骨关节炎不同中医分型的免疫学分析及痹祺胶囊的干预作用
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摘要
目的探讨不同中医证型骨关节炎患者血清白细胞介素-1(IL-1)、基质金属蛋白酶-3(MMP-3)、金属蛋白酶组织抑制剂-1(TIMP-1)、软骨寡聚基质蛋白(COMP)及红细胞免疫功能指标变化,并分析痹祺胶囊对骨关节炎的干预机制。方法选取骨关节炎患者80例,按中医辨证分型标准分为3组:肝肾不足、筋脉瘀滞组30例,脾肾两虚、湿注骨节组24例,肝肾亏虚、痰瘀交阻组26例,所有患者均给予痹祺胶囊与盐酸氨基葡萄糖胶囊口服12周,观察3组治疗前后血清IL-1、MMP-3、TIMP-1、COMP及红细胞免疫复合物花环(RBC-ICR)、红细胞C3b受体花环(RBC-C3bRR)变化情况。结果治疗前,肝肾亏虚、痰瘀交阻组血清IL-1、MMP-3、COMP水平均显著高于肝肾不足、筋脉瘀滞组和脾肾两虚、湿注骨节组(P均<0.05),脾肾两虚、湿注骨节组均显著高于肝肾不足、筋脉瘀滞组(P均<0.05);肝肾亏虚、痰瘀交阻组血清TIMP-1水平及RBC-C3bRR均显著低于肝肾不足、筋脉瘀滞组和脾肾两虚、湿注骨节组(P均<0.05),RBC-ICR显著高于肝肾不足、筋脉瘀滞组而显著低于脾肾两虚、湿注骨节组(P均<0.05);脾肾两虚、湿注骨节组血清TIMP-1水平显著低于肝肾不足、筋脉瘀滞组(P<0.05),RBC-ICR显著高于肝肾不足、筋脉瘀滞组(P<0.05)。治疗后,3组患者各项检测指标均较治疗前显著改善(P均<0.05);肝肾不足、筋脉瘀滞组IL-1、MMP-3、COMP下降及TIMP-1上升程度最大,其次为脾肾两虚、湿注骨节组,最后为肝肾亏虚、痰瘀交阻组,3组间比较差异均有统计学意义(P均<0.05)。结论不同证型的骨关节炎患者红细胞免疫功能改变程度不同,其随着病变的加重而逐渐下降;痹祺胶囊适用于任何一型骨关节炎患者,尤其对肝肾不足、筋脉瘀滞型治疗效果好,其治疗机制可能与显著降低血清IL-1、MMP-3、COMP水平,提高TIMP-1水平,改善红细胞免疫功能有关。
Objective It is to investigate the changes of serum interleukin-1(IL-1), matrix metalloproteinase-3(MMP-3), tissue inhibitor of metalloproteinase-1(TIMP-1), cartilage oligomeric matrix protein(COMP) and erythrocyte immune function indicators in patients with osteoarthritis of different types of TCM syndrome, and to analyze the intervention mechanism of Biqi capsule on this disease. Methods Eighty patients with osteoarthritis were enrolled. According to TCM syndrome differentiation criteria, they were divided into three groups: liver and kidney deficiency, sinew and vessel stasis group(group A, n=30), spleen-kidney deficiency and wet invasion in bone group(group B, n=24), liver and kidney deficiency, sputum and stasis resistance group(group C, n=26). All the patients were treated with Biqi capsules and glucosamine hydrochloride capsules for 12 weeks by oral administration. The changes of IL-1, MMP-3, TIMP-1, COMP and erythrocyte immune complex ring(RBC-ICR),erythrocyte C3 b receptor ring(RBC-C3 bRR) were observed before and after treatment. Results Before treatment, the levels of serum IL-1, MMP-3 and COMP in group C were significantly higher than those in group A and group B(P<0.05), the levels above in group B were significantly higher than those in group A(P<0.05); The levels of TIMP-1 and RBC-C3 bRR in group C were significantly lower than those in group A and group B(P<0.05), RBC-ICR was significantly higher than that in group A, but significantly lower than that in group B. The levels of serum TIMP-1 in group B were significantly lower while RBC-ICR was significantly higher than that in group A(P<0.05). After treatment, the detection indexes of the three groups were significantly improved compared with those before treatment(P<0.05); the levels of IL-1, MMP-3, COMP decreased and TIMP-1 increased the most in group A, followed by group B, and finally group C, the difference between the three groups were significant(P<0.05). Conclusion The changes of erythrocyte immune function in patients with osteoarthritis of different syndromes are different, and they gradually decrease with the increase of lesions. Biqi capsules are suitable for patients with any type of osteoarthritis, the therapeutic effect is good especially for the type of liver and kidney deficiency and stagnation of sinew and vessel, and its therapeutic mechanism may be related to significantly decreasing the levels of serum IL-1, MMP-3, COMP and increasing the level of TIMP-1, and improving red blood cell immune function.
