郑桂华 邱明山 徐振兴 张倩 李依寒 陈进春

【摘 要】目的：探討血清瘦素、CD4+/CD8+淋巴细胞比值（CD4+/CD8+比值）与类风湿关节炎（rheumatoid arthritis，RA）中医证型的关系，为RA中医辨证分型提供客观参考依据。方法：选取RA患者199例，分为风湿痹阻证、寒湿痹阻证、湿热痹阻证、痰瘀痹阻证、肝肾不足证、气血两虚证6个证型，同时选取45例正常体检者为正常对照组。收集体检正常者及RA患者空腹血清，进行瘦素、CD4+/CD8+比值检测并记录结果，收集RA患者基本信息、临床症状、红细胞沉降率、C反应蛋白等，采用统计软件SPSS 20.0进行分析。结果：①RA组血清瘦素水平、CD4+/CD8+比值高于正常对照组（P < 0.001）。②RA组各证型血清瘦素水平比较，差异有统计学意义（P < 0.001），其中痰瘀痹阻证血清瘦素水平高于其他各证型（P < 0.05）。③RA组各证型血清CD4+/CD8+比值比较，差异有统计学意义（P < 0.001），其中湿热痹阻证血清CD4+/CD8+比值高于其他各证型（P < 0.05）。④RA组血清瘦素、CD4+/CD8+比值分别与DAS28评分之间存在显著的正相关（P < 0.001）。⑤RA组血清瘦素与CD4+/CD8+比值之间存在正相关（P < 0.05）。结论：在RA的6个中医证型中，血清瘦素水平、CD4+/CD8+比值异常升高可分别作为痰瘀痹阻证、湿热痹阻证的客观参考指标。RA患者血清瘦素水平与CD4+/CD8+比值之间存在正相关，提示瘦素代谢与细胞免疫之间可能存在一定的关系。

【关键词】 类风湿关节炎;瘦素;CD4+/CD8+淋巴细胞比值;中医证型

Analysis of Serum Leptin，CD4+/CD8+ and TCM Syndrome Types of Rheumatoid Arthritis

ZHENG Gui-hua，QIU Ming-shan，XU Zhen-xing，ZHANG Qian，LI Yi-han，CHEN Jin-chun

【ABSTRACT】Objective：To explore the relationship between serum leptin，CD4+/CD8+ and TCM syndrome types of rheumatoid arthritis（RA），so as to provide objective reference for TCM syndrome differentiation.Methods：One hundred and ninety-nine patients with RA were selected and divided into

six syndrome types：rheumatism-obstruction syndrome，cold dampness-obstruction syndrome，dampness-heat-obstruction syndrome，phlegm-stasis-obstruction syndrome，liver-kidney-deficiency syndrome，qi-blood-deficiency syndrome.Forty-five cases for normal physical examination were selected as the normal control group.The serum leptin and CD4+/CD8+ were detected and the results were recorded.The basic information，clinical symptoms，erythrocyte sedimentation rate and C-reactive protein of RA patients were collected and analyzed by SPSS 20.0.Results：①The serum leptin level and CD4+/CD8+ in the RA group were higher than those in the normal control group（P < 0.001）.②The difference of the levels of serum leptin in all the RA groups was statistically singnificant

（P < 0.001）and the level in the phlegm-stasis-obstruction syndrome group was significantly higher than that of other syndrome types（P < 0.05）.③The difference of CD4+/CD8+ in RA groups was statistically significant

（P < 0.001），and the ratio in the damp-heat-obstruction syndrome group was higher than that in other syndrome types（P < 0.05）.④There were significant positive correlations between serum leptin，CD4+/CD8+ and DAS28 score in the RA group（P < 0.001）.⑤There was a positive correlation between serum leptin and CD4+/CD8+ in the RA group（P < 0.05）.Conclusion：In the six TCM syndrome types of RA，the abnormal increase of serum leptin level and CD4+/CD8+ can be used as the objective reference indexes of phlegm-stasis syndrome and damp-heat syndrome respectively.There is a positive correlation between serum leptin level and CD4+/CD8+ in RA patients，which suggests that there may be a certain relationship between leptin metabolism and cellular immunity.

【Keywords】 rheumatoid arthritis;leptin;CD4+/CD8+;TCM syndrome type

类风湿关节炎（rheumatoid arthritis，RA）是以慢性进行性关节损害为特点的自身免疫病。炎症是RA发病的关键因素[1]，而以淋巴细胞浸润和渗出为主的血管炎性滑膜炎是其主要的病理特征。其临床表现除常见的关节肿痛、晨僵、变形等，往往伴食欲下降、体质量减轻、乏力等全身症状。瘦素作为机体营养代谢的“感知因子”，参与RA能量与物质代谢，其含量的消长是判断营养代谢与病情的最可靠指标之一，又可影响机体的免疫炎性反应，在细胞因子网络方面发挥多面手的作用。因此，基于血清瘦素、相关淋巴细胞水平的变化，观察RA中医证型的代谢、免疫变化，有助于更好地了解中医证型的病理生理基础及与临床实验室指标的相关性，达到辨证的客观性、可重复性。

1 临床资料

1.1 研究对象 选取2018年1月至2019年12月在厦门市中医院就诊的门诊及住院RA患者199例，同时选取体检科正常体检者45例。……