青附蠲痹汤治疗寒湿痹阻型类风湿关节炎的临床疗效观察
|
摘要
目的:观察青附蠲痹汤治疗寒湿痹阻型类风湿关节炎(RA)临床疗效及安全性,探讨其疗效机制。方法:寒湿痹阻型RA患者120例,按随机数字表法分为治疗组(青附蠲痹汤联合甲氨喋呤片)60例和对照组(甲氨喋呤片)60例,连续治疗8周后,评价RA患者DAS28评分及证候疗效。于治疗前和治疗后采集RA患者静脉血,分别检测血沉(ESR)、类风湿因子(RF)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、基质金属蛋白酶-3(MMP-3)及基质金属蛋白酶抑制剂-1(TIMP-1)含量。记录治疗过程中出现的所有不良反应。结果:经8周治疗,治疗组和对照组总有效率分别为96.67%和83.33%,治疗组显著优于对照组(P<0.05)。治疗后,治疗组较对照组同期显著改善关节疼痛、关节肿胀、屈伸不利、晨僵及肢体冷痛等症状评分(P<0.01)。治疗组DAS28评分、ESR、RF及CRP均较对照组同期显著降低(P<0.01)。治疗组TNF-α、IL-1β及MMP-3较对照组同期降低,TIMP-1较对照组同期上调(P<0.01,P<0.05)。两组不良反应率差异无统计学意义。结论:青附蠲痹汤治疗寒湿痹阻型RA疗效显著,显著改善临床症状,降低CRP、ESR、CRP水平,其疗效机制可能与抑制促炎性细胞因子TNF-α、IL-1β表达,降低MMP-3水平、上调TIMP-1表达有关。
Objective: To investigate the efficacy, safety and mechanisms of Qingfu Juanbi Decoction in treating rheumatoid arthritis(RA) with syndrome of cold-dampness arthralgia. Methods: A total of 120 RA Patients with syndrome of cold-dampness arthralgia were randomly divided into the treatment group(60 cases) and the control group(60 cases). Patients of the treatment group were treated with Qingfu Juanbi Decoction and methotrexate, and patients of the control group were treated with methotrexate, both of them for 8 weeks. The DAS28 score and efficacy of syndrome of TCM were assessed. Collected blood from patients with RA before and after treatment to detect the content of CRP, ESR, TNF-α, IL-1β, MMP-3, and TIMP-1 in serum. Adverse events were recorded during therapy. Results: After 8 weeks of therapy, the total efficacy rates of treatment group and the control group were 96.67% and 83.33%. The treatment group was significantly better than the control group(P<0.05). The symptom scores of joint pain, joint swelling, unfluent flexion and extension, morning stiffness and limb crymodynia had significant improvement in treatment group(P<0.01). DAS28 scores and levels of ESR, RF and CRP in treatment group were significantly lower than the control group(P<0.01). Compared with control group, TNF-α, IL-1β and MMP-3 were reduced and TIMP-1 was increased(P<0.01, P<0.05). There was no significant difference in the adverse frequency between two groups. Conclusion: Qingfu Juanbi Decoction was an effective drug in treating RA with syndrome of cold-dampness arthralgia to significantly improve clinical symptoms and reduce CRP, ESR, CRP levels. Its therapeutic mechanism may be related to inhibiting the expression of pro-inflammatory cytokines TNF-α, IL-1β, decreasing MMP-3 levels and up-regulating TIMP-1 expression.
