宁动颗粒对抽动―秽语综合征患儿IL-12、TNF-α的影响

Effect of Ningdong Granule on the Levels of IL-12 and TNF-αin Children Patients with Tourette′s Syndrome

目的观察宁动颗粒对抽动―秽语综合征（Tourette′s syndrome，TS）患儿血清白细胞介素-12（IL-12）、肿瘤坏死因子-α （TNF-α）水平的影响。方法将90例TS患儿随机分为宁动颗粒组、硫必利组、宁动颗粒联合硫必利治疗组（联合治疗组），并以同期30名正常健康儿童作为健康对照组。宁动颗粒组予以宁动颗粒（组成：天麻、党参、麦冬、白芍、龙骨、牡蛎、地龙、甘草等），每日1剂，分早晚2次开水冲服；硫必利组予以硫必利片口服，开始剂量为50~100 mg/d，每天2次，根据个体差异及病情变化调整剂量，最大剂量300 mg/d；联合治疗组予以同等剂量的宁动颗粒与硫必利合用。疗程均为3个月。通过美国耶鲁综合抽动严重程度量表（Yale global tic severity scale，YGTSS）评估其治疗前后的病情变化，采用酶联免疫吸附法（enzyme-labeled immunosorbent assay， ELISA）检测血清细胞因子IL-12和TNF-α水平。结果（1）宁动颗粒组、联合治疗组及硫必利组总有效率分别为79.3%、83.3%、67.9%，宁动颗粒组及联合治疗组明显高于硫必利组（P〈0.05），且联合治疗组明显高于宁动颗粒组（P〈0.05）。（2）各组治疗后YGTSS评分较治疗前明显降低（P〈0.05）；治疗后宁动颗粒组与联合治疗组YGTSS评分均低于硫必利组（P〈0.05），但两组间比较差异无统计学意义（P〉0.05）。（3）宁动颗粒组、硫必利组及联合治疗组患儿治疗前血清IL-12、TNF-α分别为（124.95±22.78，209.52±21.69）、（123.00±24.26，205.10±26.16）和（126.14±25.65，208.97±22.46），与健康对照组（64.56±27.59，78.13±33.42）比较显著升高，差异有统计学意义 （P〈0.05）；治疗后宁动颗粒组与联合治疗组血清IL-12、TNF-α分别为（104.67±16.84，183.01±24.95）、（109.04±16.81，179.87±23.45），均较治疗前明显降低，差异有统计学意义（P〈0.05）；而硫必利组治疗前后血清IL-12、TNF-α水平变化不明显。结论宁动颗粒能够调节TS患儿异常的血清IL-12及TNF-α水平，这可能是其治疗TS的药效学机制之一。

Objective To observe the effect of Ningdong Granule （NG） on serum levels of inter- leukin-12 （IL-12） and tumor necrosis factor-α （TNF-α） of children patients with Tourette＇s syndrome （TS）. Methods Totally 90 TS children patients were randomly assigned to the NG group, the NG ＋ Tiapride group （abbreviated as the combined treatment group）, and the Tiapride group, 30 in each group. Besides ,another 30 healthy children were recruited as the healthy control group. Patients in the NG group were treated with NG （consisting of all gastrodia rhizome, Codonopsis pilosula, Ophiopogon japonicus, white peony root, Fthinocerotidae, oyster, earthworm, licorice root, etc.）, one dose daily, administered by dissolving it in boiled water, taken in two portions in the morning and in the evening respectively. Pa- tients in the Tiapride group took Tiapride Tablet, 50 -100 mg each time, twice daily. The dosage was adjusted according to individual difference and changes of pathogenic conditions. The maximal dosage was 300 mg per day. Those in the combined treatment group were treated with equal dose of NG and Tiapride Tablet in combination. The treatment course was 3 months for all. Changes of pathogenic conditons before and after treatment were assessed by Yale global tic severity scale （YGTSS）. Serum levels of IL-12 and TNF-（ were detected by enzyme-labeled immunosorbent assay （ELISA） before and after treatment. Results （1） The total effective rate of the NG group, the combined treatment group, and the Tiapride group was 79.3%, 83.3%, and 67.9%, respectively. It was the lowest in the Tiapride group （P 〈0.05）. It was significantly higher in the combined treatment group than in the NG group （P 〈0.05）. （2） The post-treatment YGTSS score was obviosly lower in each group after treatment than before treatment （P 〈0.05）. The post- treatment YGTSS score was obviosly lower in the NG group and the combined treatment group than in the Tiapride group （P 〈0.05）, but with no statistical difference between the fromer two groups （P 〉0.05）.（3） Compared with the healthy control group before treatment, serum levels of IL-12 and TNF-α （pg/mL） were 124.95 ±22.78 and 209.52 ±21.69 in the NG group, 126. 14 ±25.65 and 208.97 ±22.46 in the combined treatment group, 123.00 ±24.26 and 205.10 ~26.16 in the Tiapride group, being higher than those in the healthy control group （64.56 ±27.59 and 78.13 ±33.42 ; P 〈0.05）. After treatment, serum levels of of IL- 12 and TNF-α were 104.67 ±16.84 and 183.01 ±24.95 in the NG group, 109.04 ±16.81 and 179.87 ±23.45 in the combined treatment group, significantly lower than before treatment （P 〈0.05）. But there was no statis- tical difference in serum levels of IL-12 or TNF-α in the Tiapride group between before treatment （123.00 ± 24.26 and 205. 10 ±26. 16） and after treatment （117.75 ±16.79 and 199.76 ±33.21 ; P 〉0.05）. Conclusion NG could modulate abnormal serum levels of IL- 12 and TNF-oL in TS children patients, which might be one of its pharmacodynamic mechanisms for treating TS.