祛痰化瘀解毒方药对高脂血症痰瘀互阻证患者单核细胞亚群异常的影响

Impact of Qutan Huayu Jiedu Herbs on Monocyte Subpopulations Abnormality in Patients with Hyperlipidemia of Phlegm-Stagnancy Obstruction Syndrome Pattern

目的研究高脂血症痰瘀互阻证患者外周血单核细胞亚群比例及其表面受体TLR4、CD163和CD36表达变化,初步探讨和评价祛痰化瘀解毒方药干预的治疗效果。方法采用流式细胞仪将单核细胞分为CD14highCD16-(Mo1)、CD14highCD16+(Mo2a)和CD14lowCD16+(Mo2b)3个亚群。检测83例高脂血症痰瘀互阻证患者和42名同龄健康对照者外周血单核细胞亚群比例及其表面TLR4、CD163和CD36的表达水平。对其中11例接受祛痰化瘀治疗(对照组)和10例在祛痰化瘀基础上加用解毒治疗(治疗组)的患者,比较治疗前后外周血单核细胞亚群比例及其表面TLR4、CD163和CD36的表达变化。结果患者外周血单核细胞Mo2a亚群比例较正常对照显著升高(5.35±2.57vs3.09±2.38,P<0.01)。Mo1亚群TLR4受体的表达较健康组降低(50.73±24.45vs69.92±21.06,P<0.01),其余亚群差异无统计学意义。经过4周治疗,治疗组患者Mo2a亚群细胞比例明显地降低(疗后/疗前3.73±1.05vs5.50±2.06,P=0.043;对照组疗后/疗前4.20±1.81vs5.65±1.89,P=0.097)。两干预组对TLR4、CD36、CD163的表达影响差异无统计学意义。结论高脂血症痰瘀互阻证患者外周血单核细胞Mo2a亚群比例及Mo1表面受体TLR4的表达具有特征性改变,可能与高脂血症导致的免疫损伤有关;祛痰化瘀解毒方药能较好地改善Mo2a亚群比例失调。

Objective To investigate the distribution of monocyte subpopulations and the changes of Toll-like receptor 4 （TLR4）,CD163 and CD36 expressions in the peripheral blood of patients with hyperlipidemia of phlegm-stagnancy obstruction syndrome pattern （HLE-PSO）,and to evaluate the intervening effects of Qutan Huayu Jiedu （QHJ） herbs on these parameters. Methods Monocytes in the peripheral blood were sorted using flow cytometry into 3 subpopulations：the CD14high CD16-（Mo1）,the CD14high CD16＋ （Mo2a） and the CD14low CD16＋ （Mo2b） subpopulation. The percentages of various monocyte subpopulations in 83 patients and 42 matched healthy controls were determined and the levels of their surface receptors TLR4,CD163 and CD36 expressions were assayed with flow cytometer. Furthermore,patients allocated in the tested group （10 patients） and the control group （11 patients） were treated with QHJ Herbs and Qutan Huayu （QH,removing Phlegm and dissolving stagnancy but without detoxication） herbs respectively. The changes of monocyte subpopulations percentage and TLR4,CD163 and CD36 expressions were determined 4 weeks after they received treatment. Results Percentage of Mo2a subpopulation was significantly higher in HLE-PSO patients than the normal range （5.35±2.57 vs. 3.09±2.38,P0.01）,but the deviation of the other two subpopulations in percentage was insignificant. The TLR4 expression on Mo1 monocyte in patients was lower than normal （50.73±24.45 vs. 69.92±21.06,P0.01）,while CD163 and CD36 expressions of all three subpopulations in patients were similar to those in healthy persons respectively. After 4 weeks of treatment,a significant lowered Mo2a proportions were observed in the tested group （3.73±1.05 vs. 5.50±2.06,P=0.043）; but not in the control group （4.20±1.81 vs. 5.65±1.89,P=0.097）,while the levels of TLR4,CD163 and CD36 were not significantly altered after treatment in both groups. Conclusions The elevated proportions of Mo2a subpopulation and the lowered TLR4 expression in Mo1 subpopulation are the characteristic changes in HLE-PSO patients,which might be related with the hyperlipidemia caused immune injury in patients. QHJ herbs could effectively improve the disproportion of Mo2a subpopulation.