李凌汉+何虹+林勇

[摘要] 目的 探討膝骨性关节炎患者不同中医证型患者外周血Th17细胞和相关的细胞因子（IL-17、IL-1β和IL-6）的水平与盘龙七片疗效的关系。 方法 选取淤血阻滞、阳虚寒凝、肾虚髓空三种中医证型患者各25、24和26例，正常对照组24例，患者采用盘龙七片治疗，每日3次，每次3片，治疗前和治疗6周后，留取正常对照组和患者外周血，采用流式细胞术和ELIS法检测Th17细胞和血清细胞因子IL-17、IL-1β和IL-6浓度，并进行疗效评估。 结果 肾虚髓空、阳虚寒凝、瘀血阻滞三种中医证型患者Th17细胞比例和细胞因子浓度均高于正常对照组，且呈现逐渐增高的趋势，差异有统计学意义（P<0.05）；三种中医证型有效治疗者，Th17细胞比例和细胞因子浓度显著降低，差异有统计学有统计学意义（P<0.05）；三种中医证型患者疗效呈现增高的趋势，肾虚髓空型高于另外两种证型，差异有统计学意义（P<0.05）。 结论 膝骨性关节炎患者外周血Th17细胞比例和细胞因子IL-17、IL-1和IL-6浓度与盘龙七片的疗效有关，可作为中医证型和预后的参考指标。

[关键词] 骨关节炎，膝；Th17细胞；白细胞介素-6；IL-1β；盘龙七片

[中图分类号] R593.22 [文献标识码] A [文章编号] 2095-0616（2017）13-09-04

[Abstract] Objective To explore the levels of peripheral blood Th17 cells and related cytokines including IL-17，IL-1βand IL-6 for different Traditional Chinese Medicine（TCM）Syndromes of patients with knee osteoarthritis and the relationship between Panlong Seven effect. Methods Knee osteoarthritis patients were divided into symptoms as blood stasis type （n=25），Yang deficiency cold coagulation type （n=24），kidney deficiency type（n=26） three groups.24 healthy persons served as control.All patients were administrated with Panlong Seven tablets，3 times a day，3 tablets each time.Before treatment and 6 weeks after treatment，peripheral blood in normal control group and all patients were collected.Flow cytometry and ELISA were used to detect the Th17 cells and theconcentrations of IL-17，IL-1β and IL-6 in serum，meanwhile to evaluate the therapeutic effect of Panlong Seven. Results The levels of Th17 cells and related cytokines in three TCM syndrome types patients of kidney deficiency type，Yang deficiency cold coagulation，blood stasis were higher compared with the normal control group.There were statistically significant difference（P<0.05）.The levels of them showed a gradually increasing trend.The percentage of Th17 cells and the concentration of cytokines were significantly decreased in effective patients in three TCM syndroms.There were statistically significant difference（P<0.05）.The curative effect showed gradually increasing trend.kidney deficiency type were higher than other two types，and there were statistically significant difference （P<0.05）. Conclusion The effect of Panlong Seven is related to the levels of Th17 cells and cytokines IL-17，IL-1β and IL-6 in peripheral blood of patients with knee osteoarthritis，and they can be used as reference for TCM syndrome and prognosis.

[Key words] Knee osteoarthritis；Th17 cell；Interleukin-6；Interleukin-1β；Panlong seven

骨性关节炎（Osteoarthritis，OA）是全球范围内的常见病、多发病之一，国内研究数据统计表明，55岁以上人群X线显示有OA表现者约60%。随着人口老龄化，发病率在全球范围内呈现出一种逐年上升的趋势。目前尚没有一种根治方法。疼痛和发病的机制与关节滑膜细胞分泌过多的IL-1、IL-6、前列腺素E1并释放入血液有关，关节液中玻璃酸钠的分子量、浓度均降低导致骨关节发炎[1-2]。临床上辩证分型有肝肾亏虚、精血亏虚、瘀血阻滞三种。治则：滋补肝肾、补气活血、化瘀止痛。盘龙七片在治疗膝关节骨性关节炎和类风湿性关节炎临床实践中已经初步显示出较好的疗效和减少副作用[3-6]。本研究就盘龙七片对膝骨性关节炎三种不同的中证型的疗效及其与外周血Th17细胞及其相关细胞因子关系进行研究。……