寻常型银屑病血热证患者免疫血清学标志物的系统评价

目的：系统评价寻常型银屑病血热证患者免疫血清学标志物γ-干扰素（interferon-γ, IFN-γ）、白介素（interleukin, IL）-4、IL-17、IL-23、IL-6、α-肿瘤坏死因子（tumor necrosis factor-α, TNF-α）和IL-10水平的变化。方法：完整检索7个数据库中的近30年相关文献，纳入17篇文献，共包括768例受试者（443例寻常型银屑病血热证患者和325例健康对照者）。评价被纳入文献的研究质量并提取有效数据，然后采用随机效应模型合并受试组和对照组受试者的免疫血清学标志物水平效应量。结果：总效应量分析结果显示，受试组患者的血清IFN-γ水平（均数差24.90 pg/ml,95% CI：12.36~37.43）、IL-17水平（均数差28.92 pg/ml,95% CI：17.44~40.40）、IL-23水平（均数差310.60 pg/ml,95% CI：4.96~616.24）和TNF-α水平（均数差19.84 pg/ml,95% CI：13.80~25.87）显著高于对照组， IL-4水平（均数差-13.5 pg/ml,95% CI：-17.74~-9.26）和IL-10水平（均数差-10.33 pg/ml,95% CI：-12.03~-8.63）显著低于对照组，IL-6水平没有显著变化。结论：寻常型银屑病血热证患者的血清IFN-γ、IL-17、IL-23和TNF-α水平显著升高，而IL-4和IL-10水平显著降低。该结论尚需得到高质量、大样本量临床研究的进一步证实。

Immune signatures in patients with psoriasis vulgaris of blood-heat syndrome:a systematic review and meta-analysis

Objective:Tosystematically evaluate the changes of the levels of immunologically serological markers, such as interferon-γ (IFN-γ), interleukin (IL)-4, IL-17, IL-23, IL-6, IL-10 and tumor necrosis factor-α (TNF-α), in patients with psoriasis vulgaris of blood-heat syndrome.Methods: The relevantliterature in the past 30 years was completely searched from seven databases and seventeen literatures were found, in which 768 subjects including 443 patients with psoriasis vulgaris of blood-heat syndrome and 325 healthy controls were involved. The study quality of these literatures was evaluated and some valid data were extracted. Differences in serum marker levels between subjects and controls were pooled as mean differences (MD) using the random-effects model.Results:The pooled MD were higher in patients than in healthy controls for IFN-γ (MD 24.90 pg/ml, 95%CI: 12.36 ~ 37.43), IL-17 (MD 28.92 pg/ml, 95% CI: 17.44 ~ 40.40), IL-23 (MD 310.60 pg/ml, 95% CI: 4.96 ~ 616.24), TNF-α(MD 19.84 pg/ml, 95% CI: 13.80 ~ 25.87). The levels of the pooled IL-4 (MD -13.5 pg/ml, 95% CI: -17.74 ~ -9.26) and IL-10 (MD-10.33 pg/ml, 95% CI: -12.03 ~ -8.63) were lower in patients than in the healthy controls. There were no signiifcant differences in IL-6 levels between subjects and controls.Conclusion:The levels of IFN-γ, IL-17, IL-23, and TNF-α are signiifcantly elevated while the levels of IL-4 and IL-10 are signiifcantly decreased in sera of patients with psoriasis vulgaris of blood-heat syndrome. However, this conclusion is remained to be further conifrmed by clinical research with high-quality data and large sample sizes.