蠲痹汤联合甲氨蝶呤对类风湿关节炎患者血清相关因子及骨代谢的影响
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摘要
目的研究蠲痹汤联合甲氨蝶呤对类风湿关节炎(RA)患者血清相关因子及骨代谢的影响。方法选择2014年6月至2016年6月期间收治的160例RA患者,将其随机分为对照组和治疗组各80例。对照组患者采用甲氨蝶呤治疗,治疗组患者采用甲氨蝶呤联合蠲痹汤治疗,4周为1个疗程,连续治疗3个疗程。记录比较两组患者治疗前后血清相关因子[粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素6(IL-6)、白细胞介素8(IL-8)],骨代谢指标[血清中Ⅰ型前胶原羧基端前肽(PICP)、骨碱性磷酸酶(B-ALP)和甲状旁腺激素PTH)和25羟维生素D],血沉(ESR)、C反应蛋白(CRP)、类风湿因子(RF)及中医证候评分情况,并评价疗效。结果治疗组总有效率为91. 25%,高于对照组的76. 25%,差异有统计学意义(P <0. 05)。治疗后,两组患者GM-CSF、IL-6、IL-8、B-ALP、ESR、CRP含量均较治疗前下降(P <0. 05),并且治疗组患者均低于对照组,差异有统计学意义(P <0. 05);两组患者治疗后PICP、PTH和25羟维生素D含量均较治疗前升高,并且治疗组均高于对照组,差异有统计学意义(P <0. 05)。两组患者经过治疗后中医证候评分均降低,治疗组评分低于对照组,差异有统计学意义(P <0. 05)。结论采用蠲痹汤联合甲氨蝶呤治疗RA患者,疗效显著,可通过抑制炎症反应,调节骨代谢,改善患者症状,值得临床推广。
Objective To explore the impacts on the relevant factors in serum and bone metabolism in the patients with rheumatoid arthritis( RA) treated with juanbi decoction and methotrexate. Methods From June 2014 to June2016,160 RA patients were collected and randomized into a control group and an observation group,80 cases in each one.In the control group,methorexate was used. In the observation group,the combined medication with juanbi decoction and methotrexate was adopted. The medication for 4 weeks was as one session and the consecutive 3 sessions were required. Before and after treatment,the relevant factors in serum( GM-CSF,IL-6 and IL-8) and bone metabolism[PICP,B-ALP,PTH and 25( OH) D],ESR,CRP,RF as well as TCM symptom score were recorded and compared in the two groups. The therapeutic effects were evaluated in the two groups. Results The total effective rate was 91. 25% in the observation group,higher than 76. 25% in the control group,indicating the significant difference( P < 0. 05). After treatment,the levels of GM-CSF,IL-6,IL-8,B-ALP,ESR and CRP were all reduced as compared with the levels before treatment in the two groups. The levels of these indexes in the observation group were all lower than the control group,indicating the significant differences( P < 0. 05). The levels of PICP,PTH and 25( OH) D after treatment were all increased as compared with the levels before treatment in the two groups,and the levels of these indexes in the observation group were all higher than the control group,indicating the significant differences( P < 0. 05). After treatment,TCM symptom scores were all reduced in the two groups and the score in the observation group was lower than the control group,indicating the significant difference( P < 0. 05). Conclusion The combined medication with juanbi decoction and methotrexate achieves the significant effects on RA. This medication relieves the symptoms through suppressing inflammatory reaction and regulating bone metabolism in RA patients. Hence,this therapeutic method deserves to be promoted in clinical practice.
Objective To explore the impacts on the relevant factors in serum and bone metabolism in the patients with rheumatoid arthritis( RA) treated with juanbi decoction and methotrexate. Methods From June 2014 to June2016,160 RA patients were collected and randomized into a control group and an observation group,80 cases in each one.In the control group,methorexate was used. In the observation group,the combined medication with juanbi decoction and methotrexate was adopted. The medication for 4 weeks was as one session and the consecutive 3 sessions were required. Before and after treatment,the relevant factors in serum( GM-CSF,IL-6 and IL-8) and bone metabolism[PICP,B-ALP,PTH and 25( OH) D],ESR,CRP,RF as well as TCM symptom score were recorded and compared in the two groups. The therapeutic effects were evaluated in the two groups. Results The total effective rate was 91. 25% in the observation group,higher than 76. 25% in the control group,indicating the significant difference( P < 0. 05). After treatment,the levels of GM-CSF,IL-6,IL-8,B-ALP,ESR and CRP were all reduced as compared with the levels before treatment in the two groups. The levels of these indexes in the observation group were all lower than the control group,indicating the significant differences( P < 0. 05). The levels of PICP,PTH and 25( OH) D after treatment were all increased as compared with the levels before treatment in the two groups,and the levels of these indexes in the observation group were all higher than the control group,indicating the significant differences( P < 0. 05). After treatment,TCM symptom scores were all reduced in the two groups and the score in the observation group was lower than the control group,indicating the significant difference( P < 0. 05). Conclusion The combined medication with juanbi decoction and methotrexate achieves the significant effects on RA. This medication relieves the symptoms through suppressing inflammatory reaction and regulating bone metabolism in RA patients. Hence,this therapeutic method deserves to be promoted in clinical practice.
