干燥综合征中医辨证分型与免疫炎症指标的相关性研究

Study on the correlation between TCM syndrome differentiation and immune inflammation index of Sjogren's syndrome

目的:观察原发性干燥综合征(primary Sjogren's syndrome,pSS)中医各证型分布与红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)及免疫球蛋白IgA、IgG和IgM变化的关系。方法:将157例确诊的pSS患者按照中医辨证分型标准分为燥邪犯肺证、湿热阻络证、气血瘀阻证、肝肾阴虚证和气阴两虚证,观察和检测不同证型分组间患者的年龄、病程、国际普适生活质量量表中的总体健康分、焦虑自评量表(self rating anxiety scale,SAS)和抑郁自评量表(self rating depression scale,SDS)、ESR、CRP、TNF-α、IL-6、免疫球蛋白IgA、IgG和IgM等免疫炎性指标的变化,分析比较pSS中医不同证型与免疫炎性指标分子水平变化的关系,以及对生活质量和精神情志的影响。结果:气阴两虚证患者总体健康评分显著低于燥邪犯肺证患者(P<0.001);气阴两虚证患者的SAS和SDS评分均显著高于燥邪犯肺证患者(P<0.001);湿热阻络证患者ESR、CRP、TNF-α、IL-6、IgG均显著高于燥邪犯肺证和气血瘀阻证患者(P<0.05)。相关性检验中发现,湿热阻络证与CRP、IL-6、TNF-α等指标呈正相关(P<0.05)。结论:pSS患者的CRP、IL-6、TNF-α等免疫炎性指标与中医证候存在关联。

Objective:To determine the relationship between the distribution of TCM syndromes of primary Sjogren's syn⁃drome(pSS)and the changes of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),immunoglobulin IgA,IgG and IgM.Methods:A total of 157 pSS patients were divided into dampness heat obstructing collaterals syndrome,dryness invading lung syndrome,Qi blood stasis syndrome,Yin deficiency syn⁃drome of the liver and kidney and Qi Yin deficiency syndrome according to TCM syndrome differentiation standard.The age,course of disease,general health score in international universal quality of life scale,self rating anxiety scale(SAS),self rating depression scale(SDS),ESR,CRP,TNF-α,IL-6,immunoglobulin IgA,IgG and IgM were evaluated.Moreover,the relation⁃ship between different TCM syndromes of pSS and the changes of immune inflammatory indexes was analyzed and compared,as well as the impact of PSS on quality of life and mental emotion was analsed.Results:The overall health score of patients with Qi Yin deficiency syndrome was significantly lower than that of patients with dryness invading lung syndrome(P<0.001),while the SAS and SDS scores of patients with Qi Yin deficiency syndrome were significantly higher than those of patients with dryness in⁃vading lung syndrome(P<0.001).ESR,CRP,TNF-α,IL-6,and IgG levels of patients with dampness heat obstructing collat⁃erals syndrome were significantly higher than those of patients with dryness invading lung syndrome and Qi blood stasis syndrome(P<0.05).Correlation analysis demonstrated that dampness heat obstructing collaterals syndrome was positively correlated with CRP,IL-6 and TNF-αand other inflammatory indicators(P<0.05).Conclusion:Inflammatory indicators such as CRP,IL-6 and TNF-αin pSS patients are associated with TCM syndromes.