复发缓解型多发性硬化缓解期患者血清NfL、sPD-1、sPD-L1与肾虚湿热证的相关性  

Correlation between Serum NfL,sPD-1,sPD-L1 and the Syndrome of Kidney Deficiency and Dampheat in Relapsing-remitting Multiple Sclerosis Patients during the Remission Period

作　　者：刘佳[1,2] 孔令博[1,2] 贾珍[3] 杨琦 张靖泽[1] 张弛 李彬 曹渊博[3] SUGIMOTO KAZUO 高颖 LIU Jia;KONG Lingbo;JIA Zhen;YANG Qi;ZHANG Jingze;ZHANG Chi;LI Bin;CAO Yuanbo;SUGIMOTO KAZUO;GAO Ying(Dongzhimen Hospital,Bejjing University of Chinese Medicine,Bejjing,100700;Institute for Brain Disorders,Beijing University of Chinese Mediceine;The Second Hospital of Hebei Medical University)

机构地区：[1]北京中医药大学东直门医院,北京市100700 [2]北京中医药大学中医脑病研究院 [3]河北医科大学第二医院

出　　处：《中医杂志》2023年第1期37-42,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81904131);北京市自然科学基金(7222114);国家科技部聘请外国文教专家项目(QN2021110001L);中医药传承与创新“百千万”人才工程(岐黄工程)项目(国中医药人教发[2018]12号)。

摘　　要：目的初步探讨复发缓解型多发性硬化(RRMS)缓解期肾虚湿热证患者的血清学特征。方法回顾性选取RRMS缓解期患者27例作为RRMS组,以同期招募的26例健康志愿者作为健康组,并将RRMS组患者辨证分为肾虚湿热证和肾虚非湿热证两个亚组。采集所有受试者临床信息,采用扩展残疾量表(EDSS)评估患者神经功能损伤情况,利用单分子阵列分析技术检测受试者血清神经丝轻链蛋白(NfL)、可溶型程序性死亡受体1(sPD-1)、可溶型程序性死亡配体1(sPD-L1)水平,并采用Spearman法对RRMS患者血清NfL、sPD-1、sPD-L1水平之间的相关性及其与病程、发作次数、EDSS评分的相关性进行分析。结果RRMS组患者血清NfL、sPD-1、sPD-L1水平显著高于健康组(P<0.05或P<0.01);肾虚湿热证亚组患者血清NfL、sPD-1、sPD-L1水平均高于肾虚非湿热证亚组患者(P<0.05或P<0.01)。RRMS组患者血清NfL水平与sPD-1、sPD-L1水平均呈正相关(P<0.01),sPD-1水平与sPD-L1水平呈正相关(P<0.001);RRMS组患者血清sPD-1水平与发作次数呈正相关(P=0.030)。结论RRMS缓解期患者血清NfL、sPD-1、sPD-L1显著升高,且肾虚湿热证患者较肾虚非湿热证患者升高程度更为明显,提示RRMS肾虚湿热证患者可能存在更为严重的免疫炎症和神经损伤。Objective To preliminarily investigate the serological characteristics of relapsing-remitting multiple sclerosis(RRMS) patients with kidney deficiency and damp-heat syndrome during the remission period.Methods Twenty-seven patients with RRMS during the remission period were retrospectively included as the RRMS group,while 26 healthy volunteers of the same time period were recruited as the healthy group.The patients in the RRMS group were further divided into two subgroups according to whether there was damp-heat or not.The clinical data of all subjects was collected,and the expanded disability status scale(EDSS) was used to evaluate the neurological impairment.Single molecule array(Simoa) technology was used to detect the serum levels of neurofilament light chain(NfL),soluble programmed cell death protein 1(sPD-1),and soluble programmed death-ligand 1(sPD-L1).Spearman method was taken to analyze the correlation between serum NfL,sPD-1,and sPD-L1 levels in RRMS patients,and their correlations with course of disease,attack times,and EDSS score.Results The serum levels of NfL,sPD-1and sPD-L1 were significantly higher in the RRMS group than in the healthy group(P<0.05 or P<0.01),and were higher in the kidney deficiency and damp-heat subgroup than in the non-damp-heat syndrome subgroup(P<0.05 or P<0.01).In patients with RRMS,serum NfL level was positively correlated to sPD-1 and sPD-L1 levels(P<0.01),and sPD-1 level was positively correlated to sPD-L1 level(P<0.001);serum sPD-1 level was positively correlated to attack times(P = 0.030).Conclusion Serum levels of NfL,sPD-1,and sPD-L1 in patients with RRMS significantly increase during the remission period,and more changes are found if there is kidney deficiency and dampheat syndrome than non-damp-heat syndrome,suggesting that RRMS patients with kidney deficiency and damp-heat syndrome may be related to more serious immune inflammation and nerve damage.

关 键 词：多发性硬化 肾虚湿热证 复发缓解型 缓解期 神经丝轻链蛋白 可溶型程序性死亡受体1 可溶型程序性死亡配体1 

分 类 号：R277.7[医药卫生—中医学]