类风湿性关节炎中医证型与血浆白蛋白及Th17/Treg相关细胞因子的相关性研究

常军英; 王勇; 高伟; 康华

doi:10.16766/j.cnki.issn.1674-4152.004545

类风湿性关节炎中医证型与血浆白蛋白及Th17/Treg相关细胞因子的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.004545

邯郸市中医院风湿科，河北邯郸 056000

基金项目:

河北省中医药管理局科研计划项目 2022651

详细信息

通讯作者:
王勇，E-mail：wy19790928@163.com

中图分类号: R593.22 R255.6
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- 文章访问数: 7
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出版历程
- 收稿日期: 2025-09-18
- 网络出版日期: 2026-11-10

Correlation of traditional Chinese medicine syndrome types of rheumatoid arthritis with plasma albumin and Th17/Treg related cytokines

Department of Rheumatology Handan Hospital of Traditional Chinese Medicine, Handan, Hebei 056000, China

摘要

摘要: 目的研究类风湿性关节炎（RA）中医证型与血浆白蛋白（ALB）及Treg、辅助性T细胞17/调节性T细胞（Th17/Treg）相关细胞因子的相关性。方法选取2023年4月—2025年5月邯郸市中医院收治的102例RA患者及对照组（50例健康体检者），分析Th17/Treg相关细胞因子、ALB及与中医证型的关系。结果湿热痹阻证、寒湿痹阻证、痰瘀痹阻证、肝肾亏虚证分别50、20、17、15例；RA组Th17、白介素-17（IL-17）、白介素-23（IL-23）高于对照组（P＜0.05），而调节性T细胞（Treg）、血浆ALB低于对照组（P＜0.05）；RA患者Th17、IL-17、IL-23、类风湿性关节炎疾病活动评分（DAS28）呈正相关关系，ALB与细胞因子呈负相关关系（P＜0.05）；RA患者寒湿痹阻证、肝肾亏虚证Th17更低（P＜0.05），寒湿痹阻证、肝肾亏虚证IL-17、IL-23更高（P＜0.05），肝肾亏虚证ALB最低（P＜0.05）；湿热痹阻证DAS28评分＞5.1比例最高，肝肾亏虚证DAS28评分在3.3~5.0比例最高（P＜0.05）；湿热痹阻证、寒湿痹阻证、痰瘀痹阻证VAS评分更高，关节肿胀数、关节压痛数更多，血沉、CRP更高（P＜0.05）。结论 RA患者中医证型与ALB及Th17/Treg平衡、相关细胞因子有关，需开展针对性中医治疗。
- 类风湿性关节炎 /
- 中医证型 /
- 白蛋白 /
- Th17/Treg /
- 细胞因子 /
- 相关性
Abstract: Objective To study the correlation of the traditional Chinese medicine (TCM) syndrome types of rheumatoid arthritis (RA) with plasma albumin (ALB) and helper T cell 17/regulatory T cell (Th17/Treg) related cytokines. Methods A total of 102 RA patients (RA group) and 50 healthy individuals undergoing physical examinations during the same period (control group) were selected as the research subjects. The relationships between Th17/Treg-related cytokines, ALB, and the traditional Chinese medicine syndrome types were analyzed. Results There were 50 cases of damp-heat obstruction syndrome, 20 cases of cold-dampness obstruction syndrome, 17 cases of phlegm-stasis obstruction syndrome, and 15 cases of liver-kidney deficiency syndrome. The levels of Th17, interleukin-17 (IL-17) and IL-23 in the RA group were higher than those in the control group (P < 0.05), while regulatory T cells (Treg) and plasma ALB were lower (P < 0.05). Th17, IL-17, IL-23 and the rheumatoid arthritis disease activity score (DAS28) score in RA patients were positively correlated pairwise, while ALB was significantly negatively correlated with the scores of Th17, IL-17, IL-23 and DAS28 (P < 0.05). In RA cases, Th17 in cold-dampness obstruction syndrome and liver-kidney deficiency syndrome was lower than that in damp-heat obstruction syndrome and phlegm-stasis obstruction syndrome (P < 0.05), while IL-17 and IL-23 were higher (P < 0.05), ALB was the lowest in liver-kidney deficiency syndrome, followed by damp-heat obstruction syndrome (P < 0.05). The proportions of DAS28 scores >5.1 were the highest in damp-heat obstruction syndrome. The proportion of DAS28 score ranging from 3.3 to 5.0 was the highest in patients with liver-kidney deficiency syndrome (P < 0.05). Compared with the syndrome of liver -kidney deficiency, the VAS scores of damp-heat obstructions syndrome, cold-dampness obstruction syndrome and phlegm-stasis obstruction syndrome were higher, the number of joint swellings and joint tenderness was more, and the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher (P < 0.05). Conclusion The TCM syndrome types of RA patients are correlated with ALB, Th17/Treg balance, and related cytokines, necessitating targeted TCM treatment.
- Rheumatoid arthritis /
- Traditional Chinese medicine syndrome types /
- Albumin /
- Th17/Treg /
- Cytokine /
- Correlation

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图 1 RA患者中医证型构成

Figure 1. Composition of TCM syndrome types in RA patients

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图 2 RA组及对照组Th17、Treg细胞比例(流式细胞技术)

注：A、B为RA患者Th17、Treg细胞比例，C、D为对照组患者Th17、Treg细胞比例。

Figure 2. Proportions of Th17 and Treg cells in the RA group and the control group (flow cytometry)

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表 1 不同中医证型的RA患者基线资料比较

Table 1. Comparison of baseline data of RA patients with different TCM syndrome types

