青蒿素对 AECOPD 患者外周血中炎症因子及 Th17/Treg 失衡的调控

目的：通过检测青蒿素干预前后慢性阻塞性肺疾病急性加重期(AECOPD)患者外周血中 Th17细胞,Treg 细胞占 CD4+ T 细胞的比例,炎症因子 IL-6、IL-21、转化生长因子β(TGF-β)的含量,初步探讨青蒿素对 COPD 患者外周血中炎症因子和 Th17/Treg 失衡的调控机制。方法随机收集 AECOPD 20例,将其分为1640干预组和青蒿素干预组,收集同一时期肺功能正常健康体检者20例作为对照组,抽取清晨空腹静脉血,采用流式细胞术检测所有实验对象 CD4+ Th17细胞和 Treg 细胞占 CD4+ T 细胞的比例；采用 ELISA 方法检测所有实验对象血清中炎症因子 IL-6、IL-21、TGF-β的水平。结果①CD4+ Th17细胞/CD4+ T 细胞和 Th17/CD4+ Treg 细胞的比例1640干预组高于青蒿素干预组和对照组,青蒿素干预组高于对照组,差异有统计学意义(P <0.05)。Treg 细胞/CD4+ T 细胞的比例1640干预组则低于青蒿素干预组和对照组,青蒿素干预组低于对照组,差异有统计学意义(P <0.05)。炎症因子 IL-6和 IL-21的水平1640干预组高于青蒿素干预组和对照组；青蒿素干预组高于对照组,差异有统计学意义(P <0.05)。④炎症因子 TGF-β的水平1640干预组则低于青蒿素干预组和对照组,青蒿素干预组低于对照组,差异有统计学意义(P <0.05)。⑤Th17/Treg 细胞的比值与炎症因子 IL-6(r =0.095,P <0.05),IL-21(r =0.051,P <0.05)的水平呈正相关,与 TGF-β(r =-0.002,P <0.05)的水平呈负相关；炎症因子 TGF-β的水平与炎症因子 IL-6(r =-2.075,P <0.05),IL-21(r =-2.869,P <0.05)的水平呈负相关。结论 AECOPD 患者外周血中存在 Th17/Treg 的失衡,炎症因子 IL-6、IL-21、TGF-β与 Th17/Treg 的失衡密切相关,青蒿素可能能够通过下调 IL-6和 IL-21的表达,上调 TGF-β的表达来调节其失衡。

Effect of artemisinin on inflammatory factors and Th17/Treg imbalance in the peripheral blood of AECOPD patients

Objective To determine the value of Th1 7/CD4 + T cells and Treg/CD4 + T cells,and the amount of inflammatory factors IL-6,IL-21,TGF-β in the peripheral blood of patients with chronic obstructive pulmonary disease in acute exacerbation (AECOPD) before and after the artemisinin intervention.Methods The study selected 20 healthy people as the control group and 20 patients with AECOPD.The AECOPD patients were divided into 1 640 intervention and art intervention by different intervention agent.Collecting fasting vein blood to determine the ratio of Th1 7/CD4 + T cells and Treg/CD4 + T cells by flow cytometry and the levels of IL-6,IL-21,TGF-βby ELISA.Results ①CD4 + Th1 7/CD4 + T cells and Th1 7/CD4 + Treg:The ratio was highest in the 1 640 intervention group,followed by art intervention group and control group(P < 0.05).CD4 + Treg/CD4 + T cell The ratio was lowest in the 1 640 intervention group,followed by art intervention group and control group(P <0.05).The levels of IL-6 and IL-21 were the highest in the 1 640 intervention group,the levels of IL-6,IL-21 in art intervention group is higher than control group(P <0.05).④The levels of TGF-βis lowest in the 1 640 intervention group,the levels of TGF-βin the art intervention group is higher than in the control group(P <0.05).⑤The value of Th17/Treg was positively correlated with levels of inflammatory factors IL-6(r =0.095,P <0.05) and IL-21(r =0.05 1,P <0.05),was negatively correlated with the level of TGF-β(r =-0.002,P <0.05).The level of inflammatory factors TGF-βwas negatively correlated with the level of inflammatory factors IL-6 (r =-2.075,P <0.05) and IL-21 (r =-2.869,P <0.05).Conclusions The imbalance of the proportion of Th1 7 and Treg may be the important immunopathogenesis of COPD.The imbalance is closely related to the inflammatory factors IL-6,IL-21,TGF-β.Art can adjust this imbalance by inhibiting the expression of IL-6 and IL-21 and increasing the expression of TGF-β.