祛风通络除湿方对难治性类风湿关节炎患者血清TNF-α与VEGF的影响
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摘要
目的:探究祛风通络除湿方对难治性类风湿关节炎(RA)患者血清肿瘤坏死因子(TNF-α)与内皮生长因子(VEGF)的影响。方法:将2015年1月—2018年1月期间本院收治的96例难治性RA患者随机分为对照组和观察组,各48例。两组患者均口服甲氨蝶呤治疗,观察组患者在此基础上加用祛风通络除湿方治疗。比较两组患者的血清TNF-α与VEGF、关节肿胀数、关节压痛数、僵硬时间和不良反应发生率。结果:治疗前两组患者的血清TNF-α与VEGF、关节肿胀数、关节压痛数、僵硬时间比较差异无统计学意义(P> 0. 05);治疗后较治疗前两组患者的血清TNF-α与VEGF水平、关节肿胀数、关节压痛数、僵硬时间均显著降低,且观察组低于对照组;观察组的不良反应总发生率(10. 40%)低于对照组(27. 06%),差异具有统计学意义(P <0. 05)。结论:难治性RA患者采用祛风通络除湿方治疗能够有效缓解关节肿胀、压痛和僵硬,改善血清TNF-α与VEGF水平,且不良反应发生率低,可在临床上进一步推广和使用。
Objective: To investigate the effect of Huafeng Tongluo Hushi Formula on serum tumor necrosis factor-α( TNF-α) and endothelial growth factor( VEGF) in patients with refractory rheumatoid arthritis( RA). Methods: Ninety-six patients with refractory RA admitted to our hospital between January 2015 and January 2018 were randomized into a control group and an observation group,with 48 cases in each group. Both groups were treated with oral methotrexate,and patients in the observation group were treated with Qufeng Tongluo Hushi Formula. The serum levels of TNF-α and VEGF,joint swelling,joint tenderness,stiffness and incidence of adverse reactions were compared between the two groups. Results: There was no significant difference in serum TNF-α and VEGF,joint swelling,joint tenderness and stiffness between the two groups before treatment( P > 0. 05). Serum TNF-α and VEGF were higher in both groups than those before treatment. The level,the number of joint swelling,the number of joint tenderness and the stiffness time all decreased significantly and the observation group's were lower than those of the control group. The total incidence of adverse reactions in the observation group( 10. 40%) was lower than the control group' s( 27.06%) and the difference in statistics was significant( P < 0. 05). Conclusion: The treatment of patients with refractory RA using Qufeng Tongluo Hushi Formula can effectively relieve joint swelling,tenderness and stiffness,improve serum TNF-α and VEGF levels and the incidence of adverse reactions is low,and can be further promoted and used in clinical practice.
Objective: To investigate the effect of Huafeng Tongluo Hushi Formula on serum tumor necrosis factor-α( TNF-α) and endothelial growth factor( VEGF) in patients with refractory rheumatoid arthritis( RA). Methods: Ninety-six patients with refractory RA admitted to our hospital between January 2015 and January 2018 were randomized into a control group and an observation group,with 48 cases in each group. Both groups were treated with oral methotrexate,and patients in the observation group were treated with Qufeng Tongluo Hushi Formula. The serum levels of TNF-α and VEGF,joint swelling,joint tenderness,stiffness and incidence of adverse reactions were compared between the two groups. Results: There was no significant difference in serum TNF-α and VEGF,joint swelling,joint tenderness and stiffness between the two groups before treatment( P > 0. 05). Serum TNF-α and VEGF were higher in both groups than those before treatment. The level,the number of joint swelling,the number of joint tenderness and the stiffness time all decreased significantly and the observation group's were lower than those of the control group. The total incidence of adverse reactions in the observation group( 10. 40%) was lower than the control group' s( 27.06%) and the difference in statistics was significant( P < 0. 05). Conclusion: The treatment of patients with refractory RA using Qufeng Tongluo Hushi Formula can effectively relieve joint swelling,tenderness and stiffness,improve serum TNF-α and VEGF levels and the incidence of adverse reactions is low,and can be further promoted and used in clinical practice.
引文
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[11]程立,周腊梅,蒋雪峰,等.桂芍知母汤对类风湿关节炎患者血清TNF-α和趋化因子CX3CL1的影响[J].中国现代医学杂志,2017,27(20):65-68.
[12]李雪峰,尚俊英,甄志强,等.血管内皮细胞生长因子在类风湿关节炎患者血清中的水平及其临床意义[J].广西医科大学学报,2017,34(1):20-23.
