苏子降气汤调控MAPK信号通路改善COPD患者炎症状态的研究

Research on the regulation of the MAPK signaling pathway by Suzi Jiangqi decoction to improve the inflammatory state of COPD patients

目的旨在探讨苏子降气汤通过调控丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)信号通路对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者炎症状态的影响。方法选取2023年4月至2024年4月在浙江省金华市中心医院传统医学中心及呼吸内科门诊治疗的COPD稳定期E组患者70例,采用随机数字表法分为观察组和对照组,每组35例。对照组接受噻托溴铵粉雾剂联合布地奈德福莫特罗粉吸入治疗,观察组在对照组基础上加用中药苏子降气汤治疗。治疗12周后,通过肺功能检查、气道黏液高分泌评价,白细胞介素(interleukin,IL)-17、IL-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α水平测定,CT定量参数,痰中IL-17、p38MAPK、核因子κB(nuclear factor kappa-B,NF-κB)及C-X-C基序趋化因子配体8(C-X-C motif chemokine ligand 8,CXCL8)的mRNA表达水平检测来评估疗效。结果治疗后两组患者的肺功能指标第一秒用力呼气容积与用力肺活量的比值、咳嗽评分、咯痰难度评分、痰液性状评分及痰量评分均显著改善,观察组改善更明显(P<0.05)。治疗后两组血清IL-17、IL-6、TNF-α水平均下降,观察组下降更明显(P<0.05)。治疗后观察组肺CT定量参数肺叶低衰减区占肺体积的百分比、肺气肿指数均明显下降(P<0.05)。观察组治疗后痰中IL-17、p38MAPK、NF-κB及CXCL8 mRNA表达水平也显著降低(P<0.05)。结论苏子降气汤可通过调节IL-17介导的MAPK信号通路改善COPD患者的肺功能及炎症状态,对COPD的治疗有积极疗效。

Objective To explore the impact of Suzi Jiangqi decoction(SJD)on the inflammatory state of patients with chronic obstructive pulmonary disease(COPD)through the regulation of the mitogen-activated protein kinase(MAPK)signaling pathway.Methods A total of 70 patients with stable COPD,treated from April 2023 to April 2024 at the Department of Traditional Chinese Medicine and Department of Respiratory outpatient clinic of Affiliated Jinhua Hospital,School of Medicine Zhejiang University were selected and randomly divided into observation group and control group,with 35 cases in each group.The control group received tiotropium bromide powder inhalation combined with budesonide/formoterol powder inhalation treatment,while the observation group was given SJD in addition to treatment of control group.After 12 weeks of treatment,the therapeutic effects were evaluated by assessing lung function,airway mucus hypersecretion,levels of interleukin(IL)-17,IL-6,and tumor necrosis factor(TNF)-α,CT quantitative parameters of the lung,as well as the expression levels of IL-17,p38MAPK,nuclear factor kappa-B(NF-κB)and C-X-C motif chemokine ligand 8(CXCL8)mRNA in sputum.Results Following treatment,there was a significant improvement in lung function indicators such as first second expiratory volume/forced vital capacity%,cough score,sputum difficulty score,sputum quality score,and sputum volume score for patients in both groups,with more pronounced improvements observed in observation group(P<0.05).The levels of serum cytokines IL-17,IL-6 and TNF-α decreased in both groups after treatment,with observation group showing a more significant reduction(P<0.05).Additionally,the percentage ratio of low attenuation area to lung area(LAA%),emphysema index of lung CT in observation group significantly decreased after treatment(P<0.05).Similarly,the expression levels of IL-17,p38MAPK,NF-κB and CXCL8 mRNA in sputum were also significantly reduced after treatment in observation group(P<0.05).Conclusion SJD may improve lung function and inflammatory status in COPD patients by regulating the MAPK signaling pathway mediated by IL-17,demonstrating a positive therapeutic effect on the treatment of COPD.