【摘要】：研究目的： 1.以正常人為對(duì)照,觀測(cè)尋常型進(jìn)展期白癜風(fēng)患者外周血中CD3、CD4、CD8、CD4/CD8及sIL-2R、TNF-α水平,探討白癜風(fēng)發(fā)病的細(xì)胞免疫機(jī)制。 2.分析白癜風(fēng)中醫(yī)辨證分型與外周血T細(xì)胞亞群及sIL-2R、TNF-α水平的相關(guān)性,探討其中的規(guī)律性,有利于指導(dǎo)白癜風(fēng)的臨床分型診治。 研究對(duì)象： 2011年6月至2012年3月期間至江蘇省中醫(yī)院皮膚科就診的白癜風(fēng)初診患者,年齡在18-65周歲之間,共收集患者35例。診斷與分型分期依據(jù)《白癜風(fēng)臨床分型及療效標(biāo)準(zhǔn)(2010年修訂稿)》。這些患者近3個(gè)月內(nèi)未系統(tǒng)服用過(guò)糖皮質(zhì)激素、免疫抑制劑及免疫調(diào)節(jié)劑,之前未確診過(guò)其他自身免疫性疾病。 方法： 1.試驗(yàn)組：35例(男性20例,女性15例)年齡從18到58周歲(33.63±10.09歲)的尋常型進(jìn)展期白癜風(fēng)患者。對(duì)照組：20例(男性10例,女性10例)年齡從23到64周歲(35.26±11.12歲)的健康個(gè)體,沒(méi)有任何的自身免疫性疾病史。 2.采用統(tǒng)一設(shè)計(jì)的成人白癜風(fēng)臨床調(diào)查表并對(duì)患者本人詢(xún)問(wèn),內(nèi)容包括姓名、性別、年齡、病程、癥狀、體征、臨床分型、分期、舌苔、脈象等。 3.檢測(cè)方法：CD3、CD4、CD8采用流式細(xì)胞術(shù)檢測(cè),sIL-2R及TNF-α采用酶聯(lián)免疫吸附法檢測(cè)。 4.統(tǒng)計(jì)學(xué)方法：Excel軟件建立數(shù)據(jù)庫(kù),SPSS19.O軟件進(jìn)行統(tǒng)計(jì)分析。統(tǒng)計(jì)采用獨(dú)立樣本t檢驗(yàn)、秩和檢驗(yàn)和X2檢驗(yàn),0.01P0.05為差異具有顯著的統(tǒng)計(jì)學(xué)意義,P0.01為差異具有非常顯著的統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.尋常型進(jìn)展期白癜風(fēng)患者的年齡構(gòu)成在18-30歲,30-40歲,40-65歲之間未見(jiàn)差異,性別構(gòu)成也無(wú)差異(P0.05)。 2.中醫(yī)證型的分布與尋常型進(jìn)展期白癜風(fēng)不同亞型、年齡組及性別的構(gòu)成無(wú)明顯相關(guān)(P均0.05)。 3.與正常對(duì)照組相比較,尋常型進(jìn)展期白癜風(fēng)患者外周血CD3水平降低,有顯著差異(0.01P0.05)；外周血CD4水平降低,有非常顯著的差異(P0.01)；血CD8及CD4/CD8水平?jīng)]有明顯的統(tǒng)計(jì)學(xué)差異(P均0.05)。與正常對(duì)照相比,散在型進(jìn)展期白癜風(fēng)患者外周血CD3降低,有顯著差異(0.01P0.05)；CD4降低,有非常顯著的差異(P0.01)；CD8及CD4/CD8水平?jīng)]有顯著的統(tǒng)計(jì)學(xué)差異(P均0.05)。局限型進(jìn)展期白癜風(fēng)患者外周血CD3、CD4、CD8及CD4/CD8水平與正常對(duì)照組相比均沒(méi)有顯著的統(tǒng)計(jì)學(xué)差異(P均0.05)。 4.與正常對(duì)照組相比較,尋常型進(jìn)展期白癜風(fēng)患者組外周血sIL-2R水平升高,有非常顯著的統(tǒng)計(jì)學(xué)差異(P0.01)；外周血TNF-α水平升高,有顯著的統(tǒng)計(jì)學(xué)差異(0.01P0.05)。散在型患者組外周血sIL-2R及TNF-α水平與正常對(duì)照組比較均有非常顯著的統(tǒng)計(jì)學(xué)差異(P均0.01)。局限型患者外周血sIL-2R、TNF-α水平與對(duì)照組相比,均沒(méi)有顯著的統(tǒng)計(jì)學(xué)差異(P均0.05)。 5.肝腎陰虛證、氣滯血瘀證、濕熱蘊(yùn)結(jié)證患者組之間CD3、CD4、CD8、CD4/CD8、sIL-2R、及TNF-α水平均無(wú)顯著統(tǒng)計(jì)學(xué)差異(P均0.05)。 結(jié)論： 1.本組尋常型進(jìn)展期白癜風(fēng)患者細(xì)胞免疫功能異常,主要表現(xiàn)為外周血CD3、CD4水平較正常對(duì)照組明顯降低,而CD8及CD4/CD8水平與對(duì)照組相比卻沒(méi)有統(tǒng)計(jì)學(xué)差異,外周血sIL-2R、TNF-α水平較正常對(duì)照組明顯增高。與正常對(duì)照組相比,散在型進(jìn)展期白癜風(fēng)患者外周血CD3、CD4水平明顯降低,sIL-2R、TNF-α水平明顯增高。而局限型與對(duì)照組相比卻沒(méi)有統(tǒng)計(jì)學(xué)差異。 2.尋常型進(jìn)展期白癜風(fēng)患者細(xì)胞免疫功能異常,提示了其發(fā)病與自身免疫有關(guān),也進(jìn)一步支持了白癜風(fēng)的自身免疫發(fā)病學(xué)說(shuō)。 3.白癜風(fēng)各中醫(yī)證型間外周血CD3、CD4、CD8、CD4/CD8、sIL-2R及TNF-α水平均沒(méi)有明顯統(tǒng)計(jì)學(xué)差異,提示了中醫(yī)治療白癜風(fēng)的辨證分型物質(zhì)基礎(chǔ)是多方面的,與細(xì)胞免疫之間的關(guān)系需進(jìn)一步探討。
[Abstract]:Purpose of the study: 1. To observe the levels of CD3, CD4, CD8, CD4/ CD8 and sIL-2R, TNF-and CD4/ CD8 and sIL-2R, TNF-and in peripheral blood of patients with vitiligo in normal control and observe the cellular immunity of vitiligo. 2. To analyze the correlation between TCM syndrome differentiation typing and peripheral blood T cell subpopulations and sIL-2R, TNF levels in patients with vitiligo. diagnosis and treatment of bed type Study object: From June 2011 to March 2012, the patients with vitiligo in the dermatological department of Chinese Hospital of Jiangsu Province, aged 18-65 years old A total of 35 patients were collected. The diagnosis and classification stage was based on the clinical classification of vitiligo and the standard of efficacy. (Revised 2010)>. None of these patients received corticosteroids, immunosuppressive agents and immunomodulators for nearly 3 months before Have a visit to it Method: 1. Test group: 35 cases (male 20 cases, female 15 cases) from 18 to 58 years old (33. 63) 10 Control group: 20 patients (10 males and 10 females) with age from 23 to 64 years old (35. 