| Thromboangiitis obliterans (thromboangitis obliterans, TAO), also known as Buerger’s disease, is a chronic occlusive disease, inflammatory, segmental and periodic episodes of a vascular involvement; Epidemiology showed that TAO was distributed worldwide, especially in Southeast Asia, occurring in the Middle East and the Far East and central Europe, in which the Jews the incidence of central rate as high as 80%, in India for the 45%-63%[1], in a low social status, psychological pressure were particularly evident in men [2] smoke, in our TAO occurs in 20 to 40 years old between young men and women smoking, and the prevalence is 29:1; TAO is a chronic progressive the disease, patients are not in immediate danger of death, but their life expectancy than normal shortening, and pose a risk for amputation disability, worthy of attention is the amputation of thromboangiitis obliterans reported rates of about 4%. Etiology of TAO is not clear, the present study has confirmed that the active or passive smoking is an important component in the occurrence and development of this disease, other relevant factors include autoimmune disorders, gene polymorphism, sex hormone and prostaglandin, genetic disorders, cold and wet life relief, chronic injury and infection; the main clinical manifestations of TAO for limb ischemia, pain, intermittent claudication, lesions involving the arterial pulse disappeared or weakened and migratory superficial phlebitis, lesions, serious person can appear gangrene of limbs, secondary infection, resulting in amputation disability and other serious consequences; the current treatment for TAO mainly include smoking, use vasodilators, improve microcirculation, antibiotics, the sugar cortical hormone, Chinese traditional medicine, pharmaceutical preparations and surgical operation or interventional operation etc..Because of its etiology and pathogenesis is not yet clear at TAO, the disease has become one of the refractory diseases; with the deepening of research, more and more scholars tend to believe that the pathogenesis of TAO is due to immune complex formation and deposition in the patients blood vessels leading to vascular inflammation and thrombosis caused by the disorder of immune function, with an important role in the pathogenesis of TAO. The disorder of immune function in the body’s response to inflammation of the whole course of TAO through the body’s own disease; lymphocyte subsets in immune function regulation and play an important role in stabilizing; studies show, T lymphocyte subsets had abnormal changes in a variety of clinical diseases, such as autoimmune diseases, viral infection, malignant tumor, and different subsets of T lymphocytes in a variety of diseases, the development process will produce different effects。Helper T cell subgroup of 17 (Th17) is a recently found a new kind of CD4+T cell subgroup, in the differentiation, regulation and biological role is different from traditional Thl cells and Th2 cells, Th17 mainly secreted cytokines IL 17 a, and IL-17 a strong pro-inflammatory role [3], it of angiogenesis, the recruitment of inflammatory cells and the release of inflammatory factor regulating endothelial cells play an important role, can effectively mediated inflammatory reaction.Th17 cell differentiation process, regulation mechanism is very complicated, so far Thl7 cells and the secretion of IL-17 the mechanism of action in the body has not been fully elucidated, but with the in-depth research, at present a lot of related diseases are confirmed and Th 17 cells and high expression of IL-17 or expression:in recent years such as found in a variety of autoimmune diseases such as autoimmune cerebrospinal meningitis (EAE) [4] [5], rheumatoid arthritis and the process of target tissues can be detected the expression of IL-17; Th17 cells and IL 17 in diseases such as inflammatory bowel disease (IBD) also play an important role in [6]. And in view of the Th17 in autoimmune arthritis mediated the effect of T cell activation and bone resorption has discovered by Sato, etc [7]; Found in the study of viral hepatitis, liver tissue and peripheral blood in patients with frequency and IL 17 of Th 17 cells in expression levels were significantly increased, prompt Th17 cells and IL-17 May worsen the liver inflammation [8]; In infection and other inflammatory diseases, Caruso etc. [9] also puts forward the IL-23/IL-17 axis is associated with the pathogenesis of helicobacter pylori gastritis; IL-21 can be mediated is characterized by 17 high expression of IL-such as experimental colitis [10]. Also studies show that Th17 cells and the secretion of IL-17 also have a close relationship with the occurrence of tumor development [11]; Other such as crohn’s disease [12], the pathogenesis of psoriasis [13] and so on are also associated with Th17 cells and their secretion of cytokines; The enough evidence to show that Th17 cells in mediating inflammation and autoimmune disease plays an important role. But Th17 cells and their secretion of cytokines IL-17 with buerger’s disease onset and progression of the process there is no correlation between related reports yet.ObjectiveThis topic