基于Th17/Treg平衡轴观察桂枝汤合玉屏风散加减治疗慢性自发性荨麻疹的临床疗效  

To Observe the Clinical Efficacy of Modified Guizhi Decoction Combined with Yupingfeng Powder in the Treatment of Chronic Spontaneous Urticaria Based on Th17/Treg Balance Axis

作　　者：刘春保[1] 陆江涛 孔珍珍 关吉利 LIU Chunbao;LU Jiangtao;KONG Zhenzhen;GUAN Jili(Department of Dermatology,Sanya Hospital of Traditional Chinese Medicine,Guangzhou University of Chinese Medicine,Sanya 572000 Hainan,China)

机构地区：[1]广州中医药大学附属三亚市中医院皮肤科,海南三亚572000

出　　处：《中药新药与临床药理》2024年第11期1781-1787,共7页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：海南省卫生健康行业科研项目(15A200031)。

摘　　要：目的评价桂枝汤合玉屏风散加减治疗慢性自发性荨麻疹(风寒袭表、营卫不和证)的临床疗效及对辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡轴的影响。方法将116例慢性自发性荨麻疹患者随机分为试验组(58例)和对照组(58例)。对照组口服抗组胺药物(依巴斯汀片、地氯雷他定片);试验组在对照组的基础上加用桂枝汤合玉屏风散加减;疗程12周,治疗结束后随访8周。检测指标:7 d荨麻疹活动度评分(UAS7)、慢性荨麻疹患者生活质量评估问卷(CUQ2oL)、荨麻疹控制程度测试(UCT)达标率、中医证候评分、相关生物学指标[D-二聚体(D-D)、总免疫球蛋白E(TIgE)及补体C3、C4水平;Th17、Treg细胞占比及Th17/Treg比值;白细胞介素17(IL-17)、IL-23、IL-35和转化生长因子β(TGF-β)水平]。采用UAS7评分下降指数(SSRI)作为疗效评价标准。结果治疗后,两组患者不同时点的UAS7评分均明显低于治疗前(P<0.05),且试验组明显低于同期对照组(P<0.05);在治疗后4、8、12周和随访4、8周,试验组患者的UCT达标率均明显高于同期对照组(P<0.05)。治疗后,两组患者的CUQ2oL量表各因子评分及总评分均明显低于治疗前(P<0.05),外周血D-D、TIgE水平明显低于治疗前(P<0.05),C3、C4水平明显高于治疗前(P<0.05);Th17细胞水平及Th17/Treg比值明显低于治疗前(P<0.05),Treg细胞水平明显高于治疗前(P<0.05);IL-17、IL-23、TGF-β水平明显低于治疗前(P<0.05),IL-35水平明显高于治疗前(P<0.05);两组患者的证候积分明显下降(P<0.05);试验组与治疗后对照组比较,差异均有统计学意义(P<0.05),以试验组效果更为明显。试验组的愈显率为60.34%(35/58),明显高于对照组的39.66%(23/58),差异有统计学意义(P<0.05)。结论在抗组胺药物基础上联合桂枝汤合玉屏风散加减治疗,可控制慢性自发性荨麻疹患者的疾病活动度,提高病情控制效果,改善患者生活质量,提高疗效,其作用机制可能与Objective To evaluate the clinical effect of modified Guizhi Decoction combined with Yupingfeng Powder on chronic spontaneous urticaria(CSU)(wind-cold invading exterior,ying-wei disharmony syndrome)and its influence on Th17/Treg balance axis.Methods A total of 116 patients with CSU were randomly divided into control group(58 cases)and test group(58 cases).The control group was treated with oral antihistamines(ebastine tablets,loratadine tablets).The test group was additionally treated with Guizhi Decoction and modified Yupingfeng Powder on the basis of the control group.The course of treatment was 12 weeks and followed up for eight weeks.Indices detection include:the weekly score of urticaria severity(UAS7),chronic urticaria quality of life questionnaire(CUQ2oL),the standard-reaching rate of urticaria control test(UCT),TCM syndrome score,and related biological parameters[levels of D-dimer(D-D),total immunoglobulin E(TIgE),complement C3 and C4,Th17,proportion of Th17 and Treg cells,ratio of Th17/Treg,levels of interleukin(IL)-17,IL-23,IL-35,and transforming growth factor-β(TGF-β)].UAS7 symptom score reduce index(SSRI)was used as a criterion for efficacy evaluation.Results After treatment,the UAS7 scores of the two groups at different time points were lower than those before treatment(P<0.05),and those were significantly lower in the test group than in the control group(P<0.05).At 4 weeks,8 weeks and 12 weeks after treatment,and at 4 weeks and 8 weeks of follow-up,the standard-reaching rate of UCT in the test group was higher than that in the control group(P<0.05).After treatment,the factor scores and total scores of CUQ2oL scale of the two groups were significantly lower than those before treatment(P<0.05),the levels of D-D and TIgE of peripheral blood were also significantly lower than those before treatment(P<0.05).But the levels of C3 and C4 were significantly higher than those before treatment(P<0.05).The levels of Th17 cells and the ratio of Th17/Treg were significantly lower than those before treatment(P<0

关 键 词：慢性自发性荨麻疹 桂枝汤 玉屏风散 辅助性T细胞17 调节性T细胞 免疫平衡 

分 类 号：R275.9[医药卫生—中西医结合]