26 vs. 11. 12 years old) Kang individual, without any autoimmune disease history. 2. Adopt the unified design adult vitiligo clinical investigation questionnaire and ask the patient oneself, the content includes name, sex, age, course of course, Symptoms, signs, clinical classification, stage, tongue coating, tongue coating, etc. 3. Detection methods: CD3, CD4, CD8 were detected by flow cytometry. sIL-2R and TNF-1R were detected by enzyme-linked immunosorbent assay. 4. Statistical methods: Exc The statistical analysis of the database and SPSS19. O software was carried out by the el software. The independent sample t test, the rank sum test and the X2 test were adopted, and the difference between 0. 01P0. 05 was significant. Statistics The significance, P0. 01 were significant statistical significance for the difference. Results: 1. The age of patients with vitiligo in the normal progression period was 18-30 years, 30-There was no difference between 40 and 65 years of age, and there was no difference in gender composition (P0.05). There was no significant correlation between the different subtypes, age groups and sex (P <0.05). 3. Compared with the control group, the level of CD3 in peripheral blood of patients with vitiligo vulgaris was decreased significantly (P0.05), and the level of CD4 in peripheral blood was decreased, and there were very significant differences (P There was no significant difference in the levels of CD8 and CD4/ CD8 in patients with vitiligo (P <0.05). Compared with normal controls, the CD3 decreased in peripheral blood of patients with vitiligo, and there were significant differences (0. 01P0. 05); CD4 decreased, and there was very significant difference (P <0.05). There was no significant statistical difference between CD8 and CD4/ CD8 levels (P 0.05). CD3, CD4, CD in peripheral blood of patients with vitiligo Compared with the control group, the levels of sIL-2R in peripheral blood of patients with vitiligo vulgaris were significantly higher than those of normal control group (P <0.05). (P 0.01), the level of TNF-VEP in peripheral blood increased, and there were significant statistical differences (0. 01P0. 05). The levels of IL-2R and TNF-IL were significantly different from those of normal control group (P 0.01). Compared with the control group, there was no significant difference in serum sIL-2R and TNF level (P 0.05). CD8 There was no significant difference in the levels of CD4/ CD8, sIL-2R and TNF-tau (P <0.05). Conclusion: 1. The abnormal cellular immune function of patients with vitiligo vulgaris in this group is mainly characterized by peripheral blood CD3, CD4 water. Compared with the normal control group, the level of CD8 and C was significantly lower than that in the control group. Compared with the control group, the levels of sIL-2R and TNF levels in peripheral blood were significantly higher than those in the control group. Compared with the group, the peripheral blood C of patients with vitiligo in the stage of progressive vitiligo The levels of CD3 and CD4 decreased significantly, and the levels of sIL-2R and TNF-2R were significantly higher, but there was no statistical difference compared with the control group. The abnormal cellular immune function of vitiligo patients with ordinary progression suggested that the pathogenesis of vitiligo is related to autoimmune diseases, and it also supports the theory of autoimmune disease of vitiligo. The peripheral blood CD3, CD4, CD8, CD4/ CD8, sIL-2R and TNF in each TCM syndrome type of vitiligo.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R758.41

