消瘀泄浊饮对CKD2~4期患者免疫调节功能及微炎症状态的影响

目的]评估消瘀泄浊饮对慢性肾脏病(chronic kidney disease,CKD)2~4期患者免疫调节功能及微炎症状态的作用。方法]选取80例CKD2~4期患者,随机分为两组:对照组40例,仅予基础治疗;治疗组40例,除基础治疗外加用中药汤剂消瘀泄浊饮治疗,1剂/d,分早晚两次服用。治疗12周后,比较两组治疗前后维甲酸相关孤儿受体γt(retinoid-related orphan receptorγt,RORγt)、叉头框转录因子p3(forkhead box p3,Foxp3)mRNA相对表达量,超敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)及肾功能相关指标水平变化情况。结果]与治疗前比较,治疗组治疗后RORγt mRNA相对表达量下降(P<0.05),且低于对照组治疗后(P<0.05);Foxp3 mRNA相对表达量升高(P<0.05),且高于对照组治疗后(P<0.05)。与治疗前比较,治疗组治疗后hs-CRP水平下降(P<0.05),且低于对照组治疗后(P<0.05);血肌酐(serum creatinine,sCr)、血尿素氮(blood urea nitrogen,BUN)、24h尿蛋白定量(24-hour urinary protein quantity,24Upr)水平较前下降(P<0.05),其中sCr、BUN水平低于对照组治疗后(P<0.05)。结论]消瘀泄浊饮能够调节免疫平衡,改善微炎症状态,延缓肾功能恶化,其机制可能与下调RORγt mRNA、上调Foxp3 mRNA水平、调节Th17/Treg平衡相关。

The Effect of Xiaoyu Xiezhuo Decoction on the Immunoregulatory Function and the Microinflammatory State of Patients with Chronic Kidney Disease(Stage 2~4)

Objective]To evaluate the effect of Xiaoyu Xiezhuo Decoction on the immunoregulatory function and microinflammation state.Methods]Eighty patients were randomly divided into two groups:40 cases in control group,which were given only basic treatment;40 cases in treatment group,which were treated with Xiaoyu Xiezhuo Decoction in addition to basic treatment,1 dose per day,taken twice in the morning and in the evening.After 12 weeks of treatment,the changes of relative expression quantity of retinoid-related orphan receptorγt(RORγt),forkhead box p3(Foxp3)mRNA,levels of high sensitivity-C reactive protein(hs-CRP)and related indicators of renal function between the two groups were compared.Results]Compared with before treatment,relative expression quantity of RORγt mRNA of treatment group decreased after treatment(P<0.05),and it was lower than that of control group after treatment(P<0.05);relative expression quantity of Foxp3 mRNA of treatment group increased after treatment(P<0.05),and it was higher than that of control group after treatment(P<0.05).Compared with before treatment,level of hs-CRP,serum creatinine(sCr),blood urea nitrogen(BUN),24-hour urinary protein quantity(24Upr)of treatment group decreased after treatment(P<0.05),and hs-CRP,sCr,BUN were lower than that of control group after treatment.Conclusion]Xiaoyu Xiezhuo Decoction can regulate immune balance,improve the microinflammatory state,delay the deterioration of renal function,and the mechanism might be related to down-regulation of RORγt mRNA,up-regulation of Foxp3 mRNA and regulation of Th17/Treg balance.