火针通过内源性GCs/GR/GILZ抑制斑块型银屑病KC-CD8+T细胞免疫环路的调控机制

慢性斑块型银屑病的持续炎症过程与CD8+T细胞在表皮聚集定位、形成KC-CD8+T细胞免疫环路活化及糖皮质激素（GCs）途径障碍密切相关。血瘀痰凝是斑块型银屑病血瘀证主要病机，本课题组前期临床和基础研究证实了火针的疗效，发现火针抑制模型KC增殖和IL-17转录。鉴于皮肤为内源性GCs的产生器官和火针的免疫调节作用，提出假说：斑块型银屑病与KC-CD8+T细胞免疫环路密切相关；火针的适度应激刺激可诱导皮肤内源性GCs合成、GR转位及下游蛋白GILZ转录，增强GILZ对IL-17+CD8+T细胞免疫激活的抑制，打破KC-CD8+T细胞炎症环路，发挥火针温阳化气、化解痰瘀互结的作用。本研究通过临床检测火针治疗前后皮损CD8+T细胞对KC自身抗原识别及活化，在小鼠慢性银屑病血瘀模型上探讨火针通过内源性GCs对免疫环路活化的调节作用，阐明火针治疗斑块型银屑病的作用靶点，为火针治疗银屑病提供科学依据。

The persistent inflammatory process of chronic plaque psoriasis is closely related to the aggregation and location of CD8+T cells in the epidermis, the activation of KC-CD8+T immune loop and the disturbance of glucocorticoid (GCs) pathway. Blood stasis and phlegm coagulation is the main pathogenesis of blood stasis syndrome of plaque psoriasis. Our previous clinical and basic research confirmed the efficacy of fire needle, and found that fire needle inhibited KC proliferation and IL17 transcription. In view of the skin as the production organ of endogenous GCs and the immunomodulatory effect of fire needle, it is hypothesized that the blood stasis syndrome of plaque psoriasis is closely related to KC-CD8+T immune loop, and that the strong stress stimulation of fire needle can induce endogenous GCs synthesis, GR translocation and downstream protein GILZ transcription, enhance the inhibition of GILZ on IL-17+CD8+T immune activation, break the KC-CD8+T inflammatory loop, and play the role of fire needle warming yang and resolving phlegm and blood stasis. In this study, we detected the recognition and activation of KC autoantigen by CD8+T in skin lesions before and after fire needle treatment, and discussed the regulation effect of fire acupuncture on immune loop activation on psoriasis-like lesion model of chronic blood stasis syndrome in mice, and clarified the action target of fire acupuncture in the treatment of plaque psoriasis, so as to provide scientific basis for fire acupuncture in the treatment of psoriasis.