Correlation of non-alcoholic fatty liver disease patients of different Traditional Chinese Medicine syndrome with Th17/Treg levels in the peripheral blood
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摘要: 目的 分析不同中医证型非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)与外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)的相关性。方法 收集100例2022年1月—2023年4月就诊的NAFLD患者，根据中医辨证分为5个不同的中医证型组，另选取15例健康受试者作为对照组。分别检测各组受试者的肝功能、血脂、血糖、BMI、受控衰减参数(controlled attenuation parameter，CAP)值、外周血Th17/Treg和细胞因子水平，并通过Pearson检验分析病情指数与外周血T淋巴细胞水平的相关性。结果 相关性分析结果显示，NAFLD患者的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总胆固醇(TC)、甘油三酯(TG)、BMI、空腹血糖(FBG)、CAP、IL-17、IL-22水平与Th17水平呈正相关(P＜0.05)，而与Treg水平呈负相关(P＜0.05)。与对照组比较，NAFLD患者的AST、ALT、GGT、ALP、TC、TG、BMI、FBG、CAP、IL-17、IL-22、Th17水平和Th17/Treg比值显著升高，IL-10和Treg水平显著降低(P＜0.05)。不同中医证型NAFLD患者的各项指标比较，AST、ALT、GGT、ALP、TC、TG、BMI、FBG、CAP、IL-17、IL-22、Th17水平和Th17/Treg比值按证型排序，从高到低依次为湿热蕴结证组、痰瘀互结证组、湿浊内停证组、脾肾两虚证组和肝郁脾虚证组；而不同中医证型中，Treg水平的排序则相反。结论 NAFLD患者的中医证型与Th17/Treg平衡呈现一定的相关性，其中以湿热蕴结证患者Th17水平最高。Abstract: Objective To analyze the correlation between non-alcoholic fatty liver disease(NAFLD) patients of different Traditional Chinese Medicine(TCM) syndromes with Th17/Treg in peripheral blood.Methods One hundred NAFLD patients who visited the clinic from January 2022 to April 2023 were collected and divided into five groups based on TCM syndrome, and another 15 healthy volunteers were selected as the control group. The liver function, blood lipid, blood glucose, BMI, controlled attenuation parameter(CAP) value, levels of Th17/Treg and cytokines in peripheral blood were detected respectively, and the correlation between the disease index and levels of Th17/Treg was analyzed by the Pearson test.Results The results of correlation analysis showed that the levels of liver function(ALT, AST, GGT, ALP), lipids(TC, TG), FBG, BMI, CAP, Th17/Treg, IL-17, and IL-22 in patients with NAFLD showed a significant positive correlation with Th17(P < 0.05), while a significant negative correlation was observed with Treg(P < 0.05). Compared with the control group, NAFLD patients showed significantly higher levels of liver function(ALT, AST, GGT, ALP), TC, TG, FBG, BMI, CAP, Th17, IL-17 and IL-22, and lower levels of IL-10 and Treg(P < 0.05). Comparison of various indicators in NAFLD patients with different TCM syndromes. AST, ALT, GGT, ALP, TC, TG, BMI, FBG, CAP, IL-17, IL-22, Th17 levels and Th17/Treg ratio are sorted by syndrome type. From high to low, they are the damp-heat accumulation syndrome, the phlegm stasis mutual accumulation syndrome, dampness turbidity internal cessation syndrome, spleen kidney deficiency syndrome and liver depression and spleen deficiency syndrome. However, the ranking of Treg levels showed the opposite trend in the comparison of different TCM syndromes.Conclusion There is a certain correlation between the TCM syndromes of NAFLD patients and the balance of Th17/Treg, with the highest level of Th17 in patients with the dampness heat accumulation syndrome.
