scores in the two groups were decreased(P<0.05 compared with those before treatment),and the decrease in the treatment group was superior to that in the control group(P<0.05).(3)The total effective rate for TCM symptoms was 92.86%in the treatment group and55.56%in the control group,and the total effective rate for CGN was 89.29%in the treatment group and 62.96%in the control group,the treatment group showing stronger effect than the control group(P<0.05)(.4)At various time points of treatment,24hUPr level in the control group did not differ from that before treatment(P>0.05);24hUPr level

关 键 词：慢性肾小球肾炎 脾肾亏虚证 参地颗粒 CTLA-4 B7-1 细胞因子 

分 类 号：R692.31[医药卫生—泌尿科学]