引文
[1]崔樱,高晖,胡美兰,等.乌龙蠲痹汤内服外敷治疗类风湿性关节炎的临床效果及对细胞因子IL-17、IL-35的影响研究[J].中外医学研究,2016,14(9):51-52.
[2]王蓉辉,陈运春,王伟丽,等.蠲痹汤加减联合甲氨喋呤及来氟米特治疗活动期类风湿性关节炎寒湿痹阻证临床观察[J].中国实验方剂学杂志,2016,22(6):167-171.
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[7]陈扬声,赵晓,姚乃捷,等.通络蠲痹汤治疗类风湿性关节炎43例[J].河南中医,2015,35(5):1026-1028.
[8]高洁,刘小娟,孔瑞娜,等.类风湿性关节炎患者骨密度及骨代谢生化标志物的变化[J].中国骨质疏松杂志,2015,21(9):1119-1122.
[9]李雪芬,钟诗婷,邓矢明.益肾蠲痹丸联合美洛昔康治疗活动期类风湿性关节炎的疗效观察[J].中医药导报,2015,21(17):81-83.
[10]何浩,杨慧琴.补肾蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎临床观察[J].湖北中医杂志,2011,33(6):27-28.
[11]许蕾,李振英,陈学旻,等.加味蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎30例[J].齐齐哈尔医学院学报,2011,32(18):2963-2964.
[12]田军伟,陶鹏飞.艾拉莫德联合甲氨蝶呤对类风湿性关节炎患者血清M-CSF、IL-6、IL-8及骨代谢的影响[J].海南医学,2017,28(3):391-394.
[13]汤荣华,黄建军.类风湿性关节炎患者血清GM-CSF、IL-6、IL-17和TNF-α的水平测定及临床意义[J].检验医学,2013,28(3):173-177.
[14]宁长青,冯伟,刘益杰,等. IL-17与类风湿性关节炎的研究进展[J].中国中医骨伤科杂志,2013,21(9):67-69.
[15]高俊,丁真奇.细胞因子在类风湿性关节炎中作用的研究现状[J].医学综述,2006(5):289-291.
[16]强建红.加味蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎50例[J].陕西中医,2014,35(7):874.
[2]王蓉辉,陈运春,王伟丽,等.蠲痹汤加减联合甲氨喋呤及来氟米特治疗活动期类风湿性关节炎寒湿痹阻证临床观察[J].中国实验方剂学杂志,2016,22(6):167-171.
[3]游碧蓉,田新玮,刘春景.六味地黄合四物汤联合甲氨蝶呤治疗类风湿性关节炎的临床观察[J].中医药导报,2016,22(6):95-97.
[4]陈锋,闵重函,周瑛,等.蚁参蠲痹胶囊联合西药治疗肾气虚寒型类风湿性关节炎35例临床观察[J].中医杂志,2016,57(12):1045-1048.
[5]李冰,刘军,肖瑜,等.抗炎症因子与类风湿性关节炎关系的研究进展[J].天津医药,2016,44(8):1053-1056.
[6]刘雪涛,李庆.类风湿性关节炎治疗药物进展[J].现代生物医学进展,2015,15(6):1171-1173.
[7]陈扬声,赵晓,姚乃捷,等.通络蠲痹汤治疗类风湿性关节炎43例[J].河南中医,2015,35(5):1026-1028.
[8]高洁,刘小娟,孔瑞娜,等.类风湿性关节炎患者骨密度及骨代谢生化标志物的变化[J].中国骨质疏松杂志,2015,21(9):1119-1122.
[9]李雪芬,钟诗婷,邓矢明.益肾蠲痹丸联合美洛昔康治疗活动期类风湿性关节炎的疗效观察[J].中医药导报,2015,21(17):81-83.
[10]何浩,杨慧琴.补肾蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎临床观察[J].湖北中医杂志,2011,33(6):27-28.
[11]许蕾,李振英,陈学旻,等.加味蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎30例[J].齐齐哈尔医学院学报,2011,32(18):2963-2964.
[12]田军伟,陶鹏飞.艾拉莫德联合甲氨蝶呤对类风湿性关节炎患者血清M-CSF、IL-6、IL-8及骨代谢的影响[J].海南医学,2017,28(3):391-394.
[13]汤荣华,黄建军.类风湿性关节炎患者血清GM-CSF、IL-6、IL-17和TNF-α的水平测定及临床意义[J].检验医学,2013,28(3):173-177.
[14]宁长青,冯伟,刘益杰,等. IL-17与类风湿性关节炎的研究进展[J].中国中医骨伤科杂志,2013,21(9):67-69.
[15]高俊,丁真奇.细胞因子在类风湿性关节炎中作用的研究现状[J].医学综述,2006(5):289-291.
[16]强建红.加味蠲痹汤联合甲氨蝶呤治疗类风湿性关节炎50例[J].陕西中医,2014,35(7):874.
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