| Objectives:1. To investigate the expression of Thl/Th2/Th17-related cytokines and hBD-2,-3 in saliva of patients with erosive oral lichen planus (EOLP) and to explore their role in pathogenesis of EOLP.2. To study the effects of glucocorticoid on the expression of T cell related cytokines, hBDs and oral candida load in patients with EOLP, as well as its influence in clinical appearance.Method:Thirty EOLP patients were enrolled in the study, along with twenty age-and sex-matched healthy controls. The enrolled EOLP patients were treated with prednisone for 1 week by 0.4mg/(kg-d), and examined before and after treatment. Unstimulated whole saliva were collected for detecting the levels of cytokines (IL-1β, TNF-a, IFN-y, IL-4, IL-6, IL-10, IL-17) by cytometric bead array (CBA) and human β-defensins (hBD-2, hBD-3) by ELIS A; oral rinse samples were collected for culture of candida species to count the candida load. In SPSS Version 19.0, the change of cytokines, human P-defensins and oral candida load was analyzed by Mann-Whitney U test and Wilcoxon signed ranks test. The correlation among cytokines, human β-defensins and oral candida load was further assessed by Spearman rank correlation and logistic regression analysis.Results:1. Expression of inflammatory factors in saliva of EOLP patients before treatment:EOLP patients showed higher levels of salivary IL-1β, IL-6, hBD-2, hBD-3 and lower IFN-y/IL-4 ratio, IL-1β/IL-6 ratio compared to those of the healthy controls. Also, the levels of salivary hBD-2 in EOLP patients were positively related to IFN-γ, and negatively related to IL-17. Salivary hBD-3 levels were negatively related to that of IL-17 and IL-10. By multiple factor analysis, EOLP was positively related to IL-6 (B=1.336, P=0.042) and negatively related to IFN-y/IL-4 ratio (B=-14.382, P=0.047).2. After treatment with prednisone for 1 week, the levels of IL-1β, TNF-a, IFN-y, IL-6, hBD-2,-3 and IFN-y/IL-4 ratio were decreased significantry. Compared to the control group, IL-1β showed no significant difference; but IL-6, hBD-2,-3 levels were significantly higher; TNF-a and IFN-y/IL-4 ratio were significantly lower. Meanwhile, the oral CFU was negatively related to TNF-a. In healthy controls, the oral CFU was negatively related to IFN-y/IL-4 ratio. Levels of IL-1β,IL-6 and TNF-a were positively related to the scores of clinical symptom and sign.3. The changes of clinical characters in 30 EOLP patients before and after treatment with prednisone were found as followings, VAS score 4.10±1.79, 1.93±1.72 (before and after), Sign score 4.53±0.51,2.77±1.36 (before and after), both decreased significantly after treatment, which indicated that prednisone intervention was effective in general.24 cases (80%) were positively treated, while in 6 cases (20%) the treatment was ineffective. Comparing the results of the effective and ineffective subgroups, salivary TNF-a levels of EOLP patients who were ineffectively treated were significantly higher than that of effective group before treatment, and the changes of IL-6 level were lower than that of effective group.Conclusion:1. High expression of IL-1β, IL-6, hBD-2, hBD-3 and Thl/Th2 imbalance in saliva of EOLP patients might be related to the pathogenesis of disease. IFN-y/IL-4 balance might be a protective factor for EOLP. Glucocorticoids had a significant effect on EOLP, and inhibited the expression of Thl/Th2 cytokines, especially, the inhibitory effect of Thl related cytokines being most pronounced.2. According to the analysis between different therapeutic effect subgroups, the results suggested that the down-regulation of IL-6 level in saliva of EOLP patients might be related to the clinical efficacy. The level of salivary TNF-a of EOLP patients might be considered as a biomarker for predicting the short-term clinical efficacy of prednisone. |
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