中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2014年
4期
255-259
,共5页
王忠永%邱会芬%张建明%高昱%张玉杰
王忠永%邱會芬%張建明%高昱%張玉傑
왕충영%구회분%장건명%고욱%장옥걸
银屑病%窄谱中波紫外线%Th17细胞%调节性T细胞%白介素-6
銀屑病%窄譜中波紫外線%Th17細胞%調節性T細胞%白介素-6
은설병%착보중파자외선%Th17세포%조절성T세포%백개소-6
Psoriasis%Ultraviolet B%Th17 cells%Regulatory T cells%Interleukin-6
目的 探讨窄谱中波紫外线(NB-UVB)治疗寻常型银屑病患者外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)和转化生长因子β1(TGF-β1)、白介素-6(IL-6)的变化及其效果.方法 选择进行期和稳定期寻常型银屑病患者各45例(共90例)作为病例组,接受NB-UVB照射治疗,共治疗8周;另选健康体检者50例作为健康对照组.采用流式细胞术检测各组治疗前后外周血Th17细胞和Treg细胞百分比,采用酶联免疫吸附法(ELISA)检测各组治疗前和治疗8周后(治疗后)血清中TGF-β1和IL-6的含量,并进行统计学分析比较;采用银屑病面积和严重程度(PASI)评分对病例组患者皮损处的红斑、浸润、鳞屑的程度和面积进行加权评分,测定银屑病皮损面积和严重程度.结果 ①治疗前,与健康对照组比较,病例组进行期和稳定期银屑病患者外周血Th17细胞百分比[(5.09±1.26)％和(4.85±1.31)％]、Th17/Treg比值[(1.97±0.53)和(1.33±0.61)]及血清中IL-6水平[(190.11±18.76)和(177.92±20.27) ng/L]均较高(P＜0.01),而Treg百分比[(2.53±0.86)和(3.46±0.92)]及血清中TGF-β1[(432.94±50.35)和(419.01±42.13)ng/L]均较低(P＜0.01).经NB-UVB治疗8周后,病例组进行期和稳定期银屑病患者外周血Th17细胞百分比[(1.38±0.52)％和(1.34±0.61)％]、Th 17/Treg比值[(0.31±0.16)和(0.26±0.13)]及IL-6水平[(110.41±10.94)和(106.15±11.23)ng/L]均较组内治疗前有明显降低(P＜0.01),而Treg百分比[(4.46±1.51)％和(4.89±1.73)％]和血清TGF-β1含量[(542.23±51.17)和(520.16±55.62) ng/L]则较治疗前有明显升高(P＜0.01).②病例组90例寻常型银屑病患者均完成治疗,进行期和稳定期银屑病患者治疗后PASI评分[(4.11±2.97)和(4.25±3.16)分]较治疗前评分[(18.25±7.13)和(18.11±6.92)分]有明显下降(P＜0.01).经NB-UVB治疗后,寻常型银屑病患者的治疗总有效率达86.67％,其中病例组进行期患者有效率为88.89％,病例组稳定期患者为84.44％,NB-UVB治疗对进行期和稳定期患者之间有效率差异无统计学意义(P＞0.05).③病例组患者PASI评分与Th17细胞百分比、Th17/Treg比值、IL-6水平之间均呈正相关(P＜ 0.01);Treg细胞百分比、TGF-β1水平与疾病严重程度之间呈负相关(P＜0.01).Th17细胞、Treg细胞、Th17/Treg比值、IL-6、TGF-β1与疾病严重程度之间均无相关性(P＞0.05).结论 银屑病的发病及其病情的严重程度评分与外周血Th17细胞、IL-6水平的高表达及Treg细胞、TGF-β1水平的低表达有关;NB-UVB可改变患者外周血Th17/Treg细胞失衡比值及相关细胞因子的表达水平.
