基于肠道菌群调控作用探讨强直性脊柱炎肾虚督寒证患者Th17分化偏移及雷氏银盏隔姜灸的治疗作用

Exploring the Deviation of Th17 Differentiation in Patients with Ankylosing Spondylitis of Kidney-Deficiency and Du-Cold Syndrome based on Regulation of Intestinal Flora and Therapeutic Effect of Lei’s Silver Calyx Moxibustion Separated by Ginger

目的:基于肠道菌群调控探讨强直性脊柱炎(AS)肾虚督寒证患者辅助性T细胞17(Th17)分化偏移及雷氏银盏隔姜灸的治疗作用。方法:选择90例肾虚督寒证AS患者,采用随机数表法分为两组。对照组给予常规西药治疗,观察组在对照组基础上联用雷氏银盏隔姜灸,均连续治疗3个月;评价两组临床疗效,比较治疗前后中医证候积分、肠道菌群、Th17、白细胞介素-17(IL-17)、白细胞介素-22(IL-22))表达水平。结果:观察组肾虚督寒证AS患者临床有效率(95.6%)高于对照组(80.0%)(P<0.05)。治疗后观察组肾虚督寒证证候积分低于对照组(P<0.05)。肠道菌群在门水平上,两组患者均由拟杆菌门、变形菌门、厚壁菌门、梭杆菌门和放线菌门等构成,其中拟杆菌门、变形菌门、厚壁菌门三者为优势门,占比约90%,两组治疗前基本一致;治疗后观察组拟杆菌门、变形菌门相对丰度较治疗前增加,而厚壁菌门较治疗前降低,对照组总体菌群相对丰度变化不大。肠道菌群属水平上,两组患者均由类杆菌、拟杆菌门、链球菌、肠杆菌、乳酸杆菌、双歧杆菌、普雷沃氏菌、其他菌构成,两组治疗前基本一致;治疗后观察组拟杆菌门相对丰度较治疗前增加,而链球菌较治疗前降低,对照组总体菌群相对丰度变化不大。治疗后观察组Th17、IL-17、IL-22水平均低于对照组(P<0.05)。结论:雷氏银盏隔姜灸应用于肾虚督寒证AS的治疗临床效果显著,可有效降低中医证候积分,通过调节肠道菌群,改善Th17、IL-17、IL-22水平。

Objective:To explore the differentiation shift of T helper cell 17(Th17)in patients with ankylosing spondylitis(AS)based on the regulation of intestinal flora and the therapeutic effect of Lei’s silver calyx moxibustion separated by ginger.Methods:A total of 90 patients with AS of kidney deficiency and Du-cold syndrome were selected and divided into two groups by random number table method,45 cases in each group.The control group was given conventional Western medicines,and the observation group was given Lei’s silver calyx moxibustion separated by ginger on the basis of the control group,both of which were treated continuously for 3 months.The clinical efficacy was evaluated,TCM syndrome scores,intestinal flora,serum Th17,IL-17 and IL-22 were compared between the two groups before and after treatment.Results:The clinical effective rate(95.6%)of AS patients with kidney deficiency and Du-cold syndrome in the observation group was higher than that in the control group(80.0%)(P<0.05).After treatment,the TCM syndrome scores of AS patients with kidney deficiency and Du-cold syndrome in the observation group were lower than those in the control group(P<0.05).At the phylum level,the intestinal flora of the two groups was composed of Bacteroidetes,Proteobacteria,Firmicutes,Fusobacterium and Actinomycetes,among which Bacteroidetes,Proteobacteria,Firmicutes,the three kinds of phylum were the dominant,accounting for about 90%.The two groups were basically the same before treatment,but after treatment,the relative abundances of Bacteroidetes and Proteobacteria in the observation group were increased compared with those before treatment,while the relative abundances of Firmicutes was decreased compared with those before treatment,while the relative abundance of the overall flora in the control group did not change much.At the genus level,the intestinal flora of the two groups were composed of Bacteroides,Bacteroidetes,Streptococcus,Enterobacter,Lactobacillus,Bifidobacterium,Prevotella,and o-thers.Before treatment,the two groups were basically the same,but after treatment,the relative abundance of Bacteroidetes in the observation group was increased,while that of Streptococcus was decreased,while the relative abundance of the overall flora in the control group did not change much.After treatment,Th17,IL-17 and IL-22 in the observation group were lower than those in the control group(P<0.05).Conclusion:The application of Lei’s silver calyx moxibustion separated by ginger in AS with kidney deficiency and Du-cold syndrome has significant clinical effect,which can effectively reduce the TCM syndrome score and improve Th17,IL-17 and IL-22 levels by regulating intestinal flora.