肉芽肿性乳腺炎不同中医证型中免疫相关因子表达变化及临床意义  

Expressions and Clinical Significance of Immune-Related Factors in Different TCM Syndrome Patterns of Granulomatous Mastitis

作　　者：刘晓菲 王楠 李斐斐 宋爱莉 张丽美[2] LIU Xiaofei;WANG Nan;LI Feifei;SONG Aili;ZHANG Limei(The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan 250335, China;Shandong Academy of Chinese Medicine, Jinan 250014, China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250335 [2]山东省中医药研究院,山东济南250014

出　　处：《中医药学报》2020年第4期23-28,共6页Acta Chinese Medicine and Pharmacology

基　　金：第六批全国老中医药专家学术经验继承工作;山东省医药卫生科技发展计划项目(2018WS191);山东省重点研发项目(2015GSF119014)。

摘　　要：目的:研究CD4+、CD8+T淋巴细胞、TNF-α及其受体p55在肉芽肿性乳腺炎不同证型中的表达情况,探讨各因子与不同证型GLM的关系及GLM发病机制。方法:收集2017年1月—2018年12月于山东中医药大学附属医院乳腺外科住院手术治疗的GLM患者手术病理组织,总数为50例,按照中医证型分组:肝郁痰凝证(肿块期)(15例)、热毒炽盛证(脓肿期)(18例)、正虚毒恋证(溃后期)(17例),免疫组化法检测病理组织中的CD4+、CD8+T淋巴细胞、TNF-α及受体P55,分析各种指标在GLM不同证型中的表达及意义。结果:CD4+T淋巴细胞、TNF-α、P55在不同证型GLM中的表达为肝郁痰凝证(肿块期)>热毒炽盛证(脓肿期)>正虚毒恋证(溃后期);CD8+T细胞表达情况为肝郁痰凝证(肿块期)<热毒炽盛证(脓肿期)<正虚毒恋证(溃后期)。CD4+、CD8+T细胞在不同证型GLM的表达呈负相关;TNF-α、P55在不同证型GLM的表达变化呈正相关。TNF-α的表达与CD4+T细胞表达呈正相关,与CD8+T细胞表达呈负相关。结论:在肉芽肿性乳腺炎不同证型中,CD4+、CD8+、TNF-α、P55随着病情进展呈现表达强弱的变化,提示肉芽肿性乳腺炎与T细胞亚群水平失衡相关,免疫状态紊乱,机体发生过强的免疫应答,导致炎症迁延不愈。本研究对肉芽肿性乳腺炎提供不同的治疗思路。Objective:To study the expressions of CD4+T lymphocytes,CD8+T lymphocytes,TNF-αand its receptor p55 in different syndromes of granulomatous mastitis(GLM),and to explore the possible relationship between the factors and GLM of different syndromes and the pathogenesis of GLM.Methods:The surgical pathological tissues of 50 GLM patients were collected and classified according to TCM syndromes,i.e.stagnation of liver-qi and phlegm(lump stage,15 cases),excessive toxic heat(abscess stage,18 cases),declined vital-qi(late stage,17 cases).The expressions of CD4+T lymphocytes,CD8+T lymphocytes,TNF-αand its receptor p55 in pathological tissues were detected by immunohistochemical method.The expressions and significance of the indicators were analyzed in different syndromes of GLM.Results:In terms of the expressions of CD4+T lymphocytes,TNF-αand receptor p55,the order from high to low was the pattern of stagnation of liver-qi and phlegm,pattern of excessive toxic heat and pattern of declined vital-qi.In terms of the expression of CD8+T lymphocytes,the order from the low to high was the pattern of stagnation of liver-qi and phlegm,pattern of excessive toxic heat and pattern of declined vital-qi.The expressions of CD4+T lymphocytes,CD8+T lymphocytes in GLM of different syndromes was negatively correlated;the expressions of TNF-αand P55 in GLM of different syndromes was positively correlated.The expression of TNF-αwas positively correlated with the expression of CD4+T lymphocytes and negatively correlated with the expression of CD8+T lymphocytes.Conclusion:Among the different types of granulomatous mastitis,the expressions of CD4+T lymphocytes,CD8+T lymphocytes,TNF-αand its receptor p55 change with the progression of the disease,suggesting that granulomatous mastitis is related to the imbalance of T cell subsets.Disorder of immune status and excessively strong immune responses will lead to protracted inflammation.This study provides different treatment ideas for granulomatous mastitis.

关 键 词：肉芽肿性乳腺炎 中医证型 T细胞亚群 肿瘤坏死因子 免疫组化 

分 类 号：R269[医药卫生—中西医结合]