Objective: To investigate the efficacy, safety and mechanisms of Qingfu Juanbi Decoction in treating rheumatoid arthritis(RA) with syndrome of cold-dampness arthralgia. Methods: A total of 120 RA Patients with syndrome of cold-dampness arthralgia were randomly divided into the treatment group(60 cases) and the control group(60 cases). Patients of the treatment group were treated with Qingfu Juanbi Decoction and methotrexate, and patients of the control group were treated with methotrexate, both of them for 8 weeks. The DAS28 score and efficacy of syndrome of TCM were assessed. Collected blood from patients with RA before and after treatment to detect the content of CRP, ESR, TNF-α, IL-1β, MMP-3, and TIMP-1 in serum. Adverse events were recorded during therapy. Results: After 8 weeks of therapy, the total efficacy rates of treatment group and the control group were 96.67% and 83.33%. The treatment group was significantly better than the control group(P<0.05). The symptom scores of joint pain, joint swelling, unfluent flexion and extension, morning stiffness and limb crymodynia had significant improvement in treatment group(P<0.01). DAS28 scores and levels of ESR, RF and CRP in treatment group were significantly lower than the control group(P<0.01). Compared with control group, TNF-α, IL-1β and MMP-3 were reduced and TIMP-1 was increased(P<0.01, P<0.05). There was no significant difference in the adverse frequency between two groups. Conclusion: Qingfu Juanbi Decoction was an effective drug in treating RA with syndrome of cold-dampness arthralgia to significantly improve clinical symptoms and reduce CRP, ESR, CRP levels. Its therapeutic mechanism may be related to inhibiting the expression of pro-inflammatory cytokines TNF-α, IL-1β, decreasing MMP-3 levels and up-regulating TIMP-1 expression.
引文
[1]Burmester G R,Pope J E.Novel treatment strategies in rheumatoid arthritis.Lancet,2017,389(10086):2338-2348
[2]Li R,Sun J,Ren L M,et al.Epidemiology of eight common rheumatic diseases in China:a large-scale cross-sectional survey in Beijing.Rheumatology(Oxford),2012,51(4):721-729
[3]Mc Innes I B,Schett G.Pathogenetic insights from the treatment of rheumatoid arthritis.Lancet,2017,389(10086):2328-2337
[4]Smolen J S,Aletaha D.Rheumatoid arthritis therapy reappraisal:Strategies,opportunities and challenges.Nat Rev Rheumatol,2015,11(5):276-289
[5]李鑫,王宝新,李如意,等.正清风痛宁联合化学药物治疗类风湿关节炎随机对照试验的系统评价.中国实验方剂学杂志,2016,22(16):205-210
[6]王宝新,李鑫,谷捷,等.湖南地区类风湿性关节炎主要中医证型分布规律研究.中华中医药学刊,2016,34(1):88-90
[7]Aletaha D,Neogi T,Silman A J,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism Collaborative Initiative.Arthritis Rheum,2010,62(9):2569-2581
[8]马俊福,李明曦,王颖,等.类风湿关节炎辨证及其客观化研究探讨.中华中医药杂志,2015,30(11):4022-4025
[9]徐鹏刚,任宝娣,王素芝.《内经》风湿病病因病机探析.陕西中医,2015,36(8):1076-1077
[10]白人骁.痹祺胶囊治疗类风湿关节炎的多中心随机对照临床试验.中华中医药杂志,2016,31(9):3821-3825
[11]Angelotti F,Parma A,Cafaro G,et al.One year in review2017:pathogenesisofrheumatoidarthritis.ClinExp Rheumatol,2017,35(3):368-378
[12]Nakagawa J,Koyama Y,Kawakami A,et al.A novel scoring system based on common laboratory tests predicts the efficacy of TNFinhibitor and IL-6 targeted therapy in patients with rheumatoid arthritis:a retrospective, multicenter observational study.Arthritis Res Ther,2017,19(1):185
[13]Zhai K F,Duan H,Luo L,et al.Protective effects of paeonol on inflammatory response in IL-1β-induced human fibroblast-like synoviocytes and rheumatoid arthritis progression via modulating NF-κB pathway.Inflammopharmacology,2017,25(5):523-532
[14]Alam J,Jantan I,SNA B.Rheumatoid arthritis:Recent advances on its etiology,role of cytokines and pharmacotherapy.Biomed Pharmacother,2017,92:615-633
