麻黄连翘赤小豆汤加减对肺经郁热型变应性鼻炎Th1/Th2,Th17和Treg细胞因子的影响

Effect of Mahuang Lianqiao Chixiaodou Tang on Thl / Th2,Th17 and Treg Levels in Patients with Allergic Rhinitis( Stagnated Heat Type)

目的:探讨麻黄连翘赤小豆汤加减治疗变应性鼻炎(AR)的临床疗效和对患者血清γ-干扰素(IFN-γ),白细胞介素-2(IL-2),白细胞介素-4(IL-4),白细胞介素-5(IL-5),白细胞介素-17(IL-17),白细胞介素-10(IL-10)和血清总Ig E(TIg E)水平的影响。方法:125例AR肺经郁热型患者随机按数字表法分为对照组62例和观察组63例,并设20例健康。对照组采用布地奈德气雾剂,200~1 600μg·d^(-1),分成2~4次使用;观察组采用麻黄连翘赤小豆汤加减内服,10 g/次,2次/d。两组疗程均为7 d。检测治疗前后IFN-γ,IL-2,IL-4,IL-5,IL-17,IL-10和TIg E水平;采用视觉模拟量表(VAS)对治疗前后鼻塞、鼻痒、喷嚏、流涕4个症状和总体症状进行评分。结果:治疗后观察组临床愈显率为80.95%,对照组为61.29%,经卡方检验观察组高于对照组(P<0.05);观察组和对照组临床总有效率分别为95.24%和91.94%,经卡方检验差异无统计学意义;治疗后观察组鼻塞、鼻痒和喷嚏评分低于对照组(P<0.05);与健康对照组比较,治疗前两组血清IFN-γ,IL-2和IL-10水平均低于健康对照组(P<0.01),IL-4,IL-5,IL-17和TIg E水平则比健康对照组高(P<0.01);与治疗前比较,两组治疗后血清IL-2,IL-10均显著升高(P<0.01),IL-5,IL-17和TIg E水平均明显下降(P<0.01),两组IFN-γ变化无统计学意义;与对照组比较,治疗后观察组血清IL-2,IL-10水平均高于对照组,IL-5,IL-17和TIg E水平均低于对照组(P<0.01);治疗后两组间IFN-γ和IL-4水平差异无统计学意义;治疗后两组IFN-γ,IL-2和IL-10水平仍然低于健康对照组(P<0.01),而IL-4,IL-5,IL-17和TIg E水平仍然高于健康对照组(P<0.01)。结论:麻黄连翘赤小豆汤加减对AR患者的Th1/Th2,Th17,Treg细胞因子均有一定的调节作用,促使其恢复平衡,减轻炎症反应,治疗AR临床疗效优于布地奈德气雾剂。

Objective： To discuss the clinical efficacy of Mahuang Lianqiao Chixiaodou Tang for allergic rhinitis（ AR） and investigate its effect on interferon-γ（ IFN-γ）,interleukin-2（ IL-2）,interleukin-4（ IL-4）,interleukin-5（ IL-5）,interleukin^-17（ IL^-17）,interleukin^-10（ IL^-10） and total Ig E（ TIg E） levels in serum of the patients. Method： One hundred and twenty-five patients with AR were randomly divided into control group（ 62 cases） and observation group（ 63 cases） by random number table,and another 20 cases were used as healthy control group. Patients in control group received budesonide aerosol,200-1 600 μg / day in 2-4 times. Patients in observation group orally took Mahuang Lianqiao Chixiaodou Tang,10 g / time,2 times / day. The treatment course was 7 days for both groups. Before and after treatment,levels of IFN-γ,IL-2,IL-4,IL-5,IL^-17,IL^-10 and TIg E levels were detected. Scores of nasal obstruction,rhinocnesmus,sternutation and rhinorrhoea as well as the overall symptoms were graded by visual analogue scale（ VAS） both before and after treatment. Result： The clinical cure rate was 80. 95% in the observation group,higher than 61. 29% in the control group according to chi square test（ P〈0. 05）. Total clinical effective rate was 95. 24% and 91. 94% respectively in observation group and control group,and there was no statistically significant difference between two groups according to chi square test. After treatment,the scores of nasal obstruction,rhinocnesmus and sternutation in observation group were lower than those in control group（ P〈0. 05）. Levels of IFN-γ,IL-2 and IL^-10 in serum of two treatment groups were lower than those in healthy control group（ P〈0. 01）,while the levels of IL-4,IL-5,IL^-17 and TIg E were higher than those in healthy control group（ P〈0. 01）. As compared with the data before treatment,the levels of IL-2 and IL^-10 in serum were significantly increased in both groups（ P〈0. 01）,while the levels of IL-5,IL^-17 and TIg E were significantly decreased（ P〈0. 01）. There was no statistically significant difference in IFN-γ level change in both groups. After treatment,the levels of IL-2 and IL^-10 in serum of observation group were higher than those in control group,while the levels of IL-5,IL^-17 and TIg E were lower than those in control group（ P〈0. 01）. There was no statistically significant difference in IFN-γ and IL-4 between two groups after treatment. The levels of IFN-γ,IL-2 and IL^-10 in the two treatment groups were still lower than those in healthy control group after treatment（ P〈0. 01）,while the levels of IL-4,IL-5,IL^-17 and TIg E were still higher than those in healthy control group（ P〈0. 01）. Conclusion： Mahuang Lianqiao Chixiaodou Tang can regulate the Th1 / Th2,Th17 and Treg levels in patients with allergic rhinitis,promote the recovery of balance and relieve inflammatory response,and its clinical efficacy was superior to budesonide aerosol for allergic rhinitis.