目的 觀察雷公藤多苷片治療支氣管哮喘的臨床療效,并探討其對(duì)Th17/Treg失衡的影響。方法 選取深圳市第二人民醫(yī)院2014年3月—2015年3月收治的中重度支氣管哮喘患者100例,隨機(jī)分為對(duì)照組和治療組,每組各50例。對(duì)照組給予常規(guī)治療,治療組在對(duì)照組的基礎(chǔ)上口服雷公藤多苷片20 mg/次,3次/d,兩組患者均連續(xù)治療14 d。治療后,觀察兩組的臨床療效,同時(shí)比較兩組外周血Th17/Treg細(xì)胞比例,Th17和Treg細(xì)胞因子白介素-17(IL-17)、白介素-23(IL-23)、白介素-10(IL-10)、轉(zhuǎn)化生長(zhǎng)因子-β₁(TGF-β₁),肺功能指標(biāo)第1秒時(shí)間肺活量(FEV₁)、第1秒時(shí)間肺活量/用力肺活量(FEV₁/FVC)。結(jié)果 治療后,治療組的總有效率(92.0%)明顯高于對(duì)照組(76.0%),兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);兩組外周血Th17細(xì)胞比例顯著降低,Treg細(xì)胞比例顯著升高,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組治療后的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組患者血漿中IL-17、IL-23顯著降低,TGF-β₁、IL-10顯著升高,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);治療組治療后的IL-17、IL-23顯著降低,TGF-β₁、IL-10顯著升高,與對(duì)照組治療后比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組的FEV₁、FEV₁/FVC較治療前顯著升高,同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);治療組治療后的FEV₁、FEV₁/FVC較對(duì)照組治療后顯著升高,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 雷公藤多苷片治療支氣管哮喘療效較好,可顯著改善肺功能,調(diào)節(jié)Th17/Treg免疫平衡可能是其作用機(jī)制。

Objective To evaluate the efficacy of Tripterygium Glycosides Tablets in treatment of bronchial asthma, and to investigate the influence of Tripterygium Glycosides Tablets to the unbalance of Th17/Treg. Methods Patients (100 cases) with moderately severe bronchial asthma in The First Affiliated Hospital of Shenzhen University from March 2014 to March 2015 were randomly divided into control and treatment groups, and each group had 50 cases. Patients in the control group were treated with conventional therapy, and patients in the treatment group were po administered with Tripterygium Glycosides Tablets on the basis of conventional therapy, 20 mg/time, three times daily. The patients in two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the changes of Th17/Treg cell ratio in peripheral blood, Th17/Treg cytokines interleukin-17 (IL-17), interleukin-23 (IL-23), interleukin-10 (IL-10), and transforming growth factor-β₁ (TGF-β₁), and lung function indices forced expiratory volume in 1 s (FEV₁), forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) were compared. Results After treatment, the clinical efficacy of patients in treatment group (92.0%) were higher than those in control group (76.0%) with significant difference (P < 0.05). Th17 cell ratio in peripheral blood of two groups was significantly reduced, and Treg cell ratio was significantly increased, and the difference was statistically significant in the same group (P < 0.05). The observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). IL-17 and IL-23 in blood plasma of two groups were significantly reduced, and TGF-β₁ and IL-10 was significantly increased, and the difference was statistically significant in the same group (P < 0.05). IL-17, IL-23, TGF-β₁, and IL-10 in the treatment group were better than those in control group, and the difference was significant between two groups (P < 0.05). FEV₁ and FEV₁/FVC of two groups were increased more than those before treatment with significant difference (P < 0.05). FEV₁ and FEV₁/FVC in treatment group were increased more than those in the control group, and the difference was significant (P < 0.05). Conclusion Tripterygium Glycosides Tablets has clinical curative effect in treatment of bronchial asthma, and can significantly improve lung function, and adjusting the Th17/Treg immune balance may be its mechanism.