卡介菌多糖核酸对特应性皮炎患者外周血T淋巴细胞表达细胞因子的影响

Effect of bacille calmette-guerin polysaccharide nucleic acid （BCG-PSN） on the expression of T cell- derived cytokines in patients with atopic dermatitis

目的 探讨卡介菌多糖核酸治疗前后特应性皮炎（AD）患者外周血表达不同细胞因子的T淋巴细胞频数及其与疾病严重程度的相关性.方法 以双盲、随机、交叉对照方法治疗AD患者,应用流式细胞术检测治疗前后8例AD患者外周血T淋巴细胞内细胞因子IL-4、IL-5、IFN-γ、TNF-α的表达;利用AD皮损面积严重度指数积分（ADASIS）评价AD患者病情严重程度.结果 治疗组IFN-γ＋CD8＋T淋巴细胞频数差值为（8.06±13.96）%,较之安慰剂组（-6.55±10.49）%明显升高（U=2.26,P＜0.05）,表达其他细胞因子的T细胞频数在两组间差异无统计学意义（P＞0.05）.治疗组ADASIS积分下降值为1.56±1.49,高于安慰剂组（-0.05±1.54）,U=2.00,P＜0.05.结论 卡介菌多糖核酸可能通过纠正T淋巴细胞亚群的免疫失衡状态治疗AD.

Objective To assess the changes in frequency of peripheral T lymphocytes expressing different cytokines in patients with atopic dermatitis （AD） before and after treatment with BCG-PSN and their relationship with disease severity. Methods A randomized, double blinded and placebo cross-over control study was conducted. A total of 8 patients with AD were recruited in this study. Intramuscular BCG-PSN or placebo was given to patients every other day for 36 days. Flow cytometry was performed to measure the frequency of IL4-, IL5-, IFN-γ- and TNFα-expressing peripheral CD4＋ T cells and CD8＋ T cells before and after the therapy. Disease severity was evaluated by atopic dermatitis area and severity index score （ADASIS）. Results The difference value in IFN-γ＋CD8＋ T cell frequency before and after therapy was significantly higher in patients treated with BCG-PSN than in those with placebo （8.056 ± 13.962 vs -6.549 ± 10.491, U = 2.26, P〈 0.05）. There was no statistical difference in the frequency of IL4-, IL5-, TNFa-expressing CD8＋ T cells between BCG-PSN- and placebo-treated patients （all P 〉 0.05）. The decrease in ADASIS was 1.56 ± 1.49 in patients treated with BCG-PSN, which was statistically higher than that in placebo-treated patients （-0.05 ± 1.54, U = 2.00, P〈 0.05）. Conclusion As an immunomodulator, BCG-PSN may control AD by restoring the balance of T-cell subsets.