[13]刘小平,侯秀娟,朱跃兰,等.温阳散寒化痰通络法治疗类风湿关节炎伴发桥本氏甲状腺炎探讨[J].环球中医药,2017,10(7):727-729.
[14]谢传美,袁国华.芍药甘草附子汤对类风湿关节炎大鼠下丘脑室旁核nNOS、IL-1β及TNF-α表达的影响[J].中国现代医学杂志,2017,27(20):6-10.
[15]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
[16]向诗非,何艳霞.温阳除痹汤治疗类风湿关节炎临床疗效及对TNF-α、IL-37水平的影响[J].陕西中医,2017,38(8):1043-1044.
[17]靖卫霞,朱跃兰.浅析活络效灵丹治疗类风湿关节炎瘀证[J].湖南中医药大学学报,2017,37(4):395-397.
[18]钱林林,衡世东,胡艳芬,等.自拟祛风除湿中药方联合光波足疗法治疗难治性类风湿关节炎效果分析[J].中医药信息,2017,34(5):58-61.
[2]巴哈尔古丽·力提甫,陈慕芝.中医辨证联合免疫抑制剂治疗活动性类风湿关节炎患者65例[J].环球中医药,2016,9(9):1119-1121.
[3]Penserga EG,Natividad TA,Salido ES,et al. Clinical profile of 266Filipino patients with rheumatoid arthritis included in the rheumatoid arthritis database and registry(RADAR)of the Philippine General Hospital[J]. International journal of rheumatic diseases,2015,18(4):433-438.
[4]周明倩,何莉娇,林笑颖,等.运脾祛湿解毒通络法在类风湿关节炎中的治法探讨[J].中国中医急症,2018,27(3):472-474.
[5]罗东萍,刘秀梅,傅自力,等.他克莫司联合甲氨蝶呤治疗难治性类风湿关节炎临床分析[J].中华风湿病学杂志,2017,21(3):185-187.
[6]Rosenthal KS,Mikecz K,Steiner HL 3rd,et al. Rheumatoid arthritis vaccine therapies:perspectives and lessons from therapeutic ligand epitope antigen presentation system vaccines for models of rheumatoid arthritis[J]. Expert review of vaccines,2015,14(6):891-908.
[7]谢戬芳,白云强,赵向聪,等.类风湿关节炎患者血清腱糖蛋白C的表达及不同改善病情抗风湿药联合用药对其水平的影响[J].中国药物与临床,2016,16(2):219-222.
[8]陈赵玲,刘岐焕,刘婧依,等.白芍总苷联合甲氨蝶呤治疗难治性类风湿关节炎效果观察[J].中华实用诊断与治疗杂志,2017,31(7):700-702.
[9]Negahban H,Masoudpur F,Rajaei E,et al. Reliability,validity,and responsiveness of the Persian version of the rheumatoid and arthritis outcome score(RAOS)in patients with rheumatoid arthritis[J]. Clinical rheumatology,2015,34(1):35-42.
[10]王瑞萍.类风湿关节炎患者血清中抗CCP抗体和TNF-α表达的临床意义[J].重庆医学,2017,46(12):1624-1625,1628.
[11]程立,周腊梅,蒋雪峰,等.桂芍知母汤对类风湿关节炎患者血清TNF-α和趋化因子CX3CL1的影响[J].中国现代医学杂志,2017,27(20):65-68.
[12]李雪峰,尚俊英,甄志强,等.血管内皮细胞生长因子在类风湿关节炎患者血清中的水平及其临床意义[J].广西医科大学学报,2017,34(1):20-23.
[13]刘小平,侯秀娟,朱跃兰,等.温阳散寒化痰通络法治疗类风湿关节炎伴发桥本氏甲状腺炎探讨[J].环球中医药,2017,10(7):727-729.
[14]谢传美,袁国华.芍药甘草附子汤对类风湿关节炎大鼠下丘脑室旁核nNOS、IL-1β及TNF-α表达的影响[J].中国现代医学杂志,2017,27(20):6-10.
[15]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
[16]向诗非,何艳霞.温阳除痹汤治疗类风湿关节炎临床疗效及对TNF-α、IL-37水平的影响[J].陕西中医,2017,38(8):1043-1044.
[17]靖卫霞,朱跃兰.浅析活络效灵丹治疗类风湿关节炎瘀证[J].湖南中医药大学学报,2017,37(4):395-397.
[18]钱林林,衡世东,胡艳芬,等.自拟祛风除湿中药方联合光波足疗法治疗难治性类风湿关节炎效果分析[J].中医药信息,2017,34(5):58-61.