α-硫辛酸对多发性硬化患者认知障碍及血清Th17/Treg细胞因子、MMP-9/TIMP-1水平的影响

Effect of α-lipoic acid on cognitive impairment and serum levels of Th17/Treg cytokines and MMP-9/TIMP-1 in patients with multiple sclerosis

目的探讨α-硫辛酸对多发性硬化(MS)患者认知障碍及血清Th17/Treg细胞因子、MMP-9/TIMP-1水平的影响。方法选取2016年2月-2018年8月间在河北医科大学第二医院接受治疗的多发性硬化患者80例,参照随机数表法将入组患者分为对照组、研究组,每组40例。对照组接受常规甲泼尼龙治疗,研究组接受α-硫辛酸+甲泼尼龙治疗,持续治疗2个疗程后评估疗效。对比两组患者的近期疗效、血清Th17/Treg细胞因子[白介素-17(IL-17)、转化生长因子β1(TGF-β1)]及基质金属蛋白酶-9(MMP-9)/金属蛋白酶组织抑制因子-1(TIMP-1)水平、药物相关不良反应发生情况的差异。结果治疗2个疗程后,研究组治疗总有效率高于对照组(97.50%vs. 85.00%),差异有统计学意义(c2=3.914,P=0.048)。研究组MoCA、MMSE评分值高于对照组(P<0.05)。研究组血清IL-17水平和IL-17/TGF-β1比值低于对照组,TGF-β1水平高于对照组,差异均有统计学意义(P<0.05)。研究组血清MMP-9水平和MMP-9/TIMP-1比值低于对照组,TIMP-1水平高于对照组,差异均有统计学意义(P<0.05)。治疗期间,两组患者发热乏力、关节肌肉酸痛及总不良反应发生率差异无统计学意义(P>0.05)。两组均无一例出现皮疹皮炎、恶心呕吐、肝肾功能损伤。结论α-硫辛酸可改善MS患者的整体病情,减轻认知障碍且用药安全性有保障,可能与其调节细胞因子稳态相关。

Objective To investigate the effects of α-lipoic acid on cognitive impairment and serum levels of Th17/Treg cytokines and MMP-9/TIMP-1 in patients with multiple sclerosis(MS).Methods 80 cases of MS patients treated in our hospital from February 2016 to August 2018 were divided into control group and study group according to the random number table,each 40 cases.Patients in control group received conventional methylprednisolone treatment and those in study group received alpha-lipoic acid+methylprednisolone treatment;efficacy was evacuated after 2 course of treatment.Short-term efficacy,serum Th17/Treg cytokines [interleukin-17(IL-17),transforming growth factor beta 1(TGF-beta1)],matrix metalloproteinase-9(MMP-9)/metalloproteinase-tissue inhibitor factor 1(TIMP-1),and drug-related adverse reactions were compared between two groups.Results After 2 courses treatment,there was statistically significant difference in efficacy between two groups(P<0.05).Total effective rate of study group was higher than that of control group(P<0.05).MoC.A and MMSE scores in study group were higher than those in control group(P<0.05).Serum levels of IL-17 and IL-17/TGF-beta 1 in study group were lower than those in control group;levels of TGF-beta 1 was higher than that in control group(P<0.05).Serum MMP-9 level and ratio of MMP-9/TIMP-1 in study group were lower than those in control group;level of TIMP-1 was higher than that in control group(P<0.05).During the treatment,there were no statistically significant difference in the incidence of fever,joint muscle pain and total adverse reactions between two groups(P>0.05).None of two groups had skin rashes,nausea and vomiting,liver and kidney function damage.Conclusions Alpha-lipoic acid could improve the condition of MS patients and was safe.Specifically it might be related to the regulation of cytokine homeostasis.