活动期溃疡性结肠炎患者Th1/Th2平衡的特点与药物调节

Unbalance of Th1/Th2 in actie ulcerative colitis patients and its medicine regulation

目的:探讨活动期溃疡性结肠炎(AUC)患者外周血及肠黏膜Th1/Th2免疫系统平衡的特点及药物调节效果。方法:38例AUC患者分为观察组(n=20)与对照组(n=18),观察组给予美沙拉嗪口服联合锡类散灌肠,对照组给予美沙拉嗪联合甲硝唑灌肠。观察比较患者治疗前、后的临床表现;血白细胞计数(WBC)、C-反应蛋白(CRP)及血沉(ESR)的变化;采用酶联免疫吸附试验(ELISA)检测并比较患者外周血及肠黏膜干扰素γ(IFN-γ,反映Th1细胞功能)、白介素4(IL-4,反映Th2细胞功能)的含量。结果:两组治疗后患者腹泻次数明显减少,且观察组较对照组明显减少(P<0.05)。治疗后WBC、CRP及ESR明显降低,且治疗后观察组的CRP水平低于对照组(P<0.05)。治疗前患者外周血及肠黏膜的IFN-γ升高,而IL-4降低;治疗后IFN-γ降低且IL-4升高,以上改变程度以观察组较对照组明显(P<0.05);相关性分析显示IFN-γ与IL-4呈显著负相关(相关系数C=-0.89,P=0.002)。结论:Th1/Th2失衡是AUC的重要免疫学特点,表现为倾向于Th1细胞;中成药锡类散的临床及免疫调节疗效均优于甲硝唑,提示锡类散可能是通过调节Th1/Th2平衡从而发挥治疗AUC的作用。

Objective：To investigate the immunological balance feature and the therapeutic effect of actie ulcerative colitis（AUC）.Methods：Thirty-eight subjects were randomely divided into the observation group（n=20）and the control group（n=18）.Patinets in observation group were given by oral administration of mesalazine and enama by Xileisan pulvis,while control group were treated by oral administration of mesalazine and enama by metronidazole.The clinical manifestation,white blood cell count（WBC）,C-reaction protein（CRP）and erythrocyte sedimentation rate（ESR）were observed before and after therapy.Moreover,interferon-γ（IFN-γ）and interleukin 4（IL-4）in both blood and intestinal mucosa were detected by ELISA.Results：Frequency of diarrhea decreased in both groups and the observation group was more significantly that of the control ones（P〈0.05）.WBC,CRP and ESR decreased after therapy,and were also with significantly lower level in the observation group（P〈0.05）.It was found that IFN-γincreased as IL-4 decreased before therapy,and the adverse phenomenon occurred after therapy.The changes in observation group were more significant（P〈0.05）.Pearson correlation analysis indicated that there was a significant negative relation between IFN-γ and IL-4（C=-0.89,P=0.002）.Conclusion：Unbalance of Th1/Th2,especially the drifting to Th1 is the principal factor for AUC.Xileisan pulvis could bring better immunoregulation effect than metronidazole,demonstrating Th1/Th2 balance maybe the target of the Chinese patent drug.