益气解毒复方对Ⅰ、Ⅱ型重症肌无力患者的临床疗效及免疫调节作用

Clinical Efficacy and Immunotherapy of Yiqi Jiedu Compound on Patients with Myasthenia Gravis Type Ⅰ and Type Ⅱ

目的观察益气解毒复方对Ⅰ、Ⅱ型重症肌无力患者的临床疗效及血清Tfr、Tfh、IL-21、AChRAb的影响。方法收集Ⅰ、Ⅱ型重症肌无力患者共60例,按随机数字表分为益气解毒复方组(常规西药+益气解毒复方)和对照组(常规西药),每组各30例,治疗12周,观察治疗前后QMG评分变化,评估临床疗效,采用流式细胞术、ELISA法检测并观察治疗前后血清Tfr、Tfh细胞比例及IL-21、AchR-Ab水平变化,观察治疗期间不良反应情况。结果治疗12周后,两组患者QMG评分均有下降(P<0.01),但益气解毒复方组在降低QMG评分上较对照组更明显(P<0.01),在愈显率及有效率方面也较对照组更明显(P<0.05);两组MG患者血清Tfh细胞比例及IL-21和AchR-Ab水平均明显降低(P<0.01),Tfr细胞比例及Tfr/Tfh比值均明显升高(P<0.01),但与对照组相比,益气解毒复方组在降低Tfh细胞比例、AchR-Ab水平及升高Tfr细胞比例上更明显(P<0.05),在升高Tfr/Tfh比值,降低IL-21水平上也更明显(P<0.01)。结论在常规西医治疗的基础上联合益气解毒复方治疗MG近期疗效显著,可协同增效,安全性好,其机制可能与升高血清Tfr细胞比例、降低血清Tfh细胞比例,上调Tfr/Tfh比值及减少IL-21,降低AchR-Ab水平有关。

Objective To observe the clinical efficacy of Yiqi Jiedu Compound on patients with myasthenia gravis typeⅠ and type Ⅱ and the effects of serum Tfr, Tfh, IL-21 and AChR-Ab.Methods 60 patients with myasthenia gravis type I and type II were recruit. The patients were randomly divided into two groups with 30 patients in each group. The Yiqi Jiedu Compound group were treated with western medicine and Yiqi Jiedu Compound, and the control group were treated with western medicine. All the patients were treated for 12 weeks. The changes of QMG score before and after treatment were observed to evaluate the clinical efficacy. Flow cytometry and ELISA were used to detect and observe the proportion of Tfr and Tfh cells in serum and the changes of IL-21 and AChR-Ab levels before and after treatment.Results After treating for 12 weeks, the QMG scores were decreased in both groups(P<0.01). Compared with the control group, the QMG scores in Yiqi Jiedu Compound group were reduced more significantly(P<0.01), and the recovery and effective rate were more obvious(P<0.05). The proportion of Tfh cells and the levels of IL-21, AchR-Ab in serum of MG patients were significantly decreased in both groups(P<0.01). The proportion of Tfr cells and Tfr/Tfh ratio were significantly increased(P<0.01). However, compared with the control group, the proportion of Tfh cells, the level of AchR-Ab in Yiqi Jiedu Compound group were reduced more significantly(P<0.05), while the proportion of Tfr cells increased more significantly(P<0.05). It was also more obvious in increasing Tfr or Tfh ratio and decreasing IL-21 level(P<0.01).Conclusion On the basis of conventional western medicine treatment combined with Yiqi Jiedu Compound has a significant short-term effect in the treatment of MG. It may be related to increasing the proportion of Tfr cells,reducing the proportion of Tfh cells, increasing the proportion of Tfr/Tfh and reducing IL-21, AchR-Ab level.