Objective It is to investigate the changes of serum interleukin-1(IL-1), matrix metalloproteinase-3(MMP-3), tissue inhibitor of metalloproteinase-1(TIMP-1), cartilage oligomeric matrix protein(COMP) and erythrocyte immune function indicators in patients with osteoarthritis of different types of TCM syndrome, and to analyze the intervention mechanism of Biqi capsule on this disease. Methods Eighty patients with osteoarthritis were enrolled. According to TCM syndrome differentiation criteria, they were divided into three groups: liver and kidney deficiency, sinew and vessel stasis group(group A, n=30), spleen-kidney deficiency and wet invasion in bone group(group B, n=24), liver and kidney deficiency, sputum and stasis resistance group(group C, n=26). All the patients were treated with Biqi capsules and glucosamine hydrochloride capsules for 12 weeks by oral administration. The changes of IL-1, MMP-3, TIMP-1, COMP and erythrocyte immune complex ring(RBC-ICR),erythrocyte C3 b receptor ring(RBC-C3 bRR) were observed before and after treatment. Results Before treatment, the levels of serum IL-1, MMP-3 and COMP in group C were significantly higher than those in group A and group B(P<0.05), the levels above in group B were significantly higher than those in group A(P<0.05); The levels of TIMP-1 and RBC-C3 bRR in group C were significantly lower than those in group A and group B(P<0.05), RBC-ICR was significantly higher than that in group A, but significantly lower than that in group B. The levels of serum TIMP-1 in group B were significantly lower while RBC-ICR was significantly higher than that in group A(P<0.05). After treatment, the detection indexes of the three groups were significantly improved compared with those before treatment(P<0.05); the levels of IL-1, MMP-3, COMP decreased and TIMP-1 increased the most in group A, followed by group B, and finally group C, the difference between the three groups were significant(P<0.05). Conclusion The changes of erythrocyte immune function in patients with osteoarthritis of different syndromes are different, and they gradually decrease with the increase of lesions. Biqi capsules are suitable for patients with any type of osteoarthritis, the therapeutic effect is good especially for the type of liver and kidney deficiency and stagnation of sinew and vessel, and its therapeutic mechanism may be related to significantly decreasing the levels of serum IL-1, MMP-3, COMP and increasing the level of TIMP-1, and improving red blood cell immune function.
引文
[1] 陈庆奇,龚敬乐.基于国内外指南的适用于我国全科医疗的膝骨关节炎诊治流程[J].中国全科医学,2016,19(2):125-129
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[11] 陈金伟,吕杰,俞银贤,等.膝骨关节炎中天然免疫和TLR/NF-κB信号通路的研究进展[J/CD].中华临床医师杂志:电子版,2013,7(24):11602-11606
[12] 熊伟.软骨寡聚基质蛋白与骨关节炎的相关性研究及临床意义[D].遵义:遵义医学院,2014
[13] Calabro S,Gallman A,Gowthaman U,et al.Bridging channel dendritic cells induce immunity to transfused red blood cells[J].J Exp Med,2016,213(6):887-896
[14] 李芳,姚建华,段哲萍,等.不同证型膝骨关节炎患者红细胞免疫功能变化及痹祺胶囊的干预效果研究[J].中国全科医学,2016,19(24):2939-2942
[15] 马雪云,韩建秋,牛钟相.补体C3b肽段的免疫功能[J].动物医学进展,2005,26(6):105-108
[2] 刘慧,周玲玲,周聪,等.骨痹颗粒对骨关节炎相关炎性反应的作用及机制[J].中华中医药杂志,2015,30(12):4466-4468
[3] 阮丽萍,刘健,叶文芳,等.中医健脾单元疗法对膝骨关节炎患者的生活质量、心肺功能的影响及免疫学机制研究[J].风湿病与关节炎,2015,4(3):5-11
[4] 阮丽萍,刘健.中医药对膝骨关节炎体液免疫作用的研究[J].风湿病与关节炎,2014,3(6):56-59;64
[5] Neogi T,Zhang Y.Osteoarthritis prevention[J].Curr Opin Rheumatol,2011,23(2):185-191
[6] 宋敬锋,毕成,刘昊.膝关节清理联合痹祺胶囊治疗膝关节骨性关节炎疗效观察[J].中华中医药杂志,2016,31(4):1358-1360
[7] 李芳,姚建华,郑桂敏,等.痹祺胶囊对骨关节炎患者血清IL-1、MMP-3和TIMP-1表达的影响[J].中华中医药杂志,2016,31(1):300-302
[8] 牟明威.痹祺胶囊治疗膝骨关节炎临床观察[J].中华中医药杂志,2013,28(4):1151-1152
[9] 杨艳,范琳琳,顾丽丽,等.痹祺胶囊治疗类风湿关节炎随机对照试验的Meta分析[J].天津中医药大学学报,2014,33(6):333-338
[10] 丁勇,祝丰奎,杨利,等.膝关节清理术联合痹祺胶囊治疗轻中度膝关节骨性关节炎临床观察[J].中华中医药杂志,2017,32(2):867-869
[11] 陈金伟,吕杰,俞银贤,等.膝骨关节炎中天然免疫和TLR/NF-κB信号通路的研究进展[J/CD].中华临床医师杂志:电子版,2013,7(24):11602-11606
[12] 熊伟.软骨寡聚基质蛋白与骨关节炎的相关性研究及临床意义[D].遵义:遵义医学院,2014
[13] Calabro S,Gallman A,Gowthaman U,et al.Bridging channel dendritic cells induce immunity to transfused red blood cells[J].J Exp Med,2016,213(6):887-896
[14] 李芳,姚建华,段哲萍,等.不同证型膝骨关节炎患者红细胞免疫功能变化及痹祺胶囊的干预效果研究[J].中国全科医学,2016,19(24):2939-2942
[15] 马雪云,韩建秋,牛钟相.补体C3b肽段的免疫功能[J].动物医学进展,2005,26(6):105-108