基于Nrf2/p62通路探讨补乌煎剂联合光疗治疗进展期白癜风的作用机制  

Buwu decoction combined with phototherapy ameliorates advanced vitiligo via Nrf2/p62 pathway

作　　者：章纬[1] 于庆生[2] 张虹亚[1] 刘涛峰[1] 王建锋[1] 吴敏[1] ZHANG Wei;YU Qingsheng;ZHANG Hongya;LIU Taofeng;WANG Jianfeng;WU Min(Department of Dermatology,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院皮肤科,合肥230031 [2]安徽中医药大学第一附属医院普外科,合肥230031

出　　处：《中国免疫学杂志》2023年第9期1858-1863,共6页Chinese Journal of Immunology

基　　金：“十二五”国家临床重点专科建设项目(财社[2013]239号)资助。

摘　　要：目的:评价补益肝肾祛风法中药补乌煎剂联合光疗治疗进展期白癜风的临床疗效,并检测患者治疗前后外周血血红素氧合酶1(HO-1)水平、T细胞亚群及核因子E2相关转录因子2(Nrf2)、死骨片1(p62)mRNA的变化,探究其初步的作用机制。方法:选择进展期白癜风患者60例,随机分为观察组和对照组各30例。两组均采用光疗(308准分子光),观察组在光疗基础上联合补益肝肾活血中药口服,评价两组患者治疗前后的临床疗效,并采用ELISA检测外周血HO-1水平;流式细胞术检测外周血T淋巴细胞亚群;RT-qPCR检测PBMC中Nrf2、p62 mRNA表达。结果:两组临床疗效比较,差异有统计学意义(Z=0.019,P<0.05);两组患者治疗后外周血HO-1水平较治疗前显著上升(P<0.01);两组患者治疗后外周血淋巴细胞CD3^(+)CD8^(+)T细胞比例较治疗前降低CD4^(+)/CD8^(+)比例较治疗前明显升高(P<0.01);两组患者治疗后外周血淋巴细胞中Nrf2、p62mRNA的相对表达量较治疗前升高(P<0.01)。结论:补益肝肾祛风中药联合308准分子光能够有效的治疗进展期白癜风,并可以上调Nrf2、p62 mRNA促进其下游HO-1表达从而发挥抗氧化、抗炎及免疫调节作用,以降低外周血CD3^(+)CD8^(+)T细胞比例,效果优于单纯的光疗组。Objective:To evaluate the clinical efficacy of TCM Buwu decoction combined with phototherapy in the treatment of advanced vitiligo,and to detect the changes of heme oxygenase-1(HO-1)level,T cell subpopulation,nuclear factor E2-related transcription factor 2(Nrf2)and dead bone tablet 1(p62)mRNA in peripheral blood of patients before and after treatment,so as to explore the preliminary mechanism of action.Methods:According to the inclusion criteria of advanced vitiligo patients,sixty patients were selected and randomly divided into obesevation group(30 cases)and control group(30 cases).Both groups were treated with 308 excimer light,and the observation group was treated with Buwu decoction on the basis of phototherapy.The clinical efficacy of the two groups was evaluated,and the level of HO-1 in serum was detected by ELISA;T cell subsets of peripheral blood lymphocytes were detected by flow cytometry;the expressions of Nrf2 and p62 mRNA in PBMC were detected by RT-qPCR.Results:There was significant difference in clinical efficacy between the two groups(Z=0.019,P<0.05).The level of HO-1 in peripheral blood of 2 groups after treatment was significantly higher than that before treatment(P<0.01).After treatment,the proportion of peripheral blood lymphocytes CD3+CD8+T cells was lower than before treatment,and the proportion of CD4+/CD8+was significantly higher than before treatment(P<0.01).The relative expression levels of Nrf2 and p62 mRNA in peripheral blood lymphocytes of two groups were higher after treatment than before treatment(P<0.01).Conclusion:TCM combined with 308 excimer light can effectively treat advanced vitiligo,and can up-regulate Nrf2 and p62 mRNA to promote the expression of HO-1 in its downstream,thus playing antioxidant,anti-inflammatory and immune regulation roles,and reduce the proportion of CD3+CD8+T cells in peripheral blood,whose effect is better than that of simple light therapy group.

关 键 词：白癜风 补乌煎剂 308准分子光 Nrf2/p62通路 T细胞亚群 

分 类 号：R758.6[医药卫生—皮肤病学与性病学]