中医证型	例数	性别[例(%)]		年龄(x±s，岁)	RA病程(x±s，年)
中医证型	例数	男性	女性	年龄(x±s，岁)	RA病程(x±s，年)
湿热痹阻证	50	27(54.00)	23(46.00)	54.26±5.57	4.25±0.46
寒湿痹阻证	20	12(60.00)	8(40.00)	55.10±5.56	4.30±0.44
痰瘀痹阻证	17	9(52.94)	8(47.06)	54.93±5.68	4.47±0.45
肝肾亏虚证	15	8(53.33)	7(46.67)	55.02±5.59	4.38±0.42
统计量		0.268^a		0.161^b	1.137^b
P值		0.966		0.923	0.338
注：^a为χ²值，^b为F值。

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表 2 RA组与对照组Th17/Treg相关细胞因子、ALB水平比较(x±s)

Table 2. Comparison of Th17/ Treg-related cytokines and ALB levels between the RA group and the control group (x±s)

中医证型	例数	Th17 (%)	IL-17 (pg/mL)	IL-23 (pg/mL)	Treg (%)	ALB (g/L)
RA组	102	2.25±0.58	101.47±33.83	84.74±31.46	1.89±0.23	34.44±3.87
对照组	50	1.52±0.07	53.21±5.48	26.77±2.89	3.94±0.45	38.46±4.14
t值		8.705	10.007	12.981	37.223	5.880
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 RA患者Th17相关细胞因子、ALB水平与DAS28评分的相关性(r值)

Table 3. The correlation between Th17-related cytokines and ALB levels in RA patients and the DAS28 score (r value)

项目	Th17	IL-17	IL-23	Treg	ALB	DAS28评分
Th17	1.000
IL-17	0.647^a	1.000
IL-23	0.526^a	0.488^a	1.000
Treg	-0.136	-0.143	-0.158	1.000
ALB	-0.433^a	-0.502^a	-0.497^a	0.089	1.000
DAS28评分	0.514^a	0.493^a	0.516^a	-0.177	-0.475^a	1.000
注：^aP＜0.05。

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表 4 各中医证型的RA患者Th17/Treg相关细胞因子、ALB水平比较(x±s)

Table 4. Comparison of Th17/Treg-related cytokines and ALB levels of RA patients with different TCM syndrome types (x±s)

中医证型	例数	Th17(%)	IL-17(pg/mL)	IL-23(pg/mL)	Treg(%)	ALB(g/L)
湿热痹阻证	50	2.83±0.29	70.46±7.35	55.67±5.84	1.84±0.26	33.69±3.57
寒湿痹阻证	20	1.72±0.19^a	146.27±14.53^a	125.63±12.75^a	1.96±0.21^a	35.78±3.64
痰瘀痹阻证	17	1.95±0.21^ab	94.68±9.57^ab	76.38±7.82^ab	1.93±0.20^ab	36.72±3.71^a
肝肾亏虚证	15	1.70±0.18^ac	119.60±12.31^abc	105.44±10.73^abc	1.87±0.18^abc	31.64±3.26^bc
F值		154.712	392.712	471.698	1.564	7.033
P值		＜0.001	＜0.001	＜0.001	0.203	＜0.001
注：与湿热痹阻证比较，^aP＜0.05；与寒湿痹阻证比较，^bP＜0.05；与痰瘀痹阻证比较，^cP＜0.05。

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表 5 各中医证型的RA患者DAS28评分及构成

Table 5. DAS28 scoring results and composition of RA patients with different TCM syndrome types

中医证型	例数	DAS28评分(x±s，分)	＞5.1分[例(%)]	3.3~5.0分[例(%)]	2.6~3.2分[例(%)]	＜2.6分[例(%)]
湿热痹阻证	50	6.02±0.64	49(98.00)	1(2.00)	0	0
寒湿痹阻证	20	5.29±0.53^a	12(60.00)	8(40.00)	0	0
痰瘀痹阻证	17	5.16±0.54^a	13(76.47)	4(23.53)	0	0
肝肾亏虚证	15	4.39±0.48^abc	4(26.66)	10(66.67)	1(6.67)	0
统计量		34.183^d	39.425^e
P值		＜0.001	＜0.001
注：与湿热痹阻证比较，^aP＜0.05；与寒湿痹阻证比较，^bP＜0.05；与痰瘀痹阻证比较，^cP＜0.05。^d为F值，^e为χ²值。

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表 6 各中医证型的RA患者症状及实验室指标比较(x±s)

Table 6. Comparison of Symptoms and laboratory indicators of RA patients with different TCM syndrome types (x±s)

中医证型	例数	VAS评分(分)	关节肿胀数(个)	关节压痛数(个)	ESR (mm/h)	CRP (mg/L)	RF (RU/mL)	抗CCP抗体(RU/mL)
湿热痹阻证	50	4.35±0.46	4.28±0.43	9.32±0.98	49.35±5.16	37.56±3.89	384.75±39.66	426.35±43.88
寒湿痹阻证	20	6.37±0.65^a	3.72±0.38^a	8.47±0.85^a	35.73±3.67^a	34.12±3.57^a	377.89±38.37	418.34±42.39
痰瘀痹阻证	17	6.04±0.63^a	2.68±0.29^ab	7.31±0.76^ab	46.37±4.38^ab	42.67±4.35^ab	380.55±38.94	422.73±42.68
肝肾亏虚证	15	3.28±0.29^abc	1.78±0.16^abc	5.43±0.56^abc	32.14±3.25^abc	30.19±3.16^abc	379.72±38.41	424.38±43.56
F值		150.851	210.552	84.507	80.913	32.330	0.181	0.168
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.909	0.918
注：与湿热痹阻证比较，^aP＜0.05；与寒湿痹阻证比较，^bP＜0.05；与痰瘀痹阻证比较，^cP＜0.05。

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