2026 年第 3 期 第 21 卷

独活寄生汤通过调控辅助性T细胞17/调节性T细胞平衡及相关细胞因子治疗强直性脊柱炎的机制与临床研究进展

Advances in mechanistic and clinical research on Duhuo Jisheng decoction for the treatment of ankylosing spondylitis by regulating Th17/Treg balance and related cytokines

作者：李心悦1王丽敏2张林3

英文作者：Li Xinyue1 Wang Limin2 Zhang Lin3

单位：1辽宁中医药大学，沈阳110032；2辽宁中医药大学附属医院风湿病科，沈阳110032;3辽宁中医药大学方剂教研室，沈阳110032

英文单位：1Liaoning University of Traditional Chinese Medicine Shenyang 110032 China; 2Department of Rheumatology Affiliated Hospital of Liaoning University of Traditional Chinese Medicine Shenyang 110032 China; 3Department of Formulaology Liaoning University of Traditional Chinese Medicine Shenyang 110032 China

关键词：强直性脊柱炎；辅助性T细胞17/调节性T细胞平衡；独活寄生汤；细胞因子；Janus激酶/信号转导和转录激活蛋白信号通路；核因子κB信号通路

英文关键词：Ankylosingspondylitis;Thelpercell17/regulatoryTcellbalance;DuhuoJishengdecoction;Cytokines;Januskinase/signaltransducerandactivatoroftranscriptionsignalingpathway;Nuclearfactor-κBsignalingpathway

• 摘要：

• 强直性脊柱炎（AS）是一种以辅助性T细胞17（Th17）/调节性T细胞（Treg）失衡为核心的免疫紊乱、慢性炎症及骨代谢异常为特征的自身免疫性疾病，临床以炎性背痛、脊柱强直为主要表现。本文系统综述国内外相关文献，探讨独活寄生汤干预AS的理论基础与作用机制：从中医理论看，该方剂源自《备急千金要方》，以“祛风湿、止痹痛、益肝肾、补气血”为核心功效，契合AS“肾虚督空为本、风寒湿瘀为标”的病机；从现代机制看，其通过多成分多靶点协同作用修复Th17/Treg平衡，既下调Th17细胞比例及转录因子维甲酸受体相关孤儿受体γt表达、减少促炎因子白细胞介素17（IL-17）分泌，又上调Treg细胞比例及叉头样转录因子3表达、增加抑炎因子IL-10释放，同时靶向调控Janus激酶/信号转导和转录激活蛋白、核因子κB等上游信号通路，抑制炎症级联反应、改善病理性骨代谢。但当前研究仍存在机制向临床转化脱节和临床证据等级不足等问题，未来需通过多中心大样本随机对照试验、个体化诊疗模型构建推动其精准应用，为AS中西医结合治疗提供理论依据。

• Ankylosing spondylitis (AS) is an autoimmune disease characterized by immune disorder, chronic inflammation and abnormal bone metabolism, with the imbalance of T helper 17 (Th17)/regulatory T (Treg) cells as the core, and its main clinical manifestations include inflammatory back pain and spinal ankylosis. This article systematically reviews relevant domestic and foreign literatures to explore the theoretical basis and mechanism of Duhuo Jisheng decoction in intervening AS. From the perspective of traditional Chinese medicine theory, this prescription is derived from Beiji Qianjin Yaofang, with the core effects of dispelling wind-dampness, relieving arthralgia, tonifying the liver and kidney, and nourishing Qi and blood, which is consistent with the pathogenesis of AS that "kidney deficiency and Du meridian insufficiency are the root cause, and wind-cold-dampness stasis are the superficial factors". From the perspective of modern mechanism, it repairs the Th17/Treg balance through the synergistic effect of multiple components and multiple targets: it not only downregulates the proportion of Th17 cells and the expression of retinoic acid receptor-related orphan receptor γt, and reduces the secretion of the proinflammatory factor interleukin-17 (IL-17), but also upregulates the proportion of Treg cells and the expression of forkhead box P3, and increases the release of the anti-inflammatory factor IL-10. Meanwhile, it targets and regulates upstream signaling pathways such as Janus kinase/signal transducer and activator of transcription and nuclear factor-κB, thereby inhibiting the inflammatory cascade reaction and improving pathological bone metabolism. However, current studies still have problems such as the disconnection between mechanism and clinical transformation and insufficient level of clinical evidence. In the future, it is necessary to promote its precise application through multicenter, large-sample randomized controlled trials and the construction of individualized diagnosis and treatment models, so as to provide a theoretical basis for the integrated Chinese and Western medicine treatment of AS.