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 解春桃;;白癜風(fēng)患者治療前后血清IL-2、SIL-2R、TNF-α和外周血B細(xì)胞及T淋巴細(xì)胞亞群檢測(cè)的臨床意義[J];放射免疫學(xué)雜志;2007年05期

2 汪京峽;段愛(ài)霞;張大軍;;白癜風(fēng)患者血清中白介素及腫瘤壞死因子水平變化的研究[J];皮膚病與性病;2006年01期

3 張學(xué)玲;毛東軍;劉影;葛邦友;沈景剛;沈奕;周彥;;白癜風(fēng)患者心理健康水平的評(píng)估及治療與細(xì)胞免疫功能的相關(guān)性研究[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2010年14期

4 高天文,李強(qiáng),李春英,李志強(qiáng),王秋楓;白癜風(fēng)2008例臨床分析[J];中國(guó)皮膚性病學(xué)雜志;2002年05期

5 繆澤群,劉少金;尋常型白癜風(fēng)患者外周血兒茶酚胺類(lèi)物質(zhì)水平的研究[J];中國(guó)皮膚性病學(xué)雜志;2004年03期

6 李東寧;裴洪菊;周和清;葛明康;董淑鳳;張韻莉;孫健;楊素華;;白癜風(fēng)患者外周血T細(xì)胞亞群的檢測(cè)[J];中國(guó)皮膚性病學(xué)雜志;2006年07期

7 姜昱;雷立清;葉楠;周穎;張艷彩;;白癜風(fēng)患者外周血CD_4,CD_8檢測(cè)及免疫調(diào)節(jié)劑對(duì)其影響[J];中國(guó)皮膚性病學(xué)雜志;2009年05期

8 季素珍,施惠娟,沈麗玉;白癜風(fēng)患者血清中可溶性白介素2受體的檢測(cè)[J];中國(guó)皮膚性病學(xué)雜志;1999年01期

9 顧勁松,涂彩霞,譚雪晶,谷玲,林熙然;白癜風(fēng)患者血清白介素、腫瘤壞死因子α及粒細(xì)胞-巨噬細(xì)胞集落刺激因子檢測(cè)[J];中華皮膚科雜志;2003年02期

10 楊靜,盛晚香;細(xì)胞間黏附分子1和白介素8與白癜風(fēng)的相關(guān)性研究[J];中華皮膚科雜志;2003年11期

相關(guān)會(huì)議論文 前1條

1 盧良君;許愛(ài)娥;陳梅花;;白癜風(fēng)分型分期與中醫(yī)證型的關(guān)系[A];浙江省中西醫(yī)結(jié)合學(xué)會(huì)皮膚科專(zhuān)業(yè)委員會(huì)第九次學(xué)術(shù)年會(huì)暨省級(jí)繼教班資料匯編[C];2005年

，

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