窄谱中波紫外线联合退白颗粒对寻常型白癜风外周血IL-2、IFN-γ、IL-4、IL-10、IL-17、TGF-β_1水平的影响

Effects of narrow band ultraviolet B combined with Tuibai Keli on levels of IL-2,IFN-γ,IL-4,IL-10,IL-17 and TGF-β_1 in peripheral blood of patients with vitiligo vulgaris

目的探讨窄谱中波紫外线(NB-UVB)联合中药退白颗粒对寻常型白癜风患者外周血辅助性T和调节性T细胞相关细胞因子IL-2、IFN-γ、IL-4、IL-10、IL-17、TGF-β1水平的影响。方法选取60例寻常型白癜风患者,均给予NB-UVB联合退白颗粒治疗,疗程3个月,观察临床疗效;同时采用ELISA法检测治疗前后外周血IL-2、IFN-γ、IL-4、IL-10、IL-17、TGF-β1水平,并与30例健康对照组进行比较。结果 NB-UVB联合退白颗粒治疗寻常型白癜风进展期有效率为88.24%,稳定率为61.54%;其中皮损面积<5%者有效率87.10%,≥5%者有效率65.52%;病程<1年者有效率87.50%,≥1年者有效率64.29%;差异均有统计学意义(P均<0.05)。治疗前白癜风患者IL-2、IFN-γ、IL-17表达水平均显著高于健康对照组而IL-4、TGF-β1均显著低于健康对照组(P均<0.05),且不同分期、皮损面积、病程分组之间差异有统计学意义(P均<0.05);进展期、皮损面积≥5%组及病程<1年组、≥1年组IL-10水平均显著低于健康对照组(P均<0.05)。采用NB-UVB联合中药退白颗粒治疗后,进展期IL-2、IFN-γ、IL-17及稳定期IFN-γ、IL-17较治疗前均明显下调(P均<0.05),不同皮损面积和病程组IL-2、IFN-γ、IL-17水平较治疗前均明显下调(P均<0.05),进展期IL-4、IL-10、TGF-β1及稳定期IL-4、TGF-β1水平上调(P均<0.05),皮损面积<5%组IL-4、TGF-β1及≥5%组IL-4、IL-10、TGF-β1明显上调(P均<0.05),病程<1年组IL-4、IL-10、TGF-β1及≥1年组IL-4、TGF-β1明显上调(P均<0.05)。结论寻常型白癜风患者外周血辅助性T和调节性T细胞主要相关细胞因子水平存在异常,且与患者临床表现相关,NB-UVB联合退白颗粒可能通过对上述细胞因子的表达水平的调节发挥对该病的治疗作用。

Objective It is to investigate the effect of narrow band ultraviolet B(NB-UVB) combined traditional Chinese medicine Tuibai Keli on the levels of peripheral blood T helper and regulatory T cell related cytokines IL-2,IFN-γ,IL-4,IL-10,IL-17,TGF-β1 in patients with vitiligo vulgaris. Methods 60 cases of vitiligo vulgaris were selected,and treated by NBUVB combined with white granule,the course of treatment was 3 months,then the clinical efficacy was observed,and the levels of IL-2,IFN-γ,IL-4,IL-10,IL-17 and TGF-β1 in peripheral blood before and after treatment were detected by ELISA.30 healthy cases were selected for control group to compare with patients. Results The effective rate of NB-UVB combined with Tuibai Keli in the treatment of patients with advanced vitiligo was 88. 24%,and was 61. 54% in stable patients; it was87. 10% in patients with lesion area < 5%,and was 65. 52% with ≥5%; it was 87. 50% in patients with disease course <1 year,and was 64. 29% with ≥1 year. There were significant differences between the two groups(all P < 0. 05). Before treatment,the expression levels of IL-2,IFN-and IL-17 in patients with vitiligo were significantly higher,but IL-4 and TGF-β1 levels were significantly lower than those in the control group(all P < 0. 05),and there were significant differences between different stages,lesion area and course of disease(all P < 0. 05); the IL-10 levels in patients of progress period,the lesion area ≥5%,disease course < 1 year or ≥1 year were significantly lower than the control group(all P < 0. 05). After treatment with NB-UVB combined with Chinese medicine,the levels of IL-2,IFN-γ,IL-17 in progressive phase,and IFN-γ and IL-17 in stable phase were significantly lower than those before treatment(all P < 0. 05),the levels of IL-2,IFN-γ and IL-17 in the difference lesions area and course of disease were significantly lower than those before treatment(all P < 0. 05),the levels of IL-4,IL-10,TGF-β1 in progressive phase and IL-4 and TGF-β1 levels in stable phase were significantly up-regulated(all P < 0. 05),the IL-4,TGF-β1 level in patients with lesion area < 5% and IL-4,IL-10,TGF-β1 levels with lesion area ≥5% was significantly up-regulated(all P < 0. 05),the IL-4,IL-10,TGF-β1 level with disease course < 1 year and the IL-4,TGF-β1 levels with disease course≥1 year was significantly up-regulated(all P < 0. 05). Conclusion Helper T and regulatory T cells major related cytokines in peripheral blood of patients with vitiligo vulgaris are abnormal,and correlated with the clinical manifestations of the patients,NB-UVB combined with Tuibai Keli may exert therapeutic effect on the disease by regulating the expression level of the cytokines.