三参饮通过IL-23、IL-17及TGF-β-Smad通路对病毒性心肌炎的干预作用

Intervention Effect of San Shen Decoction on Viral Myocarditis by IL-23,IL-17 and TGF-β-Smad Pathway

目的:探讨三参饮通过白细胞介素-23(interleukin-23,IL-23)、白细胞介素-17(interleukin-17,IL-17)及转化生长因子-β信号通路(transforming growth factor-β,TGF-β-Smad)对病毒性心肌炎干预作用。方法:90例病毒性心肌炎患者随机分对照组和观察组各45例。对照组给予临床常规治疗;观察组在对照组治疗基础上给予三参饮。比较两组患者治疗前后血清IL-23、IL-17、TGFβ1基因表达、信号传导蛋白(drosophila mothers against decapentaplegic2/3,Smad2/3)、Smad7蛋白(drosophila mothers against decapentaplegic7)表达,T淋巴细胞亚群、左心室功能变化和心肌酶谱水平及临床疗效。结果:与治疗前比较,治疗后两组患者的Smad7蛋白、每搏输出量(stroke volume variation,SV)、左心室射血分数(ejection fraction,EF)、CD_3^+、CD_4^+、CD_4^+/CD_8^+水平升高,IL-23、IL-17、TGF-β1、Smad2/3蛋白、CD_8^+、肌酸激酶(Creatine Kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)水平均较治疗前明显减低平降低;与对照组比较,观察组患者治疗后Smad7蛋白、SV、EF、CD_3^+、CD_4^+、CD_4·+/CD_8^+水平高于对照组,IL-23、IL-17、TGF-β1、Smad2/3蛋白、CD_8^+、CK、CK-MB水平低于对照组;观察组患者的有效率(95.56%)明显高于对照组(80.00%),无效率(4.44%)明显低于对照组(20.00%),差异均有统计学意义(P<0.05)。结论:三参饮可以通过IL-23、IL-17和TGF-β-Smad通道,作用于病毒性心肌炎患者,并能有效提高免疫功能和心脏功能,且具有较好的临床疗效。

Objective： To investigate the intervention effect of San Shen Decoction on viral myocarditis by interleukin-23,interleukin-17 and transforming growth factor-β Smad pathway. Methods： 90 cases with viral myocarditis were randomly divided into two groups. The control group was treated with routine clinical treatment,and the experimental group was treated with the combination of the San Shen Decoction in addition to that of the control group. The levels of serum IL-23,IL-17,TGF β1 gene expression,drosophila mothers against decapentaplegic2/3,Smad7 protein,T lymphocyte subsets,left ventricular function and myocardial enzyme levels in the two groups before and after treatment were observed. Results： Compared with that before treatment,the Smad7 protein,stroke volume variation,the Ejection Fraction,CD3＋,CD4＋ and CD4＋/CD8＋ levels of two groups of patients after treatment were significantly higher,and the IL-23,IL-17,TGF-beta 1,Smad2/3 protein,CD8＋,Creatine Kinase and creatine kinase isoenzymeslevels were significantly lower. Compared with that of the control group,Smad7 protein,SV,EF,CD3＋,CD4＋and CD4/CD8 levels in experimental group were significantly higher than those in the control group after treatment; the IL-23,IL-17,TGF-beta 1,Smad2/3 protein,CK and CK-MB level was significantly lower than that of the control group. The total effective rate of the experimental group（ 95. 56%） was significantly higher than that（ 80. 00%） of the control group. The effective rate（ 4. 44%） was significantly lower than that（ 20. 00%） of the control group. All of the differences were statistically significant（ P〈 0. 05）. Conclusion： San Shen Decoction can effectively improve the immune function and heart function through IL-23,IL-17 and TGF-beta-Smad channels in patients with viral myocarditis,and,and it has good clinical effect,which is worthy of clinical application.