is based on the determination of TAO in patients with peripheral blood T helper cells 17 (T helper cel117, Th 17) and cytokine interleukin 17 (IL.17) factors such as parameters, by between patients and healthy controls, and comparison between a group of patients with different stages, the study peripheral helper T cell subsets in 17 patients with TAO (T helper cell 17, Thl7) and cytokine interleukin (IL) 17) 17 of the change and clinical significance of analysis of the possible mechanism, in order to further explore Th17 cells and IL-17 in the onset and progression of TAO produced in the process of role, can hope to its pathogenesis related intervention measures to control or delay the development of the course of the disease, reduce the risk of injury in patients with disability.Methods:Select the vascular surgery department of the Third Hospital of Guangzhou Medical University,36 patients with thromboangiitis obliterans (TAO) of patients (diagnosis standard in strict accordance with the diagnostic criteria of TAO proposed by Olin in 2000), all male smoking patients, age 25-53 years old, average age is 38 years old, according to the course of disease in patients with different stages of the divided into ischemic group 12 cases,14 cases of malnutrition group, gangrene group 10 cases; 30 cases of healthy people were selected and divided into the control group (the male subjects, aged 35-42 years old, average age is 37 years old, no smoking and drinking habits, to rule out infection, hypertension, coronary heart disease, diabetes, autoimmune disease) in healthy volunteers. All the subjects were in the early morning fasting elbow venous blood 6ml,3ml for the percentage of blood Th17 cells by flow cytometry was used to detect the expression level of 3ml in peripheral venous blood; the other by double antibody sandwich ELISA method for detection of plasma IL-17.The results1. By flow cytometry, Th17 percentage of cells (IL-17A/CD4+T) TAO patient group (5.52±2.328)%; healthy control group (1.82±0.3935)%; TAO group and the control group compared with each other in peripheral blood Th17 cell percentage P <0.05, statistically significant results; TAO patients with ischemic group stage group (Ⅱ phase) cells in peripheral blood Thl7 percentage (5.20 ± 2.477)%; nutritional disorders of the group (Ⅲ phase) was (5.58 ± 2.435)%; gangrene of the group (Ⅳ stage) was (5.82 ± 2.185)%; compared to each other between the three P>0.05, the difference was not statistically significant;2. ELISA results in plasma levels of IL-17 expression is displayed, TAO patient group (32.17 ± 2.662)%; healthy control group (5.96 ± 0.675)%; TAO group and control group in peripheral blood levels of IL-17 expression mutual Compare P <0.05, statistically significant results; TAO patients with ischemic group stage group (Ⅱ period) IL 17-expression levels (30.58 ± 1.691)%; nutritional disorders of the group (Ⅲ period) (32.06±2.980)%; gangrene of the group (Ⅳ stage) was (34.24± 1.756)%; ischemic period group (Ⅱ period) and gangrene of the group (Ⅳ period) results P less than 0.05 compared with each other, suggesting that there was difference; and ischemia of the group (Ⅱ period), nutritional disorders of the group (Ⅲ phase) and gangrene of the group (Ⅳ period) results compared with each other and nutritional disorders of the group (Ⅲ phase) P greater than 0.05, indicating no significant difference.Conclusion:1. TAO Th17 cells in patients with significantly higher frequency and activity, IL-17 expression levels are increased, the difference was statistically significant, suggesting that the incidence Thl7 cell activation and proinflammatory role of IL-17 may be associated with thrombotic factors obliterans and is closely related to disease progression; therefore can target Th17 cells and their secreted factors mechanism of IL-17, in the course of patients with TAO suppression Th17 cell activation and differentiation and development, or regulation, inhibition of IL-17 effect of proinflammatory cytokines intervention measures may have an important impact on the course of TAO, TAO for clinical diagnosis and treatment provide new ideas.2. Ischemia group (Ⅱ) and gangrene group (Ⅳ) the expression level of IL-17 between Pvalue of less than 0.05, the difference was statistically significant, may play an important role in considering the expression level of IL-17 in the evaluation of the severity of IVTAO patients with refractory ulcers or gangrene of the inflammatory response;3. TAO between the groups of patients with different stages of Thl7 cell detection results are compared with each other although there was no significant difference, but the percentage of Th17 cells showed a gradually increasing trend; also the expression level of IL-17 in ischemia group (Ⅱ) and malnutrition group (Ⅲ), nutritional disorders group (Ⅲ) and group IV (gangrene comparison between P stage) is greater than 0.05, suggesting that there was no significant difference, but the expression level of IL-17 has gradually increased trend, the progression of the TAO expression levels and that the percentage of Thl7 cells and IL-17 may exist certain correlation. |
PDF Full Text Request