类风湿关节炎血清瘦素、CD4^(+)/CD8^(+)淋巴细胞比值与中医证型分析

Analysis of Serum Leptin,CD4+/CD8+and TCM Syndrome Types of Rheumatoid Arthritis

目的:探讨血清瘦素、CD4^(+)/CD8^(+)淋巴细胞比值(CD4^(+)/CD8^(+)比值)与类风湿关节炎(rheumatoid arthritis,RA)中医证型的关系,为RA中医辨证分型提供客观参考依据。方法:选取RA患者199例,分为风湿痹阻证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、肝肾不足证、气血两虚证6个证型,同时选取45例正常体检者为正常对照组。收集体检正常者及RA患者空腹血清,进行瘦素、CD4^(+)/CD8^(+)比值检测并记录结果,收集RA患者基本信息、临床症状、红细胞沉降率、C反应蛋白等,采用统计软件SPSS 20.0进行分析。结果:①RA组血清瘦素水平、CD4^(+)/CD8^(+)比值高于正常对照组(P<0.001)。②RA组各证型血清瘦素水平比较,差异有统计学意义(P<0.001),其中痰瘀痹阻证血清瘦素水平高于其他各证型(P<0.05)。③RA组各证型血清CD4^(+)/CD8^(+)比值比较,差异有统计学意义(P<0.001),其中湿热痹阻证血清CD4^(+)/CD8^(+)比值高于其他各证型(P<0.05)。④RA组血清瘦素、CD4^(+)/CD8^(+)比值分别与DAS28评分之间存在显著的正相关(P<0.001)。⑤RA组血清瘦素与CD4^(+)/CD8^(+)比值之间存在正相关(P<0.05)。结论:在RA的6个中医证型中,血清瘦素水平、CD4^(+)/CD8^(+)比值异常升高可分别作为痰瘀痹阻证、湿热痹阻证的客观参考指标。RA患者血清瘦素水平与CD4^(+)/CD8^(+)比值之间存在正相关,提示瘦素代谢与细胞免疫之间可能存在一定的关系。

Objective:To explore the relationship between serum leptin,CD4^(+)/CD8^(+)and TCM syndrome types of rheumatoid arthritis(RA),so as to provide objective reference for TCM syndrome differentiation.Methods:One hundred and ninety-nine patients with RA were selected and divided into six syndrome types:rheumatism-obstruction syndrome,cold dampness-obstruction syndrome,dampnessheat-obstruction syndrome,phlegm-stasis-obstruction syndrome,liver-kidney-deficiency syndrome,qi-blooddeficiency syndrome.Forty-five cases for normal physical examination were selected as the normal control group.The serum leptin and CD4^(+)/CD8^(+)were detected and the results were recorded.The basic information,clinical symptoms,erythrocyte sedimentation rate and C-reactive protein of RA patients were collected and analyzed by SPSS 20.0.Results:①The serum leptin level and CD4^(+)/CD8^(+)in the RA group were higher than those in the normal control group(P<0.001).②The difference of the levels of serum leptin in all the RA groups was statistically singnificant(P<0.001)and the level in the phlegmstasis-obstruction syndrome group was significantly higher than that of other syndrome types(P<0.05).③The difference of CD4^(+)/CD8^(+)in RA groups was statistically significant(P<0.001),and the ratio in the damp-heat-obstruction syndrome group was higher than that in other syndrome types(P<0.05).④There were significant positive correlations between serum leptin,CD4^(+)/CD8^(+)and DAS28 score in the RA group(P<0.001).⑤There was a positive correlation between serum leptin and CD4^(+)/CD8^(+)in the RA group(P<0.05).Conclusion:In the six TCM syndrome types of RA,the abnormal increase of serum leptin level and CD4^(+)/CD8^(+)can be used as the objective reference indexes of phlegm-stasis syndrome and dampheat syndrome respectively.There is a positive correlation between serum leptin level and CD4^(+)/CD8^(+)in RA patients,which suggests that there may be a certain relationship between leptin metabolism and cellular immunity.