来源：风湿病与关节炎,2018,7（3）:23-27,53.

急性痛风性关节炎患者TLRs/MyD88的表达及其与中医证型关系的初探（临床研究）

刘　静¹，谢克琴²，曹跃鹏²，刘正奇²，邓志勇²，李　贺²，孙贵炎²，吕宁霁²，马武开²，钟　琴²

　　【摘　要】目的：研究急性痛风性关节炎患者外周血Toll样受体2（TLR2）、Toll样受体4（TLR4）、髓样分化因子88（MyD88）的表达及其与中医证型的关系，为中医学的辨证论治提供客观依据。方法：将66例急性痛风性关节炎患者根据中医辨证分型分为湿热蕴结型48例，痰浊阻滞型6例，瘀热阻滞型10例，肝肾阴虚型2例。同时随机选取健康体检者20例为健康对照组。检测C-反应蛋白（CRP）、红细胞沉降率（ESR）水平，通过ELISA检测外周血中TLR2、TLR4、MyD88的浓度；采用SPSS 22.0软件分析急性痛风性关节炎患者外周血TLR2、TLR4、MyD88与不同中医证型的关系。结果：①急性痛风性关节炎患者外周血TLR2、TLR4、MyD88浓度较健康对照组显著升高（P < 0.01）。②痛风性关节炎患者外周血TLR2与ESR、CRP呈正相关（P < 0.01）。③各中医证型的痛风性关节炎患者男性所占比例明显大于女性；在年龄方面，4个证型的痛风患者差异无统计学意义（P > 0.05）。④湿热蕴结型痛风性关节炎患者外周血ESR、CRP值明显高于其他3型，差异有统计学意义（P < 0.01）。⑤TLR2在各证型之间两两比较，差异有统计学意义（P < 0.01）。TLR4、MyD88在肝肾阴虚型与瘀热阻滞型之间比较，差异无统计学意义（P > 0.05）；其他各证型之间两两比较，差异有统计学意义（P < 0.05）。结论：TLR2、TLR4、MyD88可以反映痛风性关节炎的炎症轻重。湿热蕴结型痛风患者炎症反应更为活跃，与急性痛风性关节炎密切相关。

　　【关键词】　痛风性关节炎；中医证型；Toll样受体；髓样分化因子88；辨证论治

The Expression of TLRs/MyD88 in Patients with Acute Gouty Arthritis and Its Relationship with TCM Syndrome Pattern

LIU Jing,XIE Ke-qin,CAO Yue-peng,LIU Zheng-qi,DENG Zhi-yong,LI He,SUN Gui-yan,LYU Ning-ji,MA Wu-kai,ZHONG Qin

　　【ABSTRACT】Objective:To study the expressions of TLR2,TLR4 and MyD88 in peripheral blood of patients with acute gouty arthritis and their relationship with TCM syndrome patterns,so as to provide objective basis for TCM syndrome differentiation and treatment.Methods:Sixty cases of acute gouty arthritis,according to TCM syndrome,were divided into the damp-heat-accumulation syndrome pattern（48 cases）,the phlegm-turbidity-blockage syndrome pattern（6 cases）,the stasis-heat-accumulation syndrome pattern（10 cases）,and the liver-kidney-yin-deficiency syndrome pattern（2 cases）.At the same time,20 healthy subjects were randomly selected as the healthy control group.The levels of C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were detected.The concentrations of TLR2,TLR4 and MyD88 in peripheral blood were detected by ELISA.The relationships between TLR2,TLR4 and MyD88 in peripheral blood and different TCM syndromes were analyzed by software SPSS 22.0.Results:①The concentration of TLR2,TLR4 and MyD88 in the peripheral blood of patients with acute gouty arthritis was significantly higher than that in the healthy control group（P < 0.01）.②There was a positive correlation between TLR2 and ESR and CRP in patients with gouty arthritis（P < 0.01）;③The proportion of men with gouty arthritis in all TCM syndrome patterns was significantly larger than that in women.In terms of age,there was no statistically significant difference in four syndrome patterns（P > 0.05）.④ESR and CRP values in peripheral blood of the damp-heat-accumulation syndrome pattern was significantly higher than that in the other three syndrome patterns,and the difference was statistically significant（P < 0.01）.⑤The difference was statistically significant（P < 0.01）between each two syndrome patterns.There was no significant difference of TLR4 and MyD88 between the liver-kidney-yin-deficiency syndrome pattern and the stasis-heat-accumulation syndrome pattern（P > 0.05）.There was a significant difference between each two syndrome patterns（P < 0.05）.Conclusion:TLR2,TLR4 and MyD88 can reflect the severity of gouty arthritis.Inflammation in the stasis-heat-accumulation syndrome pattern is more active and closely related to acute gouty arthritis.

　　【Keywords】 gouty arthritis;TCM syndrome pattern;TLRs;MyD88;syndrome differentiation and treatment