目的:研究中药二黄散对伴有HPV感染的CINⅠ患者对宫颈局部免疫状态的影响。方法:选取伴有HPV感染的CINⅠ患者60例进行中药二黄散治疗,并观察治疗效果,同时用ELISA方法测定阴道灌洗液辅助性T淋巴细胞(Th细胞)1、2细胞因子水平,免疫组织化学方法检测中药二黄散治疗前后宫颈组织T-bet、GATA3表达,同时结合临床资料进行分析。结果:CINⅠ和HPV治疗结束后3个月转归率分别为76.7%、51.7%,患者治疗后IL-2、IL-4、IL-10水平,与治疗前比较,差异均无统计学意义(P〉0.05);但治疗后IFN-γ水平均明显升高,与治疗前比较,差异有统计学意义(P〈0.01);且治疗后宫颈组织T-bet蛋白表达升高(P〈0.01),GATA3蛋白表达降低(P〈0.05)。T-bet/GATA3比值较治疗前显著升高(P〈0.01)。结论:中药二黄散对伴有HPV感染的CINⅠ患者有较好的治疗作用,其治疗机制可能为:上调T-bet蛋白的表达,增强Th1细胞因子IFN-γ,相应地使Th2/Th1平衡向Th1偏移从而发挥抗HPV作用及治疗宫颈病变的作用。
Objective: To investigate the improvement of cervical microenvironment of Erhuang Powder on CINⅠaccompanied by human papillomavirurus( HPV) infection. Methods: A total of 60 cases with CINⅠaccompanied by HPV infection were entered in the randomized Erhuang Powder therapy. Evaluate the outcome of them. Vaginal lavage was collected from the patients. The levels of intedeukin( IL) 2,4,10 and interferon- γ( IFN- γ) were detected by enzyme linked immunosorbent assay( ELISA). Immunohistochemistry assay was used to detect the expressions of T- bet and GATA3. Results: The total effective rates of CINⅠand HPV were 76. 7% and 51. 7%. The levels of IL- 2,IL- 4 and IL- 10 before and after treatment had no significant difference( P 0. 05). The IFN- γ levels of patients after therapy were significantly higher than that before treatment and that of the control group 1( P 0. 05). The T- bet level of patients after therapy was significantly higher than that before treatment and that of control group 1( P 0. 01). But GATA3 was significantly lower than that before- treatment and that of control group 1( P 0. 05).T- bet/GATA3 was also higher( P 0. 01). Conclusion: Erhuang Powder can be used for treatment of CIN Ⅰ accompanied by HPV infection effectively. It may regulate Th1/Th2 immune balance. IFN- γ plays an important role in the defense of cervical epithelial cell through increasing the expression of T- bet. Th1 may be more important than Th2 in lower genital tract infections.