【目的】 观察系统性红斑狼疮（SLE）患者血清 NOD 样受体热蛋白结构域相关蛋白 3（NLRP3）、半胱氨酸蛋白酶 1（Caspase-1）、白细胞介素1β（IL-1β）水平及其与中医证型的相关性，评估NLRP3、Caspase-1、IL-1β在SLE患者中医辨证 中的诊断意义。【方法】 选取符合纳入标准的于2020年10月至2024年3月就诊于临海市中医院的SLE患者110例（SLE组）及健 康体检者30例（健康对照组），比较2组受检者的血清NLRP3、Caspase-1、IL-1β水平，同时分析NLRP3、Caspase-1、IL-1β 与 SLE 疾病活动指数（SLEDAI）评分的相关性；统计 110例 SLE 患者的中医证型分布情况，并探讨 SLE 患者中医证型与血清 NLRP3、Caspase-1、IL-1β水平的相关性。【结果】（1）SLE组患者的血清NLRP3、Caspase-1水平低于健康对照组，血清IL-1β 水平高于健康对照组，差异均有统计学意义（P < 0.05）；经Spearman相关分析，SLEDAI评分与NLRP3、Caspase-1均呈负相 关（r = -0.854、-0.599，P < 0.01）；SLEDAI评分与 IL-1β呈正相关（r = 0.584，P < 0.01）。（2）110例 SLE患者的中医证型分布 从高到低依次为热毒炽盛证（33.64%）> 脾肾阳虚证（25.45%）> 阴虚内热证（24.55%）> 肝肾阴虚证（16.36%）。（3）SLE患者血 清NLRP3、Caspase-1水平从低到高的中医证型依次为热毒炽盛证 < 阴虚内热证 < 脾肾阳虚证 < 肝肾阴虚证，IL-1β水平从 高到低的中医证型依次为热毒炽盛证 > 阴虚内热证 > 脾肾阳虚证 > 肝肾阴虚证，差异均有统计学意义（P < 0.05）。（4）多因素 Logistic回归分析结果显示：血清NLRP3、Caspase-1水平与肝肾阴虚证、脾肾阳虚证、阴虚内热证、热毒炽盛证呈负相关（P < 0.05 或 P < 0.01）；血清 IL-1β水平与肝肾阴虚证、脾肾阳虚证、阴虚内热证、热毒炽盛证呈正相关（P < 0.05）。【结论】 SLE患者 血清NLRP3、Caspase-1水平与病情程度呈负相关性，血清IL-1β水平与病情程度呈正相关性；SLE患者中医证型与NLRP3、 Caspase-1、IL-1β存在一定相关性，NLRP3、Caspase-1、IL-1β有可能成为SLE中医辨证的潜在生物学指标。

Objective To observe the levels of serum NOD-like receptor thermal protein domain associated protein 3（NLRP3）， cysteine protease 1（Caspase-1）， and interleukin 1β（IL-1β）in patients with systemic lupus erythematosus（SLE）and to explore their correlation with traditional Chinese medicine（TCM）syndrome types， thus to assess the significance of NLRP3，Caspase-1 and IL-1β in TCM syndrome differentiation. Methods A total of 110 cases of SLE patients who met the inclusion criteria and 30 cases of healthy physical examinee from Linhai Hospital of Traditional Chinese Medicine during October 2020 to March 2024 were enrolled into the study. The serum NLRP3， Caspase-1， IL-1β levels of the two groups were compared， and the correlation between serum NLRP3， Caspase-1， IL-1β levels and the Systemic Lupus Erythematosus Disease Activity Index （SLEDAI）scores was analyzed. Moreover， the distribution of the TCM syndrome types in 110 cases of SLE patients was investigated and then the correlation between TCM syndrome types and serum NLRP3，Caspase-1， and IL-1β levels in SLE patients was explored. Results（1）The serum NLRP3 and Caspase-1 levels of patients in SLE group were lower than those of healthy control group， and the serum IL-1β level was higher than that of healthy control group，and the differences were statistically significant（P < 0.05）. Spearman􀆳s correlation analysis showed that the SLEDAI score was negatively correlated with both of NLRP3 and Caspase-1（r = -0.854，-0.599， P < 0.01）， and SLEDAI score was positively correlated with IL-1β（r = 0.584， P < 0.01）.（2）The TCM syndrome types in 110 cases of SLE patients ranking in descending order were as follows：excessive heat toxin syndrome（33.64%） > yang deficiency of spleen and kidney syndrome（25.45%） > internal heat due to yin deficiency syndrome（24.55%）> yin deficiency of liver and kidney syndrome（16.36%）.（3）The serum NLRP3 and Caspase-1 levels were in ascending order while the serum IL-1β level was in descending order in SLE patients with the TCM syndrome types of excessive heat toxin syndrome， internal heat due to yin deficiency syndrome， yang deficiency of spleen and kidney syndrome，yin deficiency of liver and kidney syndrome，respectively. And the differences were all statistically significant（P < 0.05）.（4）The results of multivariate logistic regression analysis showed that serum NLRP3 and caspase-1 levels were negatively correlated with syndromes of yin deficiency of liver and kidney，yang deficiency of spleen and kidney，internal heat due to yin deficiency，and excessive heat toxin （P < 0.05 or P < 0.01），while serum IL-1β level was positively correlated with the above syndromes（P < 0.05）. Conclusion Serum NLRP3 and Caspase-1 levels in SLE patients are negatively correlated with the disease activity， and serum IL-1β level is positively correlated with the disease activity. There is a certain correlation between TCM syndrome types and NLRP3，Caspase-1 and IL-1β levels in SLE patients，indicating that NLRP3，Caspase-1 and IL-1β may be the potential biological indicators for TCM syndrome differentiation of SLE.

R259.932

浙江省自然科学基金资助项目（编号：2023J011898）