CAJ | 학술논문

目的：研究阿维A治疗寻常性银屑病前后患者外周血辅助性T细胞17（Th17）/调节性T细胞（Treg）和白介素-6（IL-6）、白介素-10（IL-10）的变化，探讨阿维A治疗银屑病的作用机制。方法92例中、重度寻常性银屑病患者采用口服阿维A治疗8周，以银屑病皮损面积和严重程度（PASI）评分评价疗效；采用流式细胞术检测正常对照组及银屑病患者治疗前后外周血Th17细胞和Treg细胞百分比，同时采取酶联免疫吸附法（ELISA）检测正常对照组及患者治疗前后血清 IL-6、IL-10的含量。选择60例健康查体者作为正常对照组。结果寻常性银屑病患者外周血 Th17细胞百分比及血清中 IL-6水平显著高于正常对照组，Th17/Treg比值也显著高于正常对照组，而Treg百分比及血清中IL-10水平显著低于正常对照组，差异均有统计学意义（P＜0.01）。而阿维A治疗后Th17百分比、Th17/Treg比值、IL-6水平明显降低，与治疗前相比差异有统计学意义（P＜0.01）；而Treg百分比、IL-10水平明显升高，与治疗前相比差异也有统计学意义（P＜0.01）。阿维A治疗后PASI评分明显下降，与治疗前比较差异有统计学意义（P＜0.01）。总有效率达80.43%。患者治疗前、后PASI评分与Th17细胞比例、Th17/Treg比值、IL-6水平呈正相关性，而与 Treg 细胞比例、IL-10呈负相关性（P 均＜0.01）。结论阿维 A 可能通过调节银屑病患者外周血Th17/Treg细胞失衡及相关细胞因子而发挥其治疗作用，这可能是阿维A治疗寻常性银屑病的机制之一。
목적：연구아유A치료심상성은설병전후환자외주혈보조성T세포17（Th17）/조절성T세포（Treg）화백개소-6（IL-6）、백개소-10（IL-10）적변화，탐토아유A치료은설병적작용궤제。방법92례중、중도심상성은설병환자채용구복아유A치료8주，이은설병피손면적화엄중정도（PASI）평분평개료효；채용류식세포술검측정상대조조급은설병환자치료전후외주혈Th17세포화Treg세포백분비，동시채취매련면역흡부법（ELISA）검측정상대조조급환자치료전후혈청 IL-6、IL-10적함량。선택60례건강사체자작위정상대조조。결과심상성은설병환자외주혈 Th17세포백분비급혈청중 IL-6수평현저고우정상대조조，Th17/Treg비치야현저고우정상대조조，이Treg백분비급혈청중IL-10수평현저저우정상대조조，차이균유통계학의의（P＜0.01）。이아유A치료후Th17백분비、Th17/Treg비치、IL-6수평명현강저，여치료전상비차이유통계학의의（P＜0.01）；이Treg백분비、IL-10수평명현승고，여치료전상비차이야유통계학의의（P＜0.01）。아유A치료후PASI평분명현하강，여치료전비교차이유통계학의의（P＜0.01）。총유효솔체80.43%。환자치료전、후PASI평분여Th17세포비례、Th17/Treg비치、IL-6수평정정상관성，이여 Treg 세포비례、IL-10정부상관성（P 균＜0.01）。결론아유 A 가능통과조절은설병환자외주혈Th17/Treg세포실형급상관세포인자이발휘기치료작용，저가능시아유A치료심상성은설병적궤제지일。
Objective To investigate the therapeutic effect of acitretin and its influence on the expression of Th17/Treg cells and related cytokines including interleukin-6(IL-6) and interleukin-10(IL-10) in peripheral blood of patients with psoriasis vulgaris, and to further clarify the therapeutic mechanisms of acitretin. Methods Ninety-two cases of patients with moderate to severe psoriasis vulgaris were treated with acitretin for 8 weeks. The efficacy of treatment was evaluated by Psoriasis Area and Severity Index (PASI)scores. Peripheral blood levels of Th17 and Treg cell percentage were measured by flow cytometry. Enzyme linked immunosorbent assay(ELISA) was used to measure the serum levels of IL-6 and IL-10 in 90 patients with psoriasis before and after treatment. Sixty healthy persons were used as normal controls. Results Compared with normal human controls, patients with psoriasis vulgaris showed higher level of Th17 cells in peripheral blood (P<0.01). The ratios of Th17 to Treg cells and serum IL-6 were significantly higher in the patients than those in the normal controls (P<0.01), the percentage of Treg cells and serum level of IL-10 were significantly lower between patients and controls(P<0.01). After treatment with acitretin, Th17 cells, ratios of Th17 to Treg cells and IL-6 were significantly decreased than before (P<0.01).The percentage of Treg cells and IL-10 were significantly higher compared with before treatment(P<0.01).The total effective rate was 80.43%, and the accumulated points of Psoriasis Area and Severity Index (PASI) scores were decreased significantly. The PASI score in patient was positively correlated with the percentage of Th17, Th17/Treg ratios, serum level of IL-6, and negatively correlated with the percentage of Treg cells and IL-10(P<0.01). Conclusion Acitretin may affect Th17/Treg and related cytokines to achieve its therapeutic effect on patients with psoriasis. which may be one of the mechanisms of the acitretin treatment in psoriasis.