| Objective: To observe the clinical characteristics and immune environment of neuromyelitis optica spectrum disorders(NMOSD)during remission,and compare it with multiple sclerosis(MS).To observe the clinical efficacy of Kidney-Resolving PhlegmEliminating Blood-Activating treatment in NMOSD during remission,and to explore whether it regulates the disease's inflammatory environment by intervening related pro-inflammatory T lymphocytes.Methods: 1.Twenty-five NMOSD patients and twenty MS patients were enrolled in the clinic from May 2017 to April 2018,and twenty healthy volunteers were recruited as healthy controls(HC).Clinical information were collected,including age of onset,course of disease,onset symptoms,MRI study,antibody results,comorbidities and frequency of recurrence.Extended disability status scale(EDSS)and TCM symptom score were assessed.The ratio of CD4+IL17A+T lymphocyte,CD4+IL17A+IL6+ T lymphocyte,CD4+IFN?+ T lymphocyte in peripheral blood was detected by flow cytometry.Compare the differences among the groups,and analyze the correlation between those factors and neurological function scores.2.25 patients with NMOSD during remission were enrolled with 3 patients couldn't finish the study.TCM syndrome types of them were deficiency of liver and kidney yin and / or internal obstruction of phlegm and blood stasis.They were treated with traditional Chinese medicine based on kidney-resolving phlegm-eliminating blood-activating method for 6 months.The basic clinical information such as gender,age,the age of onset,course of disease,frequencies of relapse,time to the last relapse were collected.Before and after treatment,the TCM symptom score,the EDSS score and the Visual Analog Score(VAS)were assessed and the expression of CD4+IL17A+T lymphocyte,CD4+IL17A+IL6+ T lymphocyte,CD4+IFN?+ T lymphocyte in peripheral blood was detected by flow cytometry.Results: 1.NMOSD patients during remission:(1)The ratio of female to male in NMOSD patients during remission was 3.17:1.The age of onset of NMOSD group were significantly higher than MS group(P = 0.001).(2)The TCM symptom scores were significantly higher than MS group(P = 0.027).(3)The expression of CD4+IL17A+ / CD4+ in peripheral blood was statistically different between three groups(P = 0.046).NMOSD group was higher than HC group(P = 0.043),but there was no significant difference between the NMOSD group and the MS group,MS group and HC group(P = 0.459;P = 0.214).(4)There was a statistically significant difference in the ratio of CD4+IL17A+IL6 / CD4+IL17A+ between the three groups(P = 0.000).There was no significant difference between the NMOSD group and the MS group(P = 0.808),but the two groups were both significantly higher than the HC group(P = 0.000;P = 0.004).(5)The proportion of CD4+IFN?+ / CD4+ in peripheral blood was significantly different between the three groups(P = 0.000),but there were no significant difference between NMOSD group and MS group(P = 0.691).NMOSD group and MS were significantly lower than HC group(P = 0.000;P = 0.002).(6)Correlation analysis: The ratio of CD4+IL17A+IL6 / CD4+IL17A+ and CD4+IL17A+ / CD4+ in peripheral blood has no correlation with EDSS score and TCM symptom score(P = 0.283;P = 0.536).(7)Correlation analysis: CD4+IFN?+ / CD4+ ratio in peripheral blood was positively correlated with EDSS score and TCM symptom score(P = 0.034;P = 0.030),the more the ratio of CD4+IFN?+ / CD4+ in peripheral blood,the higher the EDSS score and TCM symptom score.2.Kidney-resolving phlegm-eliminating blood-activating treatment for NMOSD patients during remission:(1)22 patients with age range 21 to 54 years,the mean age were 34.41 ± 9.13 years.(2)The most common symptoms with sensory disturbance of 22 patients during the onset were numbness,limb pain and bundle,occupy 91%,68%,50%.(3)The EDSS score was lower than before after the treatment(P = 0.031),and the TCM symptom score significantly decrease after the treatment(P = 0.001).The VAS score was significantly lower than before after the treatment(P = 0.000).(4)The proportion of CD4+IL17A+IL6+ / CD4+IL17A+ in peripheral blood was decreased after treatment(P = 0.011).(5)There was no significant difference in the proportion of CD4+IL17A+ / CD4+ before and after treatment(P = 0.310).(6)The proportion of CD4+IFN?+ / CD4+ T lymphocytes in peripheral blood decreased after treatment,the difference was statistically significant(P = 0.022).Conclusion: 1.The pro-inflammatory T lymphocytes in patients with NMOSD during remission is not fully recovered to normal status.The ratio of Th17 cells and Th1 cells are significantly elevated,and the pro-inflammatory factor IL-6 secreting Th17 cells are also at a high expression level.The proportion of Th1 cells was positively correlated with EDSS score and TCM symptom score,suggesting that it can be used as a indicator for assessing the severity of the disease.2.Kidney-resolving phlegm-eliminating blood-activating treatment can relieve the clinical symptoms of NMOSD patients and reduce the neurological function score and the annual relapse rate.The treatment has no significant effect on the ratio of Th17 cells,but it can inhibit the ratio of IL-6 secreting Th17 cells and Th1 cells,which regulates the inflammatory environment of the circulation,thereby treating the NMOSD patients during remission. |
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