长蛇灸对强直性脊柱炎免疫因子及关节活动度的影响

Effects of Long Snake Moxibustion on Immunity Factor and Joint Activity of Ankylosing Spondylitis

目的：探讨长蛇灸对强直性脊柱炎的免疫因子调节及关节活动度影响。方法：60例强直性脊柱炎（Ankylosing spondylitis,AS）患者随机分成治疗组和对照组,各30例,治疗组给予长蛇灸（选取两组经穴,一组以督脉经穴大椎穴至腰俞穴为主,另一组以两侧华佗夹脊穴为主交替长蛇灸）,对照组给予西药常规治疗（柳氮磺胺吡啶配合非甾体抗炎药,具体服药剂量依据中华风湿病学为准）,治疗4个疗程（4周）后采用RT-PCR检测Th17、Treg、Thl的特异性转录因子FOXP3、T-bet的mRNA表达水平,流式细胞术检测CD＋4CD＋（25）FOXP3细胞、CD＋4Thl细胞及CD＋4IL-17＋Th细胞的比率。于治疗前、治疗后分别测量胸廓呼吸差、脊柱活动度评价关节功能恢复状况。结果：同组治疗前后比较,治疗组治疗后FoxP3、T-bet的mRNA表达及CD＋4CD＋（25）Treg、CD＋4Thl细胞比率较治疗前显著增加,CD＋4Th17细胞比率较治疗前显著下降,均有显著性差异（P〈0.05）,对照组FoxP3、T-bet的mRNA表达表达及CD＋4CD＋（25）Treg、CD＋4Thl、CD＋4Th17细胞比率变化不明显,（P〉0.05）,差异无统计学意义;治疗后两组FoxP3、T-bet的mRNA表达及CD＋4CD＋（25）Treg、CD＋4Thl、CD＋4Th17细胞比率比较有显著性差异,（P〈0.05）。关节功能活动度比较,治疗组治疗前后比较,治疗后与对照组比较均有显著性差异（P〈0.05）。结论：AS患者存在Thl7/Treg/Thl免疫失衡,长蛇灸能有效调节AS免疫失衡,其作用的机制可能跟长蛇灸具有双向良性调节有关;长蛇灸能有效改善AS关节功能活动度,防止关节僵硬畸形,降低致残率。

Objective：To investigate the effect of long snake moxibustion on immune factor regulation and joint activity of ankylosing spondylitis. Methods：Sixty patients with AS were randomly divided into treatment group and control group. Thirty cases of treatment group was given a long snake moxibustion（two groups of acupuncture points：Dazhui to Shenshu;Huatuo Jiaji points;alternately long snake moxibustion） and control group was given conventional western medicine therapy（willow nitrogen sulfanilamide pyridine with non-steroidal anti-inflammatory drugs（nsaids, specific dose on the basis of the rheumatology shall prevail）. Four treatments（4 weeks） later,by RT-PCR we detected Th17 and Treg, Thl specific transcription factor FOXP3, T-bet mRNA expressions. Flow cytometry was used to detect CD＋4CD＋（25）FOXP3 cells, Thl CD＋4 cells and the ratio of CD＋417 Th（＋ ）cells. Before and after treatment, the thoracic breathing and spinal activity were measured to assess the function of joint function. Results：Group comparison before and after treatment, the treatment group after treatment of FoxP3, T-bet mRNA expression and CD＋4CD＋（25） Treg, CD＋4 Thl cell ratio was significantly increased, the ratio of CD＋4 Th17 cells was decreased significantly, the all have significant difference（P〈0.05）. The control group＇s mRNA expressions of FoxP3 and T-bet expression and CD＋4CD＋（25）Treg, Thl CD＋4, CD＋4Th17 cells ratios changes were not obvious（P〈0.05）. There was no statistically significant difference. Two groups＇ FoxP3 and t-bet mRNA expressions and CD＋4CD＋（25）Treg, CD＋4Thl, CD＋4Th17 ratios were significant in the two groups（P〈0.05）. The functional activity of the joint was significant between two groups（P〈0.05）. Conclusion：As for AS patients with the Thl7/Treg/Thl immune imbalance, the long snake moxibustion can effectively regulate the immune imbalance, and the mechanism of its action may be related to the bidirectional benign regulation of long snake moxibustion. The long snake moxibustion can effectively improve the function activity of the AS joints, prevent the joint stiffness and deformity and reduce the disability rate.