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目的 探讨不同证候银屑病的发病与外周血Th1/Th17细胞轴漂移的相关性.方法 用流式细胞仪检测CD4+T细胞内细胞因子干扰素γ(IFN-γ)、白介素17A(IL-17A)的表达情况,双抗体夹心法(ELISA)检测不同证候银屑病患者血清中Th1型细胞因子IFN-γ和Th17型细胞因子IL-17A的水平.结果 血热组银屑病患者外周血单一核细胞(PBMC)中CD4+IFN-γ+水平显著高于血瘀组及健康对照组(P＜0.05),而血瘀组与健康对照组外周血PBMC中CD4+IFN-γ+平差异无统计学意义.血热组银屑病患者PBMC中CD4+IFN-γ+水平与PASI评分呈正相关(P＜0.05),血瘀组不具相关性(P＞0.05).血热组、血瘀组银屑病患者及健康对照组PBMC中CD4+IL-17A+三组间差异无统计学意义.血热组银屑病患者PBMC中CD4+IL-17A+水平与PASI评分不具相关性(P＞0.05),而血瘀组呈正相关(P＜0.05).ELISA结果示,血热组银屑病患者外周血清中IFN-γ水平显著高于血瘀组及健康对照组(P＜0.05),而血瘀组与健康对照组差异无统计学意义(P＞0.05)；血热组银屑病患者血浆中IFN-γ水平与PASI评分呈正相关(P＜0.05),血瘀组银屑病患者呈负相关(P＜0.05).血热组、血瘀组银屑病患者及健康对照血清中IL-17A水平三组间差异无统计学意义(P＞0.05),血热、血瘀组银屑病患者血清中IL-17A水平与PASI评分不具相关性(P＞0.05).结论 Th1细胞在血热型银屑病的发病中占主导地位,当血热型银屑病向血瘀型转化或正常转归时,Th1细胞的表达下降,而Th17细胞在不同证候银屑病患者中差异无统计学意义.

Objective To estimate the relationship between the development of psoriasis of different syndromes and type 1 helper T (Th1)/Th17 cell axis shift.Methods Venous blood samples were collected from 15 patients with blood-heat type psoriasis vulgaris (BHPV),15 patients with blood-stasis type psoriasis vulgaris (BSPV),and 16 healthy human controls.Flow cytometry was performed to detect the expression of a Th1 type cytokine interferon-γ (IFN-γ) and a Th17 type cytokine intedeukin 17A (IL-17A) in CD4+ T cells,and double-antibody sandwich enzyme linked immunosorbent assay (ELISA) to determine the serum level of IFN-γ and IL-17A.Statistical analysis was done by analysis of variance,least significant difference (LSD) procedure,and Spearman's correlation analysis.Results The patients with BHPV showed a statistical increase in the percentage of CD4+IFN-γ + cells in peripheral blood mononuclear cells (PBMCs) and in the serum level of IFN-γcompared with the patients with BSPV and the healthy controls (25.94％ ± 11.44％ vs.18.43％ ± 7.51％ and 13.57％ ± 7.70％,(86.48 ± 46.44) ng/L vs.(59.80 ± 12.73) ng/L and (46.00 ± 0.67) ng/L,all P ＜ 0.05),while no significant difference was observed between the patients with BSPV and the healthy controls in either of the two parameters (all P ＞ 0.05).The percentage of CD4+IFN-γ+ cells in PBMCs and psoriasis area and severity index (PASI) were positively correlated in patients with BHPV (r =0.723,P ＜ 0.05),but uncorrelated in those with BSPV (r =0.493,P ＞ 0.05).No significant differences were observed between the patients with BSPV,BHPV and the healthy controls in the percentage of CD4+IL-17A+ cells or in the serum level of IL-17A (all P ＞ 0.05).The percentage of CD4+IL-17A+ cells in PBMCs and PASI were uncorrelated in patients with BHPV (r =0.186,P ＞0.05),but positively correlated in those with BSPV (r =0.669,P ＜ 0.05).Serum IFN-γlevel and PASI were positively correlated in patients with BHPV (r =0.864,P ＜ 0.05),but negatively correlated in those with BSPV (r =-0.651,P ＜ 0.05).No statistical correlation was observed between the serum IL-17A level and PASI in either the patients with BSPV or those with BHPV (both P ＞ 0.05).Conclusions Th1 cells may exert a predominant role in the pathogenesis of BHPV,and may decrease in number when BHPV improves or shifts to BSPV,while no statistical difference is observed in the quantity of Th17 cells among patients with psoriasis of different syndromes.