目的 观察雷公藤多苷片治疗支气管哮喘的临床疗效,并探讨其对Th17/Treg失衡的影响。方法 选取深圳市第二人民医院2014年3月—2015年3月收治的中重度支气管哮喘患者100例,随机分为对照组和治疗组,每组各50例。对照组给予常规治疗,治疗组在对照组的基础上口服雷公藤多苷片20 mg/次,3次/d,两组患者均连续治疗14 d。治疗后,观察两组的临床疗效,同时比较两组外周血Th17/Treg细胞比例,Th17和Treg细胞因子白介素-17(IL-17)、白介素-23(IL-23)、白介素-10(IL-10)、转化生长因子-β₁(TGF-β₁),肺功能指标第1秒时间肺活量(FEV₁)、第1秒时间肺活量/用力肺活量(FEV₁/FVC)。结果 治疗后,治疗组的总有效率(92.0%)明显高于对照组(76.0%),两组比较差异有统计学意义(P<0.05);两组外周血Th17细胞比例显著降低,Treg细胞比例显著升高,同组治疗前后差异具有统计学意义(P<0.05);且治疗组治疗后的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。两组患者血浆中IL-17、IL-23显著降低,TGF-β₁、IL-10显著升高,同组治疗前后差异具有统计学意义(P<0.05);治疗组治疗后的IL-17、IL-23显著降低,TGF-β₁、IL-10显著升高,与对照组治疗后比较差异具有统计学意义(P<0.05)。两组的FEV₁、FEV₁/FVC较治疗前显著升高,同组治疗前后比较差异有统计学意义(P<0.05);治疗组治疗后的FEV₁、FEV₁/FVC较对照组治疗后显著升高,两组比较差异具有统计学意义(P<0.05)。结论 雷公藤多苷片治疗支气管哮喘疗效较好,可显著改善肺功能,调节Th17/Treg免疫平衡可能是其作用机制。

Objective To evaluate the efficacy of Tripterygium Glycosides Tablets in treatment of bronchial asthma, and to investigate the influence of Tripterygium Glycosides Tablets to the unbalance of Th17/Treg. Methods Patients (100 cases) with moderately severe bronchial asthma in The First Affiliated Hospital of Shenzhen University from March 2014 to March 2015 were randomly divided into control and treatment groups, and each group had 50 cases. Patients in the control group were treated with conventional therapy, and patients in the treatment group were po administered with Tripterygium Glycosides Tablets on the basis of conventional therapy, 20 mg/time, three times daily. The patients in two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the changes of Th17/Treg cell ratio in peripheral blood, Th17/Treg cytokines interleukin-17 (IL-17), interleukin-23 (IL-23), interleukin-10 (IL-10), and transforming growth factor-β₁ (TGF-β₁), and lung function indices forced expiratory volume in 1 s (FEV₁), forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) were compared. Results After treatment, the clinical efficacy of patients in treatment group (92.0%) were higher than those in control group (76.0%) with significant difference (P < 0.05). Th17 cell ratio in peripheral blood of two groups was significantly reduced, and Treg cell ratio was significantly increased, and the difference was statistically significant in the same group (P < 0.05). The observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). IL-17 and IL-23 in blood plasma of two groups were significantly reduced, and TGF-β₁ and IL-10 was significantly increased, and the difference was statistically significant in the same group (P < 0.05). IL-17, IL-23, TGF-β₁, and IL-10 in the treatment group were better than those in control group, and the difference was significant between two groups (P < 0.05). FEV₁ and FEV₁/FVC of two groups were increased more than those before treatment with significant difference (P < 0.05). FEV₁ and FEV₁/FVC in treatment group were increased more than those in the control group, and the difference was significant (P < 0.05). Conclusion Tripterygium Glycosides Tablets has clinical curative effect in treatment of bronchial asthma, and can significantly improve lung function, and adjusting the Th17/Treg immune balance may be its mechanism.