连续硬膜外阻滞对带状疱疹相关性疼痛患者调节性T淋巴细胞/辅助性T淋巴细胞17平衡及细胞因子的调节作用

邓小月; 梅晓丹; 张嬴政

doi:10.7619/jcmp.20254076

连续硬膜外阻滞对带状疱疹相关性疼痛患者调节性T淋巴细胞/辅助性T淋巴细胞17平衡及细胞因子的调节作用

Regulatory effects of continuous epidural block on the balance of regulatory T lymphocytes/helper T lymphocytes 17 and cytokines in patients with herpes zoster-related pain

摘要

摘要:
目的探讨调节性T淋巴细胞(Treg)、辅助性T淋巴细胞17(Th17)及白细胞介素(IL)-6、IL-10、IL-17在连续硬膜外阻滞(CEB)治疗带状疱疹相关性疼痛(ZAP) 中的变化及意义。
方法选取ZAP患者60例为研究对象, 采用数字随机表法将患者分为观察组(n=30)和对照组(n=30)。对照组采用常规药物治疗，观察组在对照组基础上给予CEB治疗。观察并比较2组患者的疼痛视觉模拟评分法(VAS)评分、外周血Treg细胞和Treg/Th17以及炎症因子水平。
结果 2组治疗后VAS评分低于治疗前，差异有统计学意义(P < 0.01); 治疗4、8 d后，观察组VAS评分低于对照组，差异有统计学意义(P < 0.01)。治疗4、8 d后，观察组的外周血CD4⁺Foxp3⁺Treg占CD4⁺T细胞的比例、Treg/Th17和IL-10表达水平高于治疗前, CD4⁺IL-17⁺Th17占CD4⁺T细胞的比例和IL-6、IL-17表达水平低于治疗前, 差异有统计学意义(P < 0.01或P < 0.05)。治疗8 d后，对照组的外周血CD4⁺Foxp3⁺Treg占CD4⁺T细胞的比例、Treg/Th17和IL-10表达水平比值高于治疗前, 外周血CD4⁺IL-17⁺Th17占CD4⁺T细胞的比例和IL-6、IL-17表达水平低于治疗前, 差异有统计学意义(P < 0.01或P < 0.05)。治疗4、8 d后，观察组的外周血CD4⁺Foxp3⁺Treg占CD4⁺T细胞的比例、Treg/Th17和IL-10表达水平高于对照组, 外周血CD4⁺IL-17⁺Th17占CD4⁺T细胞的比例和IL-6、IL-17表达水平低于对照组, 差异有统计学意义(P < 0.01或P < 0.05)。
结论 CEB可有效减轻ZAP患者的疼痛程度，且其可上调Treg/Th17, 降低IL-6、IL-17表达水平。

Abstract:
Objective To investigate the changes and significance of regulatory T lymphocytes (Treg), helper T lymphocytes 17 (Th17), interleukin (IL)-6, IL-10 and IL-17 in the treatment of herpes zoster-associated pain (ZAP) with continuous epidural block (CEB).
Methods A total of 60 patients with ZAP were selected as the study subjects and randomly divided into observation group (n=30) and control group (n=30) using a digital randomization table. The control group received conventional drug therapy, while the observation group received CEB treatment in addition to the conventional drug therapy administered to the control group. The pain Visual Analogue Scale (VAS) scores, peripheral blood Treg cell counts, Treg/Th17, and inflammatory cytokine levels were observed and compared between the two groups.
Results The VAS scores in both groups were significantly lower after treatment than treatment before (P < 0.01). After 4 and 8 days of treatment, the VAS scores in the observation group were significantly lower than those in the control group (P < 0.01). After 4 and 8 days of treatment, the proportion of peripheral blood CD4⁺Foxp3⁺Treg cells among CD4⁺T cells, the Treg/Th17, and the expression level of IL-10 in the observation group were significantly higher than those before treatment, while the proportion of CD4⁺IL-17⁺Th17 cells among CD4⁺T cells and the expression levels of IL-6 and IL-17 were significantly lower than those before treatment (P < 0.01 or P < 0.05). After 8 days of treatment, the proportion of peripheral blood CD4⁺Foxp3⁺Treg cells among CD4⁺T cells, the Treg/Th17, and the expression level of IL-10 in the control group were significantly higher than those before treatment, while the proportion of CD4⁺IL-17⁺Th17 cells among CD4⁺T cells and the expression levels of IL-6 and IL-17 were significantly lower than those before treatment (P < 0.01 or P < 0.05). After 4 and 8 days of treatment, the proportion of peripheral blood CD4⁺Foxp3⁺Treg cells among CD4⁺T cells, the Treg/Th17, and the expression level of IL-10 in the observation group were significantly higher than those in the control group, while the proportion of CD4⁺IL-17⁺Th17 cells among CD4⁺T cells and the expression levels of IL-6 and IL-17 were significantly lower than those in the control group (P < 0.01 or P < 0.05).
Conclusion CEB can effectively alleviate pain in patients with ZAP, upregulate the Treg/Th17, and reduce the expression levels of IL-6 and IL-17.

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