补肾驱白汤联合308nm准分子激光治疗白癜风及对外周血Th17细胞与相关细胞因子的影响  

Therapeutic Effect of Bushen-Qubai Decoction Therapy Combined with 308nm Excimer Laser in Treatment of Vitiligo Patients and Changes of Th17 Cells and Related Cytokines

作　　者：朱丽丽[1] 孙卫国[2] 赵晓峰[1] 邓之奎[3] 郭海[1] 江明[2] 

机构地区：[1]南京医科大学附属淮安第一医院中医科,江苏淮安223300 [2]南京医科大学附属淮安第一医院皮肤科,江苏淮安223300 [3]南京医科大学附属淮安第一医院中心实验室,江苏淮安223300

出　　处：《中国皮肤性病学杂志》2016年第1期79-83,共5页The Chinese Journal of Dermatovenereology

基　　金：江苏省中医药局资助项目(LZ13183)

摘　　要：目的观察补肾驱白汤联合308nm准分子激光治疗稳定期白癜风的临床疗效,并分析对患者外周血Th17细胞在CD4^+T细胞中的表达率及其相关细胞因子(IFN-γ,IL-10,IL-17和IL-23)分泌的影响。方法将60例稳定期白癜风患者随机分为2组,每组30例。两组患者均采用308nm准分子激光系统进行每周2次治疗,观察组另加服补肝肾类中药协定方——补肾驱白汤,日煎1剂分早、晚2次内服。治疗12周后,分别评定2组的临床疗效。此外,采用流式细胞术分析患者治疗前后外周血Th17细胞表达率及血浆中IFN-γ,IL-10及IL-17水平变化,采用ELISA分析外周血血浆中IL-23水平变化,并与20例健康体检者的外周血标本进行比较。结果治疗12周后,观察组显效率为86.67%,对照组显效率为63.33%,差异有统计学意义(P<0.05)。治疗前,两组患者外周血Th17细胞比例、IFN-γ,IL-17及IL-23水平较健康人群组有显著性增高(P<0.05),血浆中IL-10水平与健康人群组比较差异无统计学意义(P>0.05)。治疗后,两组患者血浆中IFN-γ水平均有一定下调,与健康人群组比较差异无统计学意义(P>0.05);观察组外周血Th17细胞比例、血浆中IL-17和IL-23水平较对照组显著下调。结论补肾驱白汤联合308nm准分子激光治疗白癜风疗效显著,可显著降低患者外周血Th17细胞比例及相关细胞因子水平,恢复机体免疫功能平衡。Objective To observe the clinical efficacy of Bushen-Qubai decoction combined with 308nm excimer laser in the treatment of vitiligo patients in stable phase, and analyze its effect on the peripheral Thl7 cells to CD4 ~ T ceils and the secretion of associated cytokines including IFN--y, IL-10, IL-17 and IL-23. Methods Sixty vitiligo patients in stable phase were randomly divided into two groups with 30 patients in each group. Patients in both groups were treated by 308nm excimer laser twice a week, and patients in observation group additionally took one dose of Bushen-Qubai decoction, morning for half dose and evening for another half dose. After 12 weeks treatment, the clinical efficacy was evaluated. Moreover, the changes of peripheral Thl7 cells and the serum level of IFN-γ,IL-10 and IL-17 were detected by the flow cytornetry before and after the treatment, and the change of serum level of IL-23 was detected by ELLSA, compared with those of 20 healthy volunteers. Results The rate of marked effect in observation group was 86. 67% compared to 63.33% of control group, with signigicant difference （P 〈0. 05）. Before treatment, the ratio of peripheral Thl7 and the serum level of IFN-γ, IL-17 and IL-23 for both group were significantly higher than those in healthy volunteers （ P 〈 0. 05 ） , but the serum level of IL-10 showed no significant difference. After treatment, the serum level of IFN-γ for both group was down-regulated, without significant difference between the patients and healthy volunteers （P 〉0. 05） ; The ratio of peripheral Thl7 and the serum level of IL-17 and IL-23 in observation group were remarkably decreased than those in control group. Conclusion The therapy of Bushen-Qubai decoction combined with 308nm exeimer laser is effective in the treatment of vitiligo patients, which can significantly down-regulate the ratio of Thl7 cells in peripheral blood and the level of related eytokines, and restore the balance of immune function.

关 键 词：补肾驱白汤 白癜风 308NM准分子激光 TH17细胞 IL-17 IL-23 

分 类 号：R758.41[医药卫生—皮肤病学与性病学]