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表 1 受试者的临床资料比较
例，X±S 组别 例数 性别 年龄/岁 病程/年 男 女 肝郁脾虚证组 25 11 14 46.19±11.75 4.36±1.58 湿热蕴结证组 23 14 9 48.11±11.22 4.00±2.15 湿浊内停证组 17 10 7 46.77±9.51 4.06±1.82 痰瘀互结证组 22 10 12 43.51±12.89 4.91±2.30 脾肾两虚证组 13 7 6 49.09±6.76 5.69±3.04 对照组 15 8 7 41.43±5.22 
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表 2 各组受试者肝功能指标的比较
U/L，X±S 组别 例数 AST ALT GGT ALP 肝郁脾虚证组 25 29.68±2.782) 25.00±3.382) 38.60±3.152) 91.64±6.492) 湿热蕴结证组 23 33.48±4.111) 33.00±4.301) 42.00±4.621) 101.43±8.771) 湿浊内停证组 17 31.59±2.851) 27.59±5.271)2) 38.53±3.142) 96.00±7.882) 痰瘀互结证组 22 32.82±3.781) 29.86±6.071)2) 39.86±5.241) 98.36±9.441) 脾肾两虚证组 13 30.23±3.982) 26.46±4.162) 38.23±4.642) 93.00±5.642) 对照组 15 28.07±3.842) 24.27±5.472) 37.13±3.072) 90.93±13.672) 与对照组比较，1)P＜0.05；与湿热蕴结证组比较，2)P＜0.05。
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表 3 各组受试者血脂、BMI和血糖水平的比较
X±S 组别 例数 TC/(mmol/L) TG/(mmol/L) BMI FBG/(mmol/L) 肝郁脾虚证组 25 5.80±0.801)2) 2.29±0.421)2) 25.12±0.771)2) 5.48±0.632) 湿热蕴结证组 23 6.38±0.761) 3.54±1.181) 26.13±1.261) 5.97±0.781) 湿浊内停证组 17 6.28±0.771) 2.76±0.531)2) 25.53±1.061) 5.64±0.751) 痰瘀互结证组 22 6.26±0.981) 3.13±0.871) 26.08±1.131) 5.80±0.651) 脾肾两虚证组 13 5.86±0.511) 2.33±0.271)2) 25.34±1.071) 5.62±0.931) 对照组 15 4.48±0.442) 1.29±0.262) 23.66±3.20 5.05±0.572) 与对照组比较，1)P＜0.05；与湿热蕴结证组比较，2)P＜0.05。
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表 4 各组受试者炎症因子水平的比较
ng/L，X±S 组别 例数 IL-17 IL-22 IL-10 肝郁脾虚证组 25 38.76±10.161)2) 37.39±11.432) 14.28±1.882) 湿热蕴结证组 23 49.78±10.841) 45.80±8.911) 8.60±1.041) 湿浊内停证组 17 45.29±11.481) 40.47±6.561) 12.05±2.021)2) 痰瘀互结证组 22 47.83±10.571) 44.25±12.461) 10.07±1.581)2) 脾肾两虚证组 13 42.62±11.571) 39.01±9.142) 13.03±1.661)2) 对照组 15 22.00±4.052) 28.32±6.782) 15.85±2.002) 与对照组比较，1)P＜0.05；与湿热蕴结证组比较，2)P＜0.05。
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表 5 各组受试者Th17、Treg、Th17/Treg水平的比较
X±S 组别 例数 Th17/% Treg/% Th17/Treg 肝郁脾虚证组 25 3.56±0.601)2) 4.85±0.631)2) 0.75±0.161)2) 湿热蕴结证组 23 4.62±1.181) 3.49±0.641) 1.35±0.361) 湿浊内停证组 17 3.92±0.671)2) 4.53±0.561)2) 0.87±0.151)2) 痰瘀互结证组 22 4.33±0.901) 3.95±0.931)2) 1.17±0.401)2) 脾肾两虚证组 13 3.68±0.701)2) 4.75±0.651)2) 0.79±0.181)2) 对照组 15 2.53±0.582) 6.13±1.042) 0.42±0.102) 与对照组比较，1)P＜0.05；与湿热蕴结证组比较，2)P＜0.05。
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