目的 探討窄譜中波紫外線(NB-UVB)治療尋常型銀屑病患者外週血輔助性T細胞17(Th17)/調節性T細胞(Treg)和轉化生長因子β1(TGF-β1)、白介素-6(IL-6)的變化及其效果.方法 選擇進行期和穩定期尋常型銀屑病患者各45例(共90例)作為病例組,接受NB-UVB照射治療,共治療8週;另選健康體檢者50例作為健康對照組.採用流式細胞術檢測各組治療前後外週血Th17細胞和Treg細胞百分比,採用酶聯免疫吸附法(ELISA)檢測各組治療前和治療8週後(治療後)血清中TGF-β1和IL-6的含量,併進行統計學分析比較;採用銀屑病麵積和嚴重程度(PASI)評分對病例組患者皮損處的紅斑、浸潤、鱗屑的程度和麵積進行加權評分,測定銀屑病皮損麵積和嚴重程度.結果 ①治療前,與健康對照組比較,病例組進行期和穩定期銀屑病患者外週血Th17細胞百分比[(5.09±1.26)％和(4.85±1.31)％]、Th17/Treg比值[(1.97±0.53)和(1.33±0.61)]及血清中IL-6水平[(190.11±18.76)和(177.92±20.27) ng/L]均較高(P＜0.01),而Treg百分比[(2.53±0.86)和(3.46±0.92)]及血清中TGF-β1[(432.94±50.35)和(419.01±42.13)ng/L]均較低(P＜0.01).經NB-UVB治療8週後,病例組進行期和穩定期銀屑病患者外週血Th17細胞百分比[(1.38±0.52)％和(1.34±0.61)％]、Th 17/Treg比值[(0.31±0.16)和(0.26±0.13)]及IL-6水平[(110.41±10.94)和(106.15±11.23)ng/L]均較組內治療前有明顯降低(P＜0.01),而Treg百分比[(4.46±1.51)％和(4.89±1.73)％]和血清TGF-β1含量[(542.23±51.17)和(520.16±55.62) ng/L]則較治療前有明顯升高(P＜0.01).②病例組90例尋常型銀屑病患者均完成治療,進行期和穩定期銀屑病患者治療後PASI評分[(4.11±2.97)和(4.25±3.16)分]較治療前評分[(18.25±7.13)和(18.11±6.92)分]有明顯下降(P＜0.01).經NB-UVB治療後,尋常型銀屑病患者的治療總有效率達86.67％,其中病例組進行期患者有效率為88.89％,病例組穩定期患者為84.44％,NB-UVB治療對進行期和穩定期患者之間有效率差異無統計學意義(P＞0.05).③病例組患者PASI評分與Th17細胞百分比、Th17/Treg比值、IL-6水平之間均呈正相關(P＜ 0.01);Treg細胞百分比、TGF-β1水平與疾病嚴重程度之間呈負相關(P＜0.01).Th17細胞、Treg細胞、Th17/Treg比值、IL-6、TGF-β1與疾病嚴重程度之間均無相關性(P＞0.05).結論 銀屑病的髮病及其病情的嚴重程度評分與外週血Th17細胞、IL-6水平的高錶達及Treg細胞、TGF-β1水平的低錶達有關;NB-UVB可改變患者外週血Th17/Treg細胞失衡比值及相關細胞因子的錶達水平.
