独活寄生汤对肝肾不足寒湿痹阻型类风湿性关节炎Th17/Treg平衡的影响  

Effects of Duhuo Jisheng Decoction on Th17/Treg Balance in Rheumatoid Arthritis of Liver-kidney Insufficiency,Cold-dampness Obstruction Pattern

作　　者：赵海燕[1] 张鸿婷[1] 郭丹丹[1] 张秀荣[1] ZHAO Haiyan;ZHANG Hongting;GUO Dandan;ZHANG Xiurong(The Second Affiliated Hospital to Heilongjiang University of TCM,Harbin 150000,China)

机构地区：[1]黑龙江中医药大学附属第二医院,黑龙江哈尔滨150000

出　　处：《西部中医药》2021年第6期8-12,共5页Western Journal of Traditional Chinese Medicine

基　　金：哈尔滨市科技创新人才研究专项资金项目(2016RAQXJ171);黑龙江省中医药管理局中医药科研课题(ZHY18-090)。

摘　　要：目的:观察独活寄生汤对肝肾不足寒湿痹阻型类风湿性关节炎(rheumatoid arthritis,RA)患者辅助性T细胞17(T helper cell 17,Th17)/调节性T细胞(regulatory T cell,Treg)平衡的影响,探讨其控制炎症因子释放的作用机制。方法:将48例RA患者随机分为观察组和对照组,每组24例。对照组给予西医常规治疗,观察组在此基础上加用独活寄生汤口服,疗程24周。记录治疗前后患者关节压痛数(trajec-tory chart,TJC)、关节肿胀数(swollen joint counts,SJC)、晨僵时间、中医证候积分、视觉模拟评分(visual analogue score,VAS)、双手平均握力。酶联免疫吸附法检测血清白细胞介素17(interleukin-17,IL-17)、白细胞介素10(interleukin-10,IL-10)、转化生长因子β(transforming growth factor-β,TGF-β)水平;散射比浊法测定外周血C反应蛋白(C-reactive protein,CRP);魏氏法测定外周血沉(erythrocyte sedimentation rate,ESR)水平;流式细胞术检测外周血Th17、Treg细胞表达水平;免疫印迹试验检测叉头状转录因子P3(forkhead transcription facter 3,Foxp3)及其磷酸化叉头状转录因子P3(forkhead tran-scription facter 3,p-Foxp3)的表达。结果:1)治疗后两组TJC、SJC、晨僵时间、中医证候积分、VAS评分、双手平均握力明显改善,且观察组优于对照组(P<0.05)。2)治疗后两组IL-17、Th17、ESR及CRP水平都较治疗前降低,且观察组优于对照组(P<0.01)。3)治疗后两组IL-10、TGF-β、Treg、Foxp3及p-Foxp3水平均升高,且观察组优于对照组(P<0.05)。结论:独活寄生汤联合西药可以有效改善肝肾不足寒湿痹阻型RA患者的临床症状,机制可能是与调节Th17/Treg的平衡,控制IL-17、IL-10、TGF-β等炎症因子的释放有关,达到改善RA自身免疫反应、减轻关节炎症的目的。Objective:To explore the effects of Duhuo Jisheng decoction on Th17/Treg balance in the patients with RA of liver-kidney insufficiency cold-dampness obstruction pattern,and discuss its mechanism of controlling the release of inflammatory factor.Methods:All 48 RA patients were randomized into the observation group and the control group,24 cases in each group.The control group accepted conventional therapy of Western medicine,and the observation group took Duhuo Jisheng decoction orally based on conventional therapy of Western medicine,the course was 24 weeks.To record TJC,SJC,morning stiffness time,TCM syndrome integral,VAS,average grip strength of both hands before and after treating.ELISA was used to measure the levels of serum IL 17,IL-10,and TGF-β;scattering turbidimetry to detect CRP in peripheral blood;westergren method to measure the levels of ESR;flow cytometry to test the expressions of Th17 and Treg in peripheral blood;Western Blotting to check the expressions of Foxp3 and p-FoxP3.Results:1)TJC,SJC,morning stiffness time,TCM syndrome integrals,VAS and average grip strength of both hands of the patients in both groups after treating were improved,and the observation group was superior to the control group(P<0.05).2)The levels of IL-17,Th17,ESR and CRP of both groups lowered after treating compared with these before treating,and the observation group was better than the control group(P<0.01).3)The levels of IL-10,TGF-β,Treg,Foxp3 and p-Foxp3 rose in both groups after treating,and the observation group was superior to the control group(P<0.05).Conclusion:Duhuo Jisheng Tang combined with Western medicine could effectively improve clinical symptoms in the patients with RA of liver kidney insufficiency cold-dampness obstruction pattern,its mechanism might be through regulating Th17/Treg balance,controlling the release of inflammatory factors including IL-17,IL-10,TGFβ,etc,therefore it could improve the autoimmune response of RA,relieve joint inflammation.

关 键 词：关节炎 类风湿 独活寄生汤 临床疗效 辅助性T细胞17/调节性T细胞 

分 类 号：R593.22[医药卫生—内科学]