| 王玉喜,姜宜惠,张志伟,董佳,杨敏,谢英.六君子汤对COPD稳定期肺脾气虚证患者p38MAPK/Th17信号通路相关细胞因子表达的影响[J].浙江中西医结合杂志,2024,34(4): |
| 六君子汤对COPD稳定期肺脾气虚证患者p38MAPK/Th17信号通路相关细胞因子表达的影响 |
| The effect of Liujunzi Decoction on the expression of p38MAPK/Th17 signaling pathway-related cytokines in COPD patients with stable lung qi deficiency syndrome |
| 投稿时间：2023-08-08 修订日期：2024-01-14 |
| DOI： |
| 中文关键词: 六君子汤 慢性阻塞性肺疾病 肺脾气虚证 p38MAPK/Th17 细胞因子 |
| 英文关键词:Liujunzi Decoction chronic obstructive pulmonary disease lung qi deficiency syndrome p38MAPK/Th17 cytokine. |
| 基金项目:杭州市卫生科技计划项目（B20200105）；杭州市临安区农业与社会发展项目（2020D011） |
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| 中文摘要: |
| 目的：探讨六君子汤对慢性阻塞性肺疾病(COPD)稳定期肺脾气虚证患者的临床疗效及治疗靶点。
方法：将92例COPD稳定期肺脾气虚证患者按随机数字表法随机分为实验组(n=46)和对照组(n=46)。对照组采用西医常规治疗，实验组采用西医常规加六君子汤口服治疗，疗程均为3个月。观察两组治疗有效率，以及治疗前后总体证候积分、COPD临床问卷(CCQ)评分、急性加重次数、肺功能的变化。流式细胞术和实时荧光定量PCR (RT-PCR)分别检测外周血辅助性T细胞17(Th17细胞)比例及单个核细胞p38丝裂原活化蛋白激酶(p38MAPK)表达水平。酶联免疫吸附试验(ELISA)测定血清相关细胞因子的表达水平。
结果：实验组(93.48%)治疗总有效率优于对照组(78.26%, P<0.05)。两组治疗后的中医证候积分、CCQ评分、急性加重次数、1秒钟用力呼气容积/用力肺活量(FEV1/FVC)、FEV1占预计值百分比(FEV1%)均较治疗前有所改善(P均<0.05)，且实验组优于对照组(P均<0.05)。流式细胞术和RT-PCR结果发现，两组治疗后Th17比例和单个核细胞p38MAPK表达水平均有所下调(P均<0.05)。ELISA结果发现治疗后两组血清中白细胞介素-6 (IL-6)、白细胞介素-8 (IL-8)、白细胞介素-17 (IL-17)、白细胞介素-22 (IL-22)、白细胞介素-23 (IL-23)、肿瘤坏死因子-α (TNF-α)等细胞因子水平均有不同程度的降低(P均<0.05)。与治疗后对照组相比，实验组Th17比例、p38MAPK表达水平及IL-6、IL-8、IL-17、IL-22、IL-23、TNF-α细胞因子水平下降幅度更显著[(3.41±0.58)%比(2.18±0.81)%, (44.36±5.26)比(40.79±3.83), (38.10±7.91)ng/L比(25.64±6.84)ng/L, (56.89±6.38)ng/L比(45.35±4.57)ng/L, (30.59±5.24)ng/L比(21.37±4.91)ng/L, (15.55±3.49)ng/L比(9.67±2.12)ng/L, (73.23±8.36)ng/L比(56.93±6.93)ng/L, (29.37±9.81)ng/L比(19.98±6.94)ng/L, P均<0.05]。
结论：六君子汤可以减轻COPD稳定期肺脾气虚证患者的临床症状。p38MAPK/Th17信号通路可能是六君子汤治疗COPD稳定期肺脾气虚证的作用靶点之一。 |
| 英文摘要: |
| Objective: To investigate the clinical efficacy and therapeutic target of Liujunzi Decoction on chronic obstructive pulmonary disease (COPD) patients with stable lung spleen qi deficiency syndrome.
Methods: 92 cases of COPD patients with stable lung spleen qi deficiency syndrome were randomly divided into experimental (n=46) and control (n=46) groups. The control group was treated with conventional western medical treatment, while the experimental group received Liujunzi Decoction and conventional western medical treatment together. Both groups were treated for 3 months. The therapeutic efficacy, traditional Chinese medicine (TCM) clinical symptom score, COPD clinical questionnaire (CCQ) score, the frequency of acute exacerbation and lung function were observed in two groups before and after treatment. Flow cytometry was used to detect the proportion of T helper cell 17 (Th17) cells in peripheral blood. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression levels of p38 mitogen-activated protein kinase (p38MAPK) in peripheral blood mononuclear cells. Enzyme-linked immunosorbent assay (ELISA) was used to measure the expression levels of cytokines in serum.
Results: The total effective rate of the experimental group (93.48%) was higher than that of the control group (78.26%, P<0.05). Both groups showed improvement in TCM clinical symptom score, forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC), forced expiratory volume in 1 second percentage (FEV1%), CCQ score, and the frequency of acute exacerbation after treatment (P<0.05). While the experimental group showed better outcomes than the control group (P<0.05). RT-PCR and flow cytometry results showed that the expression levels of p38MAPK and the proportion of Th17 cells were reduced in both groups after treatment (P<0.05). ELISA results showed that the levels of cytokines in serum such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-17 (IL-17), interleukin-22 (IL-22), interleukin-23 (IL-23) and tumor necrosis factor-α (TNF-α) were decreased to varying degrees in both groups after treatment (P<0.05). Compared with the control group, the experimental group showed a more significant decrease in the expression of p38MAPK, Th17 cells, and cytokines after treatment [(44.36±5.26) vs (40.79±3.83), (3.41±0.58)% vs (2.18±0.81)%, (38.10±7.91)ng/L vs (25.64±6.84)ng/L, (56.89±6.38)ng/L vs (45.35±4.57)ng/L, (30.59±5.24)ng/L vs (21.37±4.91)ng/L, (15.55±3.49)ng/L vs (9.67±2.12)ng/L, (73.23±8.36)ng/L vs (56.93±6.93)ng/L, (29.37±9.81)ng/L vs (19.98±6.94)ng/L, P<0.05].
Conclusion: Liujunzi Decoction can alleviate clinical symptoms in COPD patients with stable lung spleen qi deficiency syndrome, and the p38MAPK/Th17 signaling pathway may be one of the targets. |
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