목적 탐토착보중파자외선(NB-UVB)치료심상형은설병환자외주혈보조성T세포17(Th17)/조절성T세포(Treg)화전화생장인자β1(TGF-β1)、백개소-6(IL-6)적변화급기효과.방법 선택진행기화은정기심상형은설병환자각45례(공90례)작위병례조,접수NB-UVB조사치료,공치료8주;령선건강체검자50례작위건강대조조.채용류식세포술검측각조치료전후외주혈Th17세포화Treg세포백분비,채용매련면역흡부법(ELISA)검측각조치료전화치료8주후(치료후)혈청중TGF-β1화IL-6적함량,병진행통계학분석비교;채용은설병면적화엄중정도(PASI)평분대병례조환자피손처적홍반、침윤、린설적정도화면적진행가권평분,측정은설병피손면적화엄중정도.결과 ①치료전,여건강대조조비교,병례조진행기화은정기은설병환자외주혈Th17세포백분비[(5.09±1.26)％화(4.85±1.31)％]、Th17/Treg비치[(1.97±0.53)화(1.33±0.61)]급혈청중IL-6수평[(190.11±18.76)화(177.92±20.27) ng/L]균교고(P＜0.01),이Treg백분비[(2.53±0.86)화(3.46±0.92)]급혈청중TGF-β1[(432.94±50.35)화(419.01±42.13)ng/L]균교저(P＜0.01).경NB-UVB치료8주후,병례조진행기화은정기은설병환자외주혈Th17세포백분비[(1.38±0.52)％화(1.34±0.61)％]、Th 17/Treg비치[(0.31±0.16)화(0.26±0.13)]급IL-6수평[(110.41±10.94)화(106.15±11.23)ng/L]균교조내치료전유명현강저(P＜0.01),이Treg백분비[(4.46±1.51)％화(4.89±1.73)％]화혈청TGF-β1함량[(542.23±51.17)화(520.16±55.62) ng/L]칙교치료전유명현승고(P＜0.01).②병례조90례심상형은설병환자균완성치료,진행기화은정기은설병환자치료후PASI평분[(4.11±2.97)화(4.25±3.16)분]교치료전평분[(18.25±7.13)화(18.11±6.92)분]유명현하강(P＜0.01).경NB-UVB치료후,심상형은설병환자적치료총유효솔체86.67％,기중병례조진행기환자유효솔위88.89％,병례조은정기환자위84.44％,NB-UVB치료대진행기화은정기환자지간유효솔차이무통계학의의(P＞0.05).③병례조환자PASI평분여Th17세포백분비、Th17/Treg비치、IL-6수평지간균정정상관(P＜ 0.01);Treg세포백분비、TGF-β1수평여질병엄중정도지간정부상관(P＜0.01).Th17세포、Treg세포、Th17/Treg비치、IL-6、TGF-β1여질병엄중정도지간균무상관성(P＞0.05).결론 은설병적발병급기병정적엄중정도평분여외주혈Th17세포、IL-6수평적고표체급Treg세포、TGF-β1수평적저표체유관;NB-UVB가개변환자외주혈Th17/Treg세포실형비치급상관세포인자적표체수평.
Objective To study the impact of narrow band ultraviolet B (NB-UVB) irradiation on the expression of T helper 17 (Thl7) and CD4,CD25 and regulatory T (Treg) cells and their related cytokines transfor-ming growth factor beta 1 (TGF-β1) and interleukin-6 (IL-6) to further clarify how NB-UVB treatment helps patients with psoriasis vulgaris.Methods Ninety patients with active stage and stationary stage psoriasis vulgaris (45 cases each) were treated with NB-UVB for 8 weeks.Fifty healthy persons were used as normal controls.Peripheral blood levels of Th17 and Treg were measured by flow cytometry.An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of TGF-β1 and IL-6 before and after treatment.Clinical efficacy was evaluated in terms of the area of psoriasis and severity index (PASI) scores.Restlts Before treatment,the patients showed significantly higher levels of Thl7 cells in their peripheral blood than the controls.Their ratios of Th17 to Treg cells and their serum levels of IL-6 were also significantly higher.The percentage of Treg cells and the serum level of TGF-β1 were significantly lower in the patients.After the NB-UVB treatment,the Th17 cells,the ratio of Th17 to Treg cells and IL-6 had all decreased significantly.The percentage of Treg cells and TGF-β1 levels were significantly high-er compared with before phototherapy.The total effectiveness rate was 86.7％,and the average PASI scores had de-creased significantly.The PASI scores were positively correlated with the percentage of Th17,the Th17 to Treg ratio,and the serum level of IL-6,and negatively correlated with the percentage of Treg cells and TGF-β1.Conclusion The imbalance between Th17 and Treg cells and their cytokines may play an important role in the pathogenesis of pso-riasis.NB-UVB is able to significantly down-regulate the levels of Th17,IL-6 and the progression of Treg levels and TGF-β1 expression.It can regulate the balance between Thl7and Treg cells,which may be one of the mechanisms of NB-UVB treatment for psoriasis.The clinical data demonstrate that NB-UVB treatment is a safe and effective therapy for psoriasis vulgaris.
