刘静 谢克琴 曹跃鹏 刘正奇 邓志勇 李贺 孙贵炎 吕宁霁 马武开 钟琴

【摘 要】目的：研究急性痛風性关节炎患者外周血Toll样受体2（TLR2）、Toll样受体4（TLR4）、髓样分化因子88（MyD88）的表达及其与中医证型的关系，为中医学的辨证论治提供客观依据。方法：将66例急性痛风性关节炎患者根据中医辨证分型分为湿热蕴结型48例，痰浊阻滞型6例，瘀热阻滞型10例，肝肾阴虚型2例。同时随机选取健康体检者20例为健康对照组。检测C-反应蛋白（CRP）、红细胞沉降率（ESR）水平，通过ELISA检测外周血中TLR2、TLR4、MyD88的浓度；采用SPSS 22.0软件分析急性痛风性关节炎患者外周血TLR2、TLR4、MyD88与不同中医证型的关系。结果：①急性痛风性关节炎患者外周血TLR2、TLR4、MyD88浓度较健康对照组显著升高（P < 0.01）。②痛风性关节炎患者外周血TLR2与ESR、CRP呈正相关（P < 0.01）。③各中医证型的痛风性关节炎患者男性所占比例明显大于女性；在年龄方面，4个证型的痛风患者差异无统计学意义（P > 0.05）。④湿热蕴结型痛风性关节炎患者外周血ESR、CRP值明显高于其他3型，差异有统计学意义（P < 0.01）。⑤TLR2在各证型之间两两比较，差异有统计学意义（P < 0.01）。TLR4、MyD88在肝肾阴虚型与瘀热阻滞型之间比较，差异无统计学意义（P > 0.05）；其他各证型之间两两比较，差异有统计学意义（P < 0.05）。结论：TLR2、TLR4、MyD88可以反映痛风性关节炎的炎症轻重。湿热蕴结型痛风患者炎症反应更为活跃，与急性痛风性关节炎密切相关。

【关键词】 痛风性关节炎；中医证型；Toll样受体；髓样分化因子88；辨证论治

【ABSTRACT】Objective：To study the expressions of TLR2，TLR4 and MyD88 in peripheral blood of patients with acute gouty arthritis and their relationship with TCM syndrome patterns，so as to provide objective basis for TCM syndrome differentiation and treatment.Methods：Sixty cases of acute gouty arthritis，according to TCM syndrome，were divided into the damp-heat-accumulation syndrome pattern（48 cases），the phlegm-turbidity-blockage syndrome pattern（6 cases），the stasis-heat-accumulation syndrome pattern（10 cases），and the liver-kidney-yin-deficiency syndromepattern（2 cases）.At the same time，20 healthysubjects were randomly selected as the healthycontrol group.The levels of C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were detected.The concentrations of TLR2，TLR4 and MyD88 in peripheral blood were detected by ELISA.The relationships between TLR2，TLR4 and MyD88 in peripheral blood and different TCM syndromes were analyzed by software SPSS 22.0.Results：①The concentration of TLR2，TLR4 and MyD88 in the peripheral blood of patients with acute gouty arthritis was significantly higher than that in the healthy control group（P < 0.01）.②There was a positive correlation between TLR2 and ESR and CRP in patients with gouty arthritis（P < 0.01）；③The proportion of men with gouty arthritis in all TCM syndrome patterns was significantly larger than that in women.In terms of age，there was no statistically significant difference in four syndrome patterns（P > 0.05）.④ESR and CRP values in peripheral blood of the damp-heat-accumulation syndrome pattern was significantly higher than that in the other three syndrome patterns，and the difference was statistically significant（P < 0.01）.⑤The difference was statistically significant（P < 0.01）between each two syndrome patterns.There was no significant difference of TLR4 and MyD88 between the liver-kidney-yin-deficiency syndrome pattern and the stasis-heat-accumulation syndrome pattern（P > 0.05）.There was a significant difference between each two syndrome patterns（P < 0.05）.Conclusion：TLR2，TLR4 and MyD88 can reflect the severity of gouty arthritis.Inflammation in the stasis-heat-accumulation syndrome pattern is more active and closely related to acute gouty arthritis.

【Keywords】 gouty arthritis；TCM syndrome pattern；TLRs；MyD88；syndrome differentiation and treatment

单钠尿酸盐（MSU）结晶在关节软骨、滑膜及周围组织等沉积而引发非特异性炎症反应，是急性痛风性关节炎的典型特点。MSU是一种内源性危险信号相关分子（DAMPs），被机体识别后通过固有免疫引起炎症和细胞凋亡[1]。有关急性痛风性关节炎的机制研究显示：Toll样受体（TLRs）介导的通路和髓样分化因子88（MyD88）依赖的白细胞介素（IL）-1受体途径与尿酸钠结晶引起的急性炎症有关，单核巨噬细胞的细胞膜表面存在Toll样受体2（TLR2）和Toll样受体4（TLR4），可以识别细胞外的MSU晶体，并诱导IL-1β前体的转录，从而产生一系列炎症级联反应[2]。……