世界中医药

作者	单位
吴洁雅1，侯丽1，黄子明1，何昊2，张雅月1	1 北京中医药大学东直门医院，北京，100700； 2 陕西省西安医学院，西安，710021

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中文摘要:

目的：通过研究健脾益气摄血方对免疫性血小板减少症（Immune Thrombocytopenia，ITP）模型小鼠脑肠肽及T细胞相关细胞因子的影响，探讨健脾益气摄血方治疗ITP的效应机制。方法：以被动型免疫造模法建立ITP模型，实验前从30只BALB/c小鼠尾静脉取血，用全自动血细胞计数仪检测血小板计数，按照血小板计数随机分为对照组、ITP组、泼尼松组和健脾益气摄血方中剂量组、高剂量组，每组6只。以酶联免疫吸附试验法检测小鼠脑、结肠及血清中3种脑肠肽和血清、脾T细胞相关细胞因子的水平。结果：与ITP组比较，除血清小鼠垂体腺苷酸环化酶激活多肽（PACAP）外，泼尼松组3种脑肠肽在3种组织均升高；健脾益气摄血方中高剂量均可升高脑血管活性肠肽、结肠食欲刺激素和3种组织的PACAP水平。泼尼松组血清PACAP低于健脾益气摄血方中高剂量组。与ITP组比较，泼尼松降低血清、脾γ干扰素，升高血清、脾白细胞介素-2和脾白细胞介素-4、白细胞介素-10；在血清、脾，健脾益气摄血方中高剂量组可升高白细胞介素-2、白细胞介素-10，降低白细胞介素-17A。处理组间对比，益气摄血方高剂量组血清白细胞介素-2、脾转化生长因子-β1高于泼尼松组；益气摄血方高剂量组脾白细胞介素-17A低于泼尼松组。结论：健脾益气摄血方可从3个机制改善Th1/Th2细胞、Th17细胞/调节性T细胞失衡治疗ITP。1）通过上调脑肠肽水平，改善脑肠轴介导的肠道免疫功能失调，降低Th1细胞、Th17细胞数量，升高Th2细胞、调节性T细胞水平；2）通过抑制Th1细胞分泌γ干扰素和Th17细胞分泌白细胞介素-4、白细胞介素-10，促进Th2细胞分泌白细胞介素-17A和调节性T细胞分泌转化生长因子-β1、白细胞介素-27，逆转Th1/Th2细胞、Th17/调节性T细胞失衡；3）通过上调白细胞介素-2水平改善调节性T细胞缺陷间接恢复Th1/Th2细胞、Th17/调节性T细胞平衡。

English Summary:

To investigate the effects of Jianpi Yiqi Shexue Prescription on the levels of brain-gut peptides and T cell-related cytokines in a mouse model of immune thrombocytopenia(ITP) and explore its mechanism in the treatment of ITP.Methods:An ITP model was established using the passive immune modeling method.Prior to the experiment，blood was collected from 30 BALB/c mice via tail vein，and platelet counts were measured using an automated blood cell counter.The mice were then randomly divided into a control group，an ITP group，a prednisone group，and low- and high-dose Jianpi Yiqi Shexue Prescription groups，with six mice in each group.The levels of three brain-gut peptides and T cell-related cytokines in the brain，colon，and serum were measured using an enzyme-linked immunosorbent assay(ELISA).Results:Compared with the results in the ITP group，the levels of the three brain-gut peptides increased in the prednisone group except for pituitary adenylate cyclase-activating polypeptide(PACAP) in the serum.The Jianpi Yiqi Shexue Prescription groups were able to increase the levels of vasoactive intestinal peptide in the brain，colon-stimulating peptide，and PACAP in all three tissues.The serum PACAP level in the prednisone group was lower than that in the high-dose Jianpi Yiqi Shexue Prescription group.Compared with the ITP group，the prednisone group showed decreased γ-interferon levels in the serum and spleen and increased interleukin-2，interleukin-4，and interleukin-10 levels in the serum and spleen.In the serum and spleen，the Jianpi Yiqi Shexue Prescription groups showed increased interleukin-2 and interleukin-10 levels and decreased interleukin-17A level.In inter-group comparisons，the high-dose Jianpi Yiqi Shexue Prescription group showed higher serum interleukin-2 and spleen transforming growth factor-β1 levels than the prednisone group，and lower spleen interleukin-17A level than the prednisone group.Conclusion:Jianpi Yiqi Shexue Prescription can improve the imbalance between Th1/Th2 cells and Th17 cells/regulatory T cells in the treatment of ITP through the following three mechanisms:1）by up-regulating the levels of brain-gut peptides to improve gut immune dysfunction mediated by the brain-gut axis，reduce the number of Th1 cells and Th17 cells，and increase the levels of Th2 cells and regulatory T cells; 2）by inhibiting the secretion of γ-interferon from Th1 cells and interleukin-4 and interleukin-10 from Th17 cells，promoting the secretion of interleukin-17A from Th2 cells and transforming growth factor-β1 and interleukin-27 from regulatory T cells，and reversing the imbalance between Th1/Th2 cells and Th17/regulatory T cells; 3）by up-regulating the level of interleukin-2 to indirectly restore the balance between Th1/Th2 cells and Th17/regulatory T cells by improving regulatory T cell defects.

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