燥湿苦参汤联合NB-UVB 治疗寻常性银屑病及 对Th17 和Treg 及其相关因子表达的影响

Clinical efficacy of Zaoshi Kushen Decoction combined with NBUVB on psoriasis vulgaris and expressions of Th17 and Treg cell-related cytokines

摘要:

目的 探讨燥湿苦参汤联合窄谱中波紫外线（NB-UVB）治疗寻常性银屑病的临床疗效及其对 Th17、Treg 细胞相关的转录、分泌因子的影响。方法 选取2014 年6 月-2015 年12 月该院收治的寻常型银 屑病患者126 例。按照就诊顺序随机分为中医对照组、NB-UVB 对照组和研究组，每组42 例。中医对照组 内服燥湿苦参汤，NB-UVB 对照组进行NB-UVB 照射治疗，研究组内服燥湿苦参汤加用NB-UVB 局部照射。 另选择40 例体检正常者为健康对照组。3 组均治疗12 周，评价其综合疗效，对比治疗前后的外周血Th17 细胞 比例及其特异性转录因子—孤儿受体转录因子（RORγt mRNA）、分泌因子—白细胞介素17（IL-17），Treg 细胞的比例及其特异性转录因子—叉头状转录因子（Foxp3 mRNA）、分泌因子—转化生长因子（TGF-β）的表 达水平。结果 ①治疗12 周后，3 组的严重程度评分（PASI）均下降，且研究组评分低于中医对照组与NB-UVB 对照组，总有效率也高于中医对照组与NB-UVB 对照组，差异有统计学意义（P <0.05）。②与健康对照组比较， 3 组治疗前外周血Th17 细胞比例及ROR γt mRNA 与IL-17 均升高，而Treg 细胞的比例及Foxp3 mRNA 与 TGF-β 降低，差异有统计学意义（P <0.05）。治疗后，3 组Th17 细胞的相关因子表达均较治疗前下降，Treg 细 胞相关因子表达较治疗前升高，差异有统计学意义（P <0.05）。结论 燥湿苦参汤联合NB-UVB 局部照射可抑 制Th17 细胞及其相关因子的表达，恢复Treg/Th17 细胞的动态平衡，增强Treg 细胞的免疫抑制功能，从而降低 外周血及皮损处的炎症细胞因子，达到改善寻常性银屑病临床症状的理想疗效。

Abstract:

Objective To analyze the efficacy of Zaoshi Kushen Decoction combined with NB-UVB on psoriasis vulgaris and the expressions of Th17 and Treg cell-related cytokines. Methods Totally 126 patients with psoriasis vulgaris in our hospital from June 2014 to December 2015 were divided into a Chinese medicine control group (group A), a NB-UVB control group (group B) and a study group (group C) according to their visiting sequence, each group had 42 patients. The 42 patients in the group A were treated by Zaoshi Kushen Decoction, those in the group B were treated by NB-UVB local irradiation while the 42 patients in the group C were treated by Zaoshi Kushen Decoction and NB-UVB local irradiation. In addition 40 normal people of physical examination were selected as the control group. Both groups A and B were treated for 12 weeks. The percentage of Th17 cells in the peripheral blood and its specific transforming factor RORγt mRNA (orphan receptor transcription factor), secretion factor IL-17, as well as the percentage of Treg cells and its specific transforming factor Foxp3 mRNA (fork-like transcription factor), and secretory factor TGF-β were compared before and after treatment. Results After 12 weeks of treatment, the PASI scores of the three groups were significantly decreased, and the score of the group C was significantly lower than that of the group A and the group B (P < 0.05), and the total effective rate of the group C was significantly higher than that of the group A and the group B (P < 0.05). Before treatment, compared to the healthy control group, the percentage of peripheral blood Th17 cells and the levels of RORγt mRNA and IL-17 of both groups A and B were significantly increased; while Treg cell proportion and the levels of Foxp3 mRNA and TGF-β decreased significantly, the differences were statistically significant (P < 0.05). After treatment, the expressions of Th17 cell-related factors were significantly decreased compared with those before treatment, whereas the expressions of Treg cell-related factors were significantly higher than those before treatment (P < 0.05). Conclusions Zaoshi Kushen Decoction can inhibit Th17 cell expressions, restore Treg/Th17 homeostasis and enhance the immune suppression function of Treg cells, thereby reduce the inflammatory cytokines in peripheral blood and skin lesions and significantly improve the clinical symptoms of psoriasis vulgaris. For moderate or severe patients, the treatment effect of Zaoshi Kushen Decoction combined with UVB-NB radiation therapy is better.