[15]邢洁,姜萍,姜月华,等.和痹方对类风湿关节炎大鼠27n ACh R、STAT3蛋白表达及TNF-α、IL-6、IL-17表达的影响.中华中医药杂志,2018,33(2):730-733
[16]Wu Q,Wang Y,Wang Q,et al.The bispecific antibody aimed at the vicious circle of IL-1βand IL-17A,is beneficial for the collagen-induced rheumatoid arthritis of mice through NF-κB signaling pathway.Immunol Lett,2016,179:68-79
[17]Zhai T,Gao C,Huo R,et al.Cyr61 participates in the pathogenesis of rheumatoid arthritis via promoting MMP-3 expression by fibroblastlike synoviocytes.Mod Rheumatol,2017,27(3):466-475
[18]Skacelova M,Hermanova Z,Horak P,et al.Higher levels of matrix metalloproteinase-3 in patients with RA reflect disease activity and structural damage.Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2017,161(3):296-302
[19]Zhou X,Yang H,Guan F,et al.T-2 Toxin Alters the Levels of CollagenⅡand Its Regulatory Enzymes MMPs/TIMP-1 in a LowSelenium Rat Model of Kashin-Beck Disease.Biol Trace Elem Res,2016,169(2):237-246
[2]Li R,Sun J,Ren L M,et al.Epidemiology of eight common rheumatic diseases in China:a large-scale cross-sectional survey in Beijing.Rheumatology(Oxford),2012,51(4):721-729
[3]Mc Innes I B,Schett G.Pathogenetic insights from the treatment of rheumatoid arthritis.Lancet,2017,389(10086):2328-2337
[4]Smolen J S,Aletaha D.Rheumatoid arthritis therapy reappraisal:Strategies,opportunities and challenges.Nat Rev Rheumatol,2015,11(5):276-289
[5]李鑫,王宝新,李如意,等.正清风痛宁联合化学药物治疗类风湿关节炎随机对照试验的系统评价.中国实验方剂学杂志,2016,22(16):205-210
[6]王宝新,李鑫,谷捷,等.湖南地区类风湿性关节炎主要中医证型分布规律研究.中华中医药学刊,2016,34(1):88-90
[7]Aletaha D,Neogi T,Silman A J,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism Collaborative Initiative.Arthritis Rheum,2010,62(9):2569-2581
[8]马俊福,李明曦,王颖,等.类风湿关节炎辨证及其客观化研究探讨.中华中医药杂志,2015,30(11):4022-4025
[9]徐鹏刚,任宝娣,王素芝.《内经》风湿病病因病机探析.陕西中医,2015,36(8):1076-1077
[10]白人骁.痹祺胶囊治疗类风湿关节炎的多中心随机对照临床试验.中华中医药杂志,2016,31(9):3821-3825
[11]Angelotti F,Parma A,Cafaro G,et al.One year in review2017:pathogenesisofrheumatoidarthritis.ClinExp Rheumatol,2017,35(3):368-378
[12]Nakagawa J,Koyama Y,Kawakami A,et al.A novel scoring system based on common laboratory tests predicts the efficacy of TNFinhibitor and IL-6 targeted therapy in patients with rheumatoid arthritis:a retrospective, multicenter observational study.Arthritis Res Ther,2017,19(1):185
[13]Zhai K F,Duan H,Luo L,et al.Protective effects of paeonol on inflammatory response in IL-1β-induced human fibroblast-like synoviocytes and rheumatoid arthritis progression via modulating NF-κB pathway.Inflammopharmacology,2017,25(5):523-532
[14]Alam J,Jantan I,SNA B.Rheumatoid arthritis:Recent advances on its etiology,role of cytokines and pharmacotherapy.Biomed Pharmacother,2017,92:615-633
[15]邢洁,姜萍,姜月华,等.和痹方对类风湿关节炎大鼠27n ACh R、STAT3蛋白表达及TNF-α、IL-6、IL-17表达的影响.中华中医药杂志,2018,33(2):730-733
[16]Wu Q,Wang Y,Wang Q,et al.The bispecific antibody aimed at the vicious circle of IL-1βand IL-17A,is beneficial for the collagen-induced rheumatoid arthritis of mice through NF-κB signaling pathway.Immunol Lett,2016,179:68-79
[17]Zhai T,Gao C,Huo R,et al.Cyr61 participates in the pathogenesis of rheumatoid arthritis via promoting MMP-3 expression by fibroblastlike synoviocytes.Mod Rheumatol,2017,27(3):466-475
[18]Skacelova M,Hermanova Z,Horak P,et al.Higher levels of matrix metalloproteinase-3 in patients with RA reflect disease activity and structural damage.Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2017,161(3):296-302
[19]Zhou X,Yang H,Guan F,et al.T-2 Toxin Alters the Levels of CollagenⅡand Its Regulatory Enzymes MMPs/TIMP-1 in a LowSelenium Rat Model of Kashin-Beck Disease.Biol Trace Elem Res,2016,169(2):237-246
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |