目的：观察补肾强督方对肾虚督寒型强直性脊柱炎(AS)患者外周血Th17表达的影响。方法选择2011年6月~2013年10月上海市长宁区光华中西医结合医院风湿病科、急诊关节病科和上海中医药大学附属岳阳中西医结合医院风湿病科收治的AS患者，将68例AS患者随机分为西药组和中西药组，西药组给予柳氮磺胺吡啶，中西药组加补肾强督方。观察AS患者BATH功能指数(BASFI)、病情活动指数(BASDAI)、疾病缓解时间以及外周血Th17细胞比例、白介素(IL)-17、IL-23表达水平。共计给药24周，每2周记录1次患者的BASFI、BASDAI，给药前及每月对Th17、IL-23、IL-17及血沉、C反应蛋白、肝肾功能等进行检测。结果中西药组平均病情缓解时间明显小于西药组(P<0.05)，在8周时中西药组有效率为72.8%，西药组有效率为63.7%；在24周时，中西药组有效率为78.8%，西药组有效率为75.0%；给药后两组Th17细胞比例均有下降，第16周时两组组间Th17表达差异有统计学意义(P<0.05)。中西药组IL-23及IL-17表达均有所下降，差异有统计学意义(P<0.05)。结论补肾强督法治疗肾虚督寒型AS可能通过调节Th17表达水平及其细胞因子如IL-17等表达水平而改善临床症状及相关实验室检查结果。%Objective To observe the effect of Tonifying Kidney and Governor Vessel Prescription on peripheral blood expression of Th17 in patients with Kidney Deficiency and Governor Vessel Cold type of ankylosing spondylitis (AS). Methods AS patients admitted to Department of Rheumatology and Department of Emergency Joint Disease of Guanghua Hospital of Integrated Traditional Chinese and Western Medicine in Changning District in Shanghai City, Department of Rheumatology of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from June 2011 to October 2013 were chosen. All 68 cases of pa-tients were randomly divided into the Western medicine group and the integrated Chinese-Western medical treatment group, serving SASP for the Western medicine group and the Tonifying Kidney and Governor Vessel Prescription for the integrated Chinese-Western medical treatment group. The BATH function index (BASFI), BASDAI, disease median re-sponse time, the Th17 cell proportion in the peripheral blood, and the expression level of IL-17 and IL-23 of AS pa-tients were observed. The dosing period amount was 24 weeks, the patien ts' BASFI and BASDAI were recorded once two weeks, and the Th17, IL-23, IL-17 and ESR, CRP, the hepatorenal function, etc. before dosing and in each month were tested. Results The average disease median re-sponse time of the integrated Chinese-Western medical treatment group was obviously shorter than that of the Western me dicine group (P < 0.05). When it was 8 weeks, the effective rate of the integrated Chinese-Western medical treatment group was 72.8%, and the effective rate of the Western medicine group was 63.7%. When it was 24 weeks, the effective rate of the integrated Chinese-Western medical treatment group was 78.8%, and the effective rate of the Western medicine group was 75.0%. The Th17 cell proportions of the both groups were dropped after dosing. When it was 16 weeks, there were obvious differences on the expression of Th17 between the two groups, which had the statistical significance (P< 0.05). The expression of IL-23 and IL-17 of the integrated Chinese-Western medical treatment group dropped to some extent, and this also had some statistical significance (P<0.05). Conclusion Tonifying Kidney and Governor Vessel method in treating Kidney Defi-ciency and Governor Vessel Cold type of AS may improve clinical symptoms and related laboratory test results by ad-justing the expression level of Th17 and the expression level of its cytokines like IL-17.
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