中药辨证干预对慢性乙型肝炎肾虚患者树突状细胞功能影响

The function of dendritic cell in chronic hepatitis B patients with deficiency of kidney based on traditional chinese medicine syndrome differentiation intervention

目的研究中药辨证干预对慢性乙型肝炎(CHB)肾虚患者外周血树突状细胞(DC)功能的影响。方法 CHB肾虚证患者60例,健康对照组10例,分离各组外周血单个核细胞,体外诱导培养DC,流式细胞仪检测DC表面分子CD80、CD86、CD1a、HLA-DR表达率;酶联免疫吸附检测(ELISA)检测DC培养上清液中细胞因子IL-10表达水平,同时检测CHB患者血清HBV DNA定量并记录中医证候积分。予中药辨证干预治疗3个月,检测患者治疗后外周血DC表面分子CD80、CD86、CD1a、HLA-DR及培养上清中IL-10的表达水平及血清HBV DNA定量,并记录中医证候积分的变化。结果治疗前CHB肾虚证患者CD80、CD86、CD1a、HLA-DR表达率显著低于正常对照组(P<0.05),IL-10表达水平显著高于正常对照组(P<0.05);治疗后CHB肾虚证患者CD80、CD86、CD1a、HLA-DR表达率明显提高、IL-10表达水平明显降低(P<0.05),中医证候积分明显改善(P<0.05)。结论 CHB肾虚证患者存在DC成熟障碍及功能异常,主要表现为表面共刺激分子表达率下降,抑制因子表达率升高。中药辨证干预不仅能改善患者中医证候积分,同时能提高DC表面共刺激分子表达率,降低抑制因子表达率,提示DC可能与中医虚实病机存在一定相关性。

Objective To study the function of peripheral blood dendritic cell in chronic hepatitis B patients with deficiency of kidney based on TCM syndrome differentiation intervention therapy.Methods 60 CHB patients with kidney deficiency were included（treatment group）,and 10 healthy volunteers as control group.DC was isolated and cultured from peripheral blood collected from each group,the levels of the surface molecules CD80,CD86,CD1a,HLA-DR of DC were detected by FACS and the level of cytokine IL-10 in the culture supernatant were detected by ELISA.At the same time,we detected serum HBV DNA quantity and recorded the scores of TCM Syndrome of CHB patients.Patients were given TCM syndrome differentiation for three months.After treatment,the level of CD80,CD86,CD1a,HLA-DR of DC,the level of the cytokine IL-10 in the culture supernatant of DC,the serum HBV DNA quantity and the scores of TCM Syndrome of CHB patients were recorded again.Results Before treatment,the levels of CD80,CD86,CD1a,HLA-DR expression in the treatment group was lower than that of control group significantly（P 0.05）,and the expression level of IL-10 were significantly higher in the treatment group than that of the control group.After treatment,the levels of CD80,CD86,CD1a,HLA-DR expression were markedly improved and the level of IL-10 expression was significantly reduced（P 0.05）,and the scores of TCM Syndrome in the treatment group patients were improved significantly（P 0.05）.Conclusion The function of mature DC in CHB patients with kidney deficiency was abnormal,and the expression of surface co stimulatory molecules was decreased and the expression of inhibitory factor was increased in these patients.TCM syndrome differentiation not only improved the symptom score of patients,but also increased the DC expression of co-stimulatory molecules and reduced the inhibitory factor expression.It also prompted that there was some correlation between DC and asthenia and sthenia pathogenesis of TCM.