NB-UVB治疗前后特应性皮炎患者外周血Th17/Treg细胞及其转录因子的变化

The Change of Th17/Treg Cells and Related Transcription Factors with Atopic Dermatitis in Pretherapy and Posttreatment of Narrow-band Ultraviolet B(NB-UVB)

目的观察窄谱中波紫外线(NB-UVB)对特应性皮炎(AD)患者外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)和转录因子RORγt,Foxp3 mRNA水平的影响,探讨NB-UVB治疗AD的作用机制。方法选取52例AD患者,使用NB-UVB照射治疗8周,采用流式细胞术检测光疗前后外周血Th17细胞和Treg细胞百分比,应用实时荧光定量逆转录聚合酶链反应(QRT-PCR)方法,检测光疗前后外周血单一核细胞中转录因子RORγt和Foxp3 mRNA的表达水平。采用欧洲AD评分标准(SCORAD)判断疾病严重程度。另选35例健康体检者作为正常对照组。结果治疗前,AD患者外周血Th17细胞百分比、Th17/Treg比值及RORγt mRNA水平高于正常对照组,而Treg百分比及Foxp3 mRNA的表达低于正常对照组,差异均有统计学意义(P<0.01)。治疗后,Th17百分比、Th17/Treg比值及RORγt mRNA水平明显降低,与治疗前相比差异有统计学意义(P<0.01);而Treg百分比及Foxp3 mRNA的水平明显升高,与治疗前相比差异也有统计学意义(P<0.01)。经NB-UVB治疗8周后,SCORAD评分明显下降(P<0.01)。结论 AD的发生及病情严重程度与外周血Th17细胞、RORγt mRNA水平的高表达及Treg细胞、Foxp3 mRNA水平的低表达有关;NB-UVB可能通过调节患者外周血Th17/Treg细胞失衡及其特异性转录因子表达水平而发挥其治疗作用,这可能是NB-UVB治疗AD的机制之一。NB-UVB治疗AD安全有效。

Objective To observe the impact of NB-UVB treatment on the expression of T helper 17（Th17）/ regulatory T（Treg）cells and related transcription factors including retinoid-related orphan receptor gammat（RORγt）and forkhead/winged helix transcription factor 3（Foxp3）,to further clarity the mechanism of NB-UVB treatment in patients with atopic dermatitis（AD）,as well as to investigate the clinical efficacy of the NB-UVB in the treatment of AD. Methods Fifty-two patients were recruited and treated with NB-UVB therapy for 8 weeks. Peripheral blood levels of Th17 and Treg cell percentage were measured by flow cytometry. The mRNA levels of RORγt and Foxp3 in PBMC were determined by quantitative real-time PCR（QRT-PCR）in healthy controls and patients. Clinical efficacy was evaluated by scoring atopic dermatitis（SCORAD）. Thirty-five healthy persons were used as normal controls. Results Before treatment,the patient showed significantly higher levels of Th17 cells in their peripheral blood than the controls（P〈0.01）.The ratios of Th17 to Treg cells and level of RORγt were also significantly higher（P〈0.01）.The percentage of Treg cells and level of Foxp3 were significantly lower in the patients（P〈0.01）. After the NB-UVB treatment, the Th17 cells, the ratios of Th17 to Treg cells and RORγt were decreased significantly（P〈0.01）.The percentage of Treg cells and Foxp3 levels were significantly higher compared with before phototherapy（P〈0.01）. After 8 weeks of treatment with NB-UVB,SCORAD index was decreased significantly（P〈0.01）.The total effective rate was 88.46%. Conclusion The changes in the expression levels of Th17/Treg cells and related transcription factors may play an important role in the pathogenesis of AD. NB-UVB is able to significant down-regulate the levels of Th17,RORγt and the progression of Treg and Foxp3 expression.It can regulate the imbalance of the Th17/Treg cells, which may be one of the mechanisms of the NB-UVB treatment in AD. The clinical data demonstrate that NB-UVB treatment is a safe and effective therapy for AD.