Abstract: Objective　To explore the relationship between the serum levels of interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 17 (IL-17), and tumor necrosis factor α (TNF-α) and different traditional Chinese medicine syndrome types of rheumatoid arthritis. Methods　It's a prospective study. A total of 100 patients with rheumatoid arthritis admitted to Hospital Affiliated to Liaoning University of Traditional Chinese Medicine from June to November 2021 were selected, and 60 healthy volunteers were included as a control group. The gender, ages, courses of disease, and other general data and the levels of IL-4, IL-6, IL-17, and TNF-α were compared between the groups. Chi square test, t test, and one-way ANOVA were applied. Results　Among the 100 patients, there were 12 males and 88 females, and they were 36-72 (51.48±12.93) years old. In the control group, there were 14 males and 46 females, and they were 18-60 (52.27±13.21) years old. There were no statistical differences in the general data between the two groups (all P>0.05). Compared with those in the control group, the levels of IL-4, IL-6, IL-17, and TNF-α were all increased in the patients with liver-kidney deficiency syndrome, cold-damp arthralgia syndrome, damp-heat obstruction syndrome, and phlegm-stasis-arthralgia-blocking syndrome, with statistical differences (all P<0.05). The levels of IL-4, IL-17, and TNF-α were (8.27±2.20) pg/ml, (56.58±10.80) pg/ml, and (16.61±2.90) pg/ml in the patients with cold-damp arthralgia syndrome, which were higher than those in the other patients; the level of IL-6 was (95.28±16.20) pg/ml in the patients with damp-heat obstruction syndrome, which was significantly higher than those in the patients with liver-kidney deficiency syndrome, cold-damp arthralgia syndrome, and phlegm-stasis-bi-blocking syndrome [(57.54±12.04) pg/ml, (52.18±10.30) pg/ml, and (51.75±13.03) pg/ml; all P<0.001]. Conclusions　The levels of serum inflammatory factors in patients with different syndromes of rheumatoid arthritis are different. The levels of IL-4, IL-17, and TNF-α in patients with cold-dampness arthralgia syndrome are the highest, and the level of IL-6 in patients with damp-heat obstruction syndrome was the highest, which may be used as the basis for clinical syndrome differentiation.

Key words: Rheumatoid arthritis, IL-4, IL-6, IL-17, TNF-α

摘要： 目的　探讨血清中白细胞介素（interleukin，IL）-4、IL-6、IL-17、肿瘤坏死因子-α（tumor necrosis factor α，TNF-α）水平与类风湿关节炎不同中医证型之间的关系。方法　本研究为前瞻性研究。选取2021年6月至11月辽宁中医药大学附属医院收治的类风湿关节炎患者共100例，同时纳入60例健康志愿者作为对照组。比较各组研究对象的性别、年龄、病程等一般资料，同时比较各组研究对象的IL-4、IL-6、IL-17、TNF-α水平。采用卡方检验、t检验及单因素方差分析。结果　100例类风湿关节炎患者中男12例，女88例，年龄36～72（51.48±12.93）岁。对照组中男14例，女46例，年龄18～60（52.27±13.21）岁。两组研究对象的一般资料比较，差异均无统计学意义（均P>0.05）。与对照组相比，肝肾不足证、寒湿痹证、湿热痹阻证、痰瘀痹阻证患者的IL-4、IL-6、IL-17、TNF-α水平均有所升高，差异均有统计学意义（均P<0.05）。其中，寒湿痹证患者IL-4、IL-17、TNF-α水平分别为（8.27±2.20）pg/ml、（56.58±10.80）pg/ml、（16.61±2.90）pg/ml，明显高于其他证型组；湿热痹阻证患者IL-6为（95.28±16.20）pg/ml，明显高于肝肾不足证组、寒湿痹证组和痰瘀痹阻证组［（57.54±12.04）pg/ml、（52.18±10.30）pg/ml、（51.75±13.03）pg/ml，均P<0.001］。结论　不同证型类风湿关节炎患者的血清炎性因子水平不同，寒湿痹证型患者IL-4、IL-17、TNF-α水平最高，湿热痹阻证患者IL-6水平最高，或可作为临床辨证分型依据。

关键词: 类风湿关节炎, IL-4, IL-6, IL-17, TNF-α