Zuo Zheng, Liu Zili, Yuan Kai, Wang Yaoling, Dong Kangli
School of Acupuncture, Tuina and Rehabilitation, Yunnan University of TCM, Kunming 650500, China.
Zhongguo Zhen Jiu. 2018 Oct 12;38(10):1053-7. doi: 10.13703/j.0255-2930.2018.10.006.
To explore the effects and mechanisms of the long-snake moxibustion on ankylosing spondylitis (AS) based on Th17/Treg/Th1 immune imbalance.
A total of 60 AS patients were randomized into an observation group and a control group, 30 cases in each one. In the observation group, the long-snake moxibustion therapy was used on the acupoints of the governor vessel from Dazhui (GV 14) to Yaoshu (GV 2) as well as the bilateral Jiaji (EX-B 2) alternatively. The moxibustion was given once a day, for 7 days continuously as one course. There were 3 days at the interval between the courses and 4 courses were required. In the control group, the routine western medication was provided, the salazosulfapyridine combined with non-steroidal anti-inflammatory drugs were used, for 7 days continuous as one course. A total of 4 courses of medication were required. The enzyme linked immunosorbent assay (ELISA) was adopted to determine the levels of interleukin-6 (IL-6), interleukin-17 (IL-17), interleukin-23 (IL-23) and tumor necrosis factor-α (TNF-α). The real-time quantification polymerase chain reaction (RT-PCR) was used to determine the mRNA expressions of the specific transcription factors, FoxP3 and T-bet of the helper 17 cells (Th17), regulatory T cells (Treg) and T helper 1 cells (Th1). The flow cytometry was applied to determine the rates of Treg, Th1 and Th17, as well as the changes of the inflammatory reaction index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The therapeutic effects were compared between the two groups.
After treatment, the total effective rate was 93.3% (28/30) in the observation group, which was better than 86.7% (26/30) in the control group (<0.05). After treatment, the levels of CRP, ESR, IL-6, IL-17, IL-23 and TNF-α, as well as the rate of Th17 were reduced significantly as compared with those before treatment in the observation group (all <0.05). The mRNA expressions of FoxP3 and T-bet and the rates of Treg and Th1 were increased as compared with those before treatment (all <0.05). The change degree in the observation group was significant as compared with the control group (all <0.05). In the control group, the levels of CRP, ESR, IL-6, IL-17, IL-23 and TNF-α, as well as the rate of Th17 were reduced, and the mRNA expressions of FoxP3 and T-bet and the rates of Treg and Th1 were increased after treatment. But the changes were not significant as compared with those before treatment (all >0.05).
The long-snake moxibustion effectively relieves the clinical symptoms in AS patients and regulates the Th17/Treg/Th1 immune imbalance. Its effect target is probably related to the modulation of the AS immune derangement and the inflammatory responses induced by immune derangement so as to achieve the dual-positive regulatory effect.
基于Th17/Treg/Th1免疫失衡探讨长蛇灸对强直性脊柱炎（AS）的影响及作用机制。
将60例AS患者随机分为观察组和对照组，每组30例。观察组采用长蛇灸疗法，交替灸督脉自大椎（GV 14）至腰俞（GV 2）以及双侧夹脊（EX-B 2）穴位。每天灸1次，连续7天为1个疗程。疗程间间隔3天，共需4个疗程。对照组给予常规西药治疗，采用柳氮磺胺吡啶联合非甾体类抗炎药，连续服用7天为1个疗程。共需4个疗程的药物治疗。采用酶联免疫吸附测定（ELISA）法测定白细胞介素-6（IL-6）、白细胞介素-17（IL-17）、白细胞介素-23（IL-23）和肿瘤坏死因子-α（TNF-α）水平。采用实时定量聚合酶链反应（RT-PCR）法测定辅助性17细胞（Th17）、调节性T细胞（Treg）和辅助性T细胞1（Th1）特异性转录因子FoxP3和T-bet的mRNA表达。应用流式细胞术测定Treg、Th1和Th17的比例，以及炎症反应指标C反应蛋白（CRP）和红细胞沉降率（ESR）的变化。比较两组的治疗效果。
治疗后，观察组总有效率为93.3%（28/30），优于对照组的86.7%（26/30）（P<0.05）。治疗后，观察组CRP、ESR、IL-6、IL-17、IL-23和TNF-α水平以及Th17比例均较治疗前显著降低（均P<0.05）。FoxP3和T-bet的mRNA表达以及Treg和Th1的比例较治疗前升高（均P<0.05）。观察组的变化程度与对照组相比差异有统计学意义（均P<0.05）。对照组治疗后CRP、ESR、IL-6、IL-17、IL-23和TNF-α水平以及Th17比例降低，FoxP3和T-bet的mRNA表达以及Treg和Th1的比例升高。但与治疗前相比变化不显著（均P>0.05）。
长蛇灸能有效缓解AS患者的临床症状，调节Th17/Treg/Th1免疫失衡。其作用靶点可能与调节AS免疫紊乱及免疫紊乱诱导的炎症反应有关，从而达到双向正调节作用。
