来源：风湿病与关节炎,2023,12（7）:15-19,31.

十全育真汤对早期活动性强直性脊柱炎患者外周血Th17/Treg细胞平衡的影响（临床研究）

吴　琪¹，秦桂福^2,3,4，郑　毅^2,3,4，宋　玉¹

　　【摘　要】目的：观察十全育真汤对早期活动性强直性脊柱炎患者疾病活动指标、Th17/Treg相关细胞因子、Th17/Treg细胞百分比，及相关基因RORC、FoxP3 mRNA表达的影响，初步从分子水平探讨十全育真汤治疗强直性脊柱炎的机制。方法：将60例强直性脊柱炎患者采用随机数字表法分为治疗组和对照组，每组30例。治疗组给予十全育真汤治疗，对照组给予柳氮磺吡啶肠溶片治疗。对2组患者治疗前后疾病活动指标、Th17/Treg相关细胞因子水平、Th17及Treg亚群占CD4⁺T细胞百分比、RORC和FoxP3mRNA基因表达进行统计分析。结果：治疗后，2组视觉模拟评分法（VAS）评分、Bath强直性脊柱炎活动指数（BASDAI）、Bath强直性脊柱炎功能指数（BASFI）、Bath强直性脊柱炎总体指数（BAS-G）、红细胞沉降率（ESR）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-8、IL-17均明显降低，转化生长因子-β（TGF-β）、IL-10水平均显著升高（P < 0.05或P < 0.01）；除BASDAI外，治疗组上述指标均优于对照组（P < 0.05或P < 0.01）。治疗后，2组Th17亚群CD4⁺CD45RO⁺CCR6⁺细胞百分比均明显降低，治疗组Treg亚群CD4⁺CD25⁺FoxP3⁺细胞百分比明显升高（P < 0.05或P < 0.01）；且治疗组均优于对照组（P < 0.05或P < 0.01）。治疗后，2组RORC mRNA表达显著下降，FoxP3 mRNA表达显著升高（P < 0.05或P < 0.01）；且治疗组优于对照组（P < 0.05或P < 0.01）。结论：十全育真汤可显著控制早期活动性强直性脊柱炎炎症，减轻临床症状，其机制可能与抑制促炎因子（TNF-α、IL-6、IL-8、IL-17）表达，促进抑炎因子（TGF-β、IL-10）释放，通过抑制RORC基因表达，促进FoxP3基因表达，调整Th17/Treg细胞数量，纠正Th17/Treg免疫失衡有关。

　　【关键词】　强直性脊柱炎；早期；活动性；十全育真汤；Th17/Treg细胞；免疫稳态调节

Effect of Shiquan Yuzhen Tang（十全育真汤）on Th17/Treg Cell Balance in Peripheral Blood of Patients with Early Active Ankylosing Spondylitis

WU Qi,QIN Gui-fu,ZHENG Yi,SONG Yu

　　【ABSTRACT】Objective:To observe the effect of Shiquan Yuzhen Tang（十全育真汤）on disease activity indicators,Th17/Treg related cytokines,Th17/Treg cell percentage,and expression of related genes RORC and FoxP3 mRNA in patients with early active ankylosing spondylitis,and preliminary explore the mechanism of Shiquan Yuzhen Tang in treating ankylosing spondylitis at the molecular level.Methods:Sixty patients with ankylosing spondylitis were randomly divided into a treatment group and a control group,with 30 cases in each group.The treatment group was treated with Shiquan Yuzhen Tang,while the control group was treated with sulfasalazine enteric coated tablets.Statistical analysis was conducted on disease activity indicators,levels of Th17/Treg related cytokines,percentage of Th17 and Treg subsets in CD4⁺ T cells,and expre-ssion of RORC and FoxP3 mRNA genes before and after treatment in both groups.Results:After treatment,VAS,BASDAI,BASFI,BAS-G,ESR,CRP,TNF- α,IL-6,IL-8,IL-17 were significantly reduced,and TGF-β and the levels of IL-10 significantly increased（P < 0.05 or P < 0.01）.Except BASDAI,the above indicators in the treatment group were better than those in the control group（P < 0.05 or P < 0.01）.After treatment,the percentage of CD4⁺CD45RO⁺CCR6⁺ in the Th17 subgroup decreased significantly in both groups,while the percentage of CD4⁺CD25⁺FoxP3⁺ in the Treg subgroup increased significantly in the treatment group（P < 0.05 or P < 0.01）;and the treatment group was better than the control group（P < 0.05 or P < 0.01）.After treatment,the expression of RORC mRNA decreased significantly in both groups,while the expression of FoxP3 mRNA increased significantly（P < 0.05 or P < 0.01）;and the treatment group was superior to the control group（P < 0.05 or P < 0.01）.Conclusion:Shiquan Yuzhen Tang can significantly control the inflammation of early active ankylosing spondylitis and alleviate clinical symptoms,and its mechanism may be related to the inhibition of inflammatory factors（TNF-α,IL-6,IL-8,IL-17）expression,promoting the release of anti-inflammatory factors TGF-β and IL-10,promoting FoxP3 gene expression by inhibiting RORC gene expression,adjusting Th17/Treg cell count,and correcting Th17/Treg immune imbalance.

　　【Keywords】 ankylosing spondylitis;early;activity;Shiquan Yuzhen Tang（十全育真汤）;Th17/Treg cells;immune homeostasis regulation