小柴胡汤改善慢性肾小球肾炎患者炎症及减轻蛋白尿的作用研究

The Research on Xiaochaihu Decoction Improving the Inflammation of Chronic Glomerulonephritis Patients and Relieving the Proteinuria

目的观察慢性肾小球肾炎少阳病患者辅助性T细胞的1型/2型(T help cell 1/2,Th1/Th2)平衡及相关前炎症细胞因子(IFN-γ,IL-4)、调节活化正常T细胞表达和分泌的细胞因子(regulated on activation normal T cell expressed and secreted,RANTES)变化和辅助性T细胞17型(T help cell 17,Th17)的效应因子IL-17的异常变化,揭示小柴胡汤和解少阳法治疗慢性肾小球肾炎蛋白尿的机理。方法 70例慢性肾小球肾炎少阳病患者随机分为小柴胡汤治疗组(治疗组)和肾炎康复片治疗的对照组(对照组),每组35例。并选择20名健康体检者作为健康对照组。治疗组与对照组均在慢性肾脏病(chronic kidney disease,CKD)常规治疗基础上,分别给予小柴胡汤与肾炎康复片治疗,疗程4周,比较各组中医证候、疾病疗效、24h尿蛋白定量、肾功能、外周血IFN-γ、IL-4、Th1/Th2、IL-17和RANTES的变化。结果治疗前,两组Th1/Th2、IL-17和RANTES均高于健康对照组(P<0.05),IL-4均低于健康对照组(P<0.05)。治疗后治疗组中医证候、主要症状和疾病疗效的改善程度明显优于对照组(P<0.05,P<0.01);治疗组24h尿蛋白定量明显减少,疗效优于对照组(P<0.05);治疗组Th1/Th2、IL-17和RANTES较对照组均有不同程度降低(P<0.05,P<0.01),治疗组IL-4较对照组明显升高(P<0.05),两组肾功能改善比较,差异无统计学意义(P>0.05)。结论慢性肾小球肾炎少阳病患者免疫紊乱与Th1/Th2细胞平衡失调、Th17细胞功能和RANTES的异常变化有关。小柴胡汤可以通过调节慢性肾小球肾炎少阳病患者机体免疫紊乱而改善炎症,证明和解少阳理论可以用于治疗慢性肾小球肾炎炎症,起到减轻蛋白尿的作用。

Objective To observe the balance of T help cell1/2 （Thl/Th2）, the changes oT corre lated proinflammatory cytokines （IFNy and IL4）, and regulated on activation normal T cell expressed and secreted （RANTES）, and the abnormal expression of IL17, the effector of T help cell17 （Th17）in chronic glomerulonephritis （CGN）patients with Shaoyang disease, thus revealing the mechanisms of Xi aochaihu Decoction （XD）for treating proteinuria of CGN patients according to the theory of mediating Shaoyang meridian. Methods Totally 70 CGN patients with Shaoyang disease were randomly assigned to two groups, the treatment group （treated by XD）and the control group ~treated by Shenyan Kangfu Tablet （SKT） l, 35 in each group. Besides, 20 healthy volunteers were recruited as the healthy control group. Be sides, routine therapy of chronic kidney disease （CKD）, patients in the treatment group and the control group were treated with XD and SKT respectively for 4 weeks. The changes of Chinese medical syndrome, the effectiveness, 24h urinary protein, renal functions, the peripheral blood IFN3,, IL4, Thl/Th2, IL17, and RANTES were compared. Results Before treatment the Thl/Th2, IL17, and RANTES of the two trea ted groups were higher, and the IL4 level was lower than those of the healthy control group （P 〈0.05）. Af ter treatment the improvement of Chinese medical syndrome, main symptoms, the effectiveness was bet ter in the XD group than in the SKT group （P 〈0.05, P 〈0.01 ）. The proteinuria obviously decreased in the treatment group, with the efficacy superior to the SKT group （P 〈0.05）. The Thl/Th2, IL17, and RANTES decreased to various degrees when compared with the SKT group （P 〈0.05, P 〈0.01 ）. The IL4 level in creased more obviously in the treatment group than in the control group （P 〈0.05）. There was no statisti cal difference in the improvement of the renal function （P 〉0.05）. Conclusions The immune disorder of the CGN patients with Shaoyang disease was correlated with Th1/Th2 imbalance, and abnormal changes of Th17 cell functions and RANTES. XD could improve the inflammation by regulating the immune disorder of CGN patients with Shaoyang disease, which proved that the theory of mediating Shaoyang meridian could be used to improve the inflammation of CGN patients, thus relieving the Droteinuria.