禹洁 彭涛 左巧娟 谢圣发 谭劲

〔摘要〕 目的 探究利咽解毒方加减对口腔黏膜下纤维化患者趋化因子CCR2、Toll样受体2（TLR2）表达的影响。方法 选取2019年3月至2020年3月于湖南中医药大学第一附属医院接受治疗的口腔黏膜下纤维化患者114例，随机分为常规治疗组、利咽解毒方组，每组 57例，常规治疗组患者使用西药进行治疗，利咽解毒方组在常规治疗组治疗基础上使用利咽解毒方加减进行治疗。对比两组患者张口度、病变面积、中医证候评分，免疫透射比浊法检测GSH-Px、LPO、MDA水平，酶联免疫吸附实验法检测hs-CRP、IL-17、TGF-β1水平，检测两组患者血液流变学指标血浆黏度（PV）、纤维蛋白原（FIB）、高切全血黏度（HS），Western blot法检测CCR2、TLR2表达，对比两组治疗有效率。结果 治疗后，与常规治疗组相比，利咽解毒方组张口度较高，病变面积较小，中医证候评分较低（P<0.05），且两组较治疗前均有改善。治疗后，与常规治疗组相比，利咽解毒方组GSH-Px水平较高，LPO、MDA、hs-CRP、IL-17、TGF-β1、CCR2、TLR2及血液流变学指标PV、FIB、HS水平较低（P<0.05）。与常规治疗组相比，利咽解毒方组患者治疗总有效率较高（P<0.05）。与治疗前比较，两组治疗后上述指标均得到改善（P<0.05）。结论 利咽解毒方加减可使口腔黏膜下纤维化患者张口度受限状況明显缓解，病变面积缩小，炎症反应、氧化应激损伤明显减轻，血液流变学明显改善，CCR2、TLR2表达下调，治疗效果显著。

〔关键词〕 口腔黏膜下纤维化;利咽解毒方;炎症反应;血液流变学;氧化应激

〔中图分类号〕R276       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.021

〔Abstract〕 Objective To explore the effect of modified Liyan Jiedu Formula on the expression of chemokines CCR2 and toll-like receptor 2 （TLR2） in patients with oral submucous fibrosis. Methods A total of 114 patients with oral submucous fibrosis treated in The First Affiliated Hospital of Hunan University of Chinese Medicine from March 2019 to March 2020 were selected and randomly divided into conventional treatment group and Liyan Jiedu Formula group， with 57 cases in each group. Patients in conventional treatment group were treated with western medicine， while patients in Liyan Jiedu Formula group were treated with modified Liyan Jiedu Formula on the basis of conventional treatment group. The mouth opening， lesion area and traditional Chinese medicine （TCM） syndrome scores of the two groups were compared. The levels of GSH-Px， LPO and MDA were detected by immunity transmission turbidity. The levels of hs-CRP， IL-17 and TGF-β1 were detected by enzyme-linked immunosorbent assay. The hemorheological indexes plasma viscosity （PV）， fibrinogen （FIB） and high-cut whole blood viscosity （HS） of the two groups were detected. The expression of CCR2 and TLR2 was detected by Western blot， and the effective rates of the two groups were compared. Results After treatment， compared with the conventional treatment group， the Liyan Jiedu Formula group had higher mouth opening， smaller lesion area and lower TCM syndrome score （P<0.05）， and both groups showed improvement compared with before treatment. After treatment， compared with the conventional treatment group， the level of GSH-Px was higher， while the expression of LPO， MDA， hs-CRP， IL-17， TGF-β1， CCR2， TLR2 and hemorheological indexes PV， FIB and HS were lower in the Liyan Jiedu Formula group （P<0.05）. Compared with the conventional treatment group， the total effective rate of the Liyan Jiedu Formula group was higher （P<0.05）. Compared with before treatment， the above indexes were improved in both groups after treatment （P<0.05）. Conclusion Modified Liyan Jiedu Formula can significantly alleviate the mouth opening limitation in patients with oral submucous fibrosis， reduce the lesion area， alleviate the inflammation and oxidative stress injury， improve the hemorheology， down-regulate the expression of CCR2 and TLR2， and the treatment effect was significant.

〔Keywords〕 oral submucous fibrosis; Liyan Jiedu Formula; inflammatory reaction; hemorheology; oxidative stress

口腔黏膜下纤维化又称口腔黏膜下纤维性变，是一种常见的发生于机体口腔部位的慢性进行性疾病，具有癌变倾向[1-2]。口腔黏膜下纤维化具有口腔黏膜发硬、发白、纤维条索等临床症状，发病后主要临床表现为口干、吞咽困难、张口受限等，对患者身体健康、生活质量造成严重的影响，因此，寻找一种安全有效的治疗手段具有重要意义[3-4]。临床常用的治疗口腔黏膜下纤维化的手段为药物治疗，但是西医药物并不能彻底逆转纤维化，治疗效果并不理想，因此，许多专家学者开始致力于中医药治疗口腔黏膜下纤维化的研究[5]。……