来源：风湿病与关节炎,2021,10（4）:13-16.

类风湿关节炎血清瘦素、CD4⁺/CD8⁺淋巴细胞比值与中医证型分析（临床研究）

郑桂华¹，邱明山²，徐振兴²，张　倩²，李依寒²，陈进春² 

　　【摘　要】目的：探讨血清瘦素、CD4⁺/CD8⁺淋巴细胞比值（CD4⁺/CD8⁺比值）与类风湿关节炎（rheumatoid arthritis,RA）中医证型的关系，为RA中医辨证分型提供客观参考依据。方法：选取RA患者199例，分为风湿痹阻证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、肝肾不足证、气血两虚证6个证型，同时选取45例正常体检者为正常对照组。收集体检正常者及RA患者空腹血清，进行瘦素、CD4⁺/CD8⁺比值检测并记录结果，收集RA患者基本信息、临床症状、红细胞沉降率、C反应蛋白等，采用统计软件SPSS 20.0进行分析。结果：①RA组血清瘦素水平、CD4⁺/CD8⁺比值高于正常对照组（P < 0.001）。②RA组各证型血清瘦素水平比较，差异有统计学意义（P < 0.001），其中痰瘀痹阻证血清瘦素水平高于其他各证型（P < 0.05）。③RA组各证型血清CD4⁺/CD8⁺比值比较，差异有统计学意义（P < 0.001），其中湿热痹阻证血清CD4⁺/CD8⁺比值高于其他各证型（P < 0.05）。④RA组血清瘦素、CD4⁺/CD8⁺比值分别与DAS28评分之间存在显著的正相关（P < 0.001）。⑤RA组血清瘦素与CD4⁺/CD8⁺比值之间存在正相关（P < 0.05）。结论：在RA的6个中医证型中，血清瘦素水平、CD4⁺/CD8⁺比值异常升高可分别作为痰瘀痹阻证、湿热痹阻证的客观参考指标。RA患者血清瘦素水平与CD4⁺/CD8⁺比值之间存在正相关，提示瘦素代谢与细胞免疫之间可能存在一定的关系。

　　【关键词】　类风湿关节炎；瘦素；CD4⁺/CD8⁺淋巴细胞比值；中医证型

Analysis of Serum Leptin,CD4⁺/CD8⁺ and TCM Syndrome Types of Rheumatoid Arthritis

ZHENG Gui-hua,QIU Ming-shan,XU Zhen-xing,ZHANG Qian,LI Yi-han,CHEN Jin-chun

　　【ABSTRACT】Objective:To explore the relationship between serum leptin,CD4⁺/CD8⁺ and TCM syndrome types of rheumatoid arthritis（RA）,so as to provide objective reference for TCM syndrome differentiation.Methods:One hundred and ninety-nine patients with RA were selected and divided into six syndrome types:rheumatism-obstruction syndrome,cold dampness-obstruction syndrome,dampness-heat-obstruction syndrome,phlegm-stasis-obstruction syndrome,liver-kidney-deficiency syndrome,qi-blood-deficiency syndrome.Forty-five cases for normal physical examination were selected as the normal control group.The serum leptin and CD4⁺/CD8⁺ were detected and the results were recorded.The basic information,clinical symptoms,erythrocyte sedimentation rate and C-reactive protein of RA patients were collected and analyzed by SPSS 20.0.Results:①The serum leptin level and CD4⁺/CD8⁺ in the RA group were higher than those in the normal control group（P < 0.001）.②The difference of the levels of serum leptin in all the RA groups was statistically singnificant（P < 0.001）and the level in the phlegm-stasis-obstruction syndrome group was significantly higher than that of other syndrome types（P < 0.05）.③The difference of CD4⁺/CD8⁺ in RA groups was statistically significant（P < 0.001）,and the ratio in the damp-heat-obstruction syndrome group was higher than that in other syndrome types（P < 0.05）.④There were significant positive correlations between serum leptin,CD4⁺/CD8⁺ and DAS28 score in the RA group（P < 0.001）.⑤There was a positive correlation between serum leptin and CD4⁺/CD8⁺ in the RA group（P < 0.05）.Conclusion:In the six TCM syndrome types of RA,the abnormal increase of serum leptin level and CD4⁺/CD8⁺ can be used as the objective reference indexes of phlegm-stasis syndrome and damp-heat syndrome respectively.There is a positive correlation between serum leptin level and CD4⁺/CD8⁺ in RA patients,which suggests that there may be a certain relationship between leptin metabolism and cellular immunity.

　　【Keywords】 rheumatoid arthritis;leptin;CD4⁺/CD8⁺;TCM syndrome type