基于Th17/Treg/Th1免疫失衡探讨长蛇灸干预强直性脊柱炎的疗效及机制研究  

Effects and mechanism of the long-snake moxibustion on ankylosing spondylitis based on Th17/Treg/Th1 immune imbalance

作　　者：左政[1] 刘自力[1] 袁恺[1] 王耀羚 董康丽 ZUO Zheng;LIU Zili;YUAN Kai;WANG Yaoling;DONG Kangli(School of Acupuncture,Tuina and Rehabilitation,Yunnan University ofTCM,Kunming 650500,China)

机构地区：[1]云南中医学院针推康复学院,昆明650500

出　　处：《中国针灸》2018年第10期1053-1057,共5页Chinese Acupuncture & Moxibustion

基　　金：云南省科学技术厅-云南中医学院应用基础研究联合专项项目:2015 FB 205(021)

摘　　要：目的:探讨长蛇灸干预强直性脊柱炎(AS)的疗效及作用机制。方法:60例AS患者随机分为观察组和对照组,每组30例。观察组给予长蛇灸疗法,一组穴以督脉穴大椎至腰俞为主,另一组穴以两侧夹脊穴为主,两组交替使用,每日灸1次,连续治疗7 d为一疗程,疗程间间隔3 d,共治疗4个疗程;对照组给予西药常规治疗,即柳氮磺胺吡啶配合非甾体抗炎药,连续服药7 d为一疗程,治疗4个疗程。采用酶联免疫吸附实验(ELISA)法检测血浆白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、白细胞介素-23(IL-23)及肿瘤坏死因子α(TNF-α)水平;采用实时定量聚合酶链反应(RT-PCR)检测辅助性17细胞(Th17)、调节性T细胞(Treg)、T辅助细胞1型(Th1)的特异性转录因子Fox P3、T-bet的m RNA表达水平;采用流式细胞术检测CD_4^+CD_(25)^+Fox P3细胞、CD_4^+Th1细胞、CD_4^+Th17细胞的比率及炎性反应指标C反应蛋白(CRP)、血沉(ESR)的变化,并比较两组疗效。结果:治疗后观察组总有效率为93.3%(28/30),优于对照组的86.7%(26/30,P<0.05);观察组治疗后CRP、ESR、IL-6、IL-17、IL-23、TNF-α水平及CD_4^+Th17细胞比率较治疗前显著下降(均P<0.05),Fox P3、T-bet的m RNA表达及CD_4^+CD_(25)^+Treg、CD_4^+Th1细胞比率较治疗前显著增加(均P<0.05),且变化程度均较对照组显著(均P<0.05);对照组CRP、ESR、IL-6、IL-17、IL-23、TNF-α水平及CD_4^+Th17细胞比率有所下降,Fox P3、T-bet的mRNA表达及CD_4^+CD_(25)^+Treg、CD_4^+Th1细胞比率有所增加,但治疗前后差异无统计学意义(均P>0.05)。结论:长蛇灸能有效改善AS患者临床症状,调节患者Th17/Treg/Th1免疫失衡,其作用的靶点可能是通过调节AS免疫紊乱及紊乱所致的炎性应答而发挥双向良性调节作用。Objective To explore the effects and mechanisms of the long-snake moxibustion on ankylosing spondylitis（AS） based on Th17/Treg/Th1 immune imbalance. Methods A total of 60 AS patients were randomized into an observation group and a control group, 30 cases in each one. In the observation group, the long-snake moxibustion therapy was used on the acupoints of the governor vessel from Dazhui（GV 14） to Yaoshu（GV 2） as well as the bilateral Jiaji（EX-B 2） alternatively. The moxibustion was given once a day, for 7 days continuously as one course. There were 3 days at the interval between the courses and 4 courses were required. In the control group, the routine western medication was provided, the salazosulfapyridine combined with non-steroidal anti-inflammatory drugs were used, for 7 days continuous as one course. A total of 4 courses of medication were required. The enzyme linked immunosorbent assay（ELISA） was adopted to determine the levels of interleukin-6（IL-6）, interleukin-17（IL-17）, interleukin-23（IL-23） and tumor necrosis factor-α（TNF-α）. The real-time quantification polymerase chain reaction（RT-PCR） was used to determine the m RNA expressions of the specific transcription factors, Fox P3 and T-bet of the helper 17 cells（Th17）, regulatory T cells（Treg） and T helper 1 cells（Th1）. The flow cytometry was applied to determine the rates ofCD_4~＋CD_（25）~＋Treg, CD_4~＋Th1 and CD_4~＋Th17, as well as the changes of the inflammatory reaction index, C-reactive protein（CRP）, and erythrocyte sedimentation rate（ESR）. The therapeutic effects were compared between the two groups. Results After treatment, the total effective rate was 93.3%（28/30） in the observation group, which was better than 86.7%（26/30） in the control group（P〈0.05）. After treatment, the levels of CRP, ESR, IL-6, IL-17, IL-23 and TNF-α, as well as the rate of CD_4~＋Th17 were reduced significantly as compared with those before treatment in the observation group（all P〈0.0

关 键 词：强直性脊柱炎 长蛇灸 Th17/Treg/Th1免疫失衡 免疫紊乱 

分 类 号：R246.2[医药卫生—针灸推拿学]