中药雾化吸入联合艾拉莫德对干燥综合征口干症状的影响
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摘要
目的:观察中药雾化联合艾拉莫德对干燥综合征(Sjogren's syndrome,SS)口干症状的影响。方法:40例干燥综合征口干症患者随机分为治疗组与对照组各20例。治疗组给予口腔中药雾化吸入联合艾拉莫德,对照组给予常规口服药物羟氯喹、白芍总苷胶囊。比较两组患者静态唾液流率、免疫球蛋白(IgG、IgM、IgA)水平、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactin protein,CRP)水平、临床疗效和安全性指标。结果:治疗12周后,两组患者血清IgG水平、红细胞沉降率、静态唾液流率水平与治疗前比较,差异均有统计学意义(P <0. 05)。治疗组有效率为90%,对照组为50%,差异有统计学意义(P <0. 05)。两组患者血常规、肝脏功能、肾脏功能与治疗前比较,差异均无统计学意义(P> 0. 05)。结论:中药雾化吸入联合艾拉莫德可明显缓解干燥综合征患者的口干症状,提高唾液流率,明显降低ESR、CRP、血清免疫球蛋白(IgG、Ig M、IgA)水平。
Objective: To observe the effect of aerosol of Chinese medicine combined with iguratimod on xerostomia of Sjogren's syndrome( SS). Methods: 40 Sjogren' s syndrome patients with xerostomia were randomly divided into treatment group and control group,with 20 cases each. The treatment group was given oral traditional Chinese medicine aerosol inhalation combined with iguratimod,while the control group was given routine oral drug hydroxychloroquine and total paeony glycoside capsules. Static salivary flow rate,immunoglobulin( Ig G Ig M Ig A),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP) levels,clinical efficacy and safety were compared between the two groups. Results: After 12 weeks of treatment,there were significant differences in serum Ig G level,erythrocyte sedimentation rate and static salivary flow rate between the two groups( P < 0. 05). The effective rate of the treatment group was 90% and that of the control group was 50%. The difference was statistically significant( P < 0. 05). There was no significant difference in blood routine,liver function and kidney function between the two groups before and after treatment( P >0. 05). Conclusion: Aerosol inhalation of Chinese medicine combined with iguratimod can significantly alleviate xerostomia of Sjogren's syndrome patients,increase salivary flow rate,and significantly reduce the levels of ESR,CRP and serum( Ig G Ig M Ig A).
Objective: To observe the effect of aerosol of Chinese medicine combined with iguratimod on xerostomia of Sjogren's syndrome( SS). Methods: 40 Sjogren' s syndrome patients with xerostomia were randomly divided into treatment group and control group,with 20 cases each. The treatment group was given oral traditional Chinese medicine aerosol inhalation combined with iguratimod,while the control group was given routine oral drug hydroxychloroquine and total paeony glycoside capsules. Static salivary flow rate,immunoglobulin( Ig G Ig M Ig A),erythrocyte sedimentation rate( ESR),C-reactive protein( CRP) levels,clinical efficacy and safety were compared between the two groups. Results: After 12 weeks of treatment,there were significant differences in serum Ig G level,erythrocyte sedimentation rate and static salivary flow rate between the two groups( P < 0. 05). The effective rate of the treatment group was 90% and that of the control group was 50%. The difference was statistically significant( P < 0. 05). There was no significant difference in blood routine,liver function and kidney function between the two groups before and after treatment( P >0. 05). Conclusion: Aerosol inhalation of Chinese medicine combined with iguratimod can significantly alleviate xerostomia of Sjogren's syndrome patients,increase salivary flow rate,and significantly reduce the levels of ESR,CRP and serum( Ig G Ig M Ig A).
引文
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[22]张可可.“肺肠合治法”调控神经肽VIP治疗干燥综合征的实验研究[D].南京:南京中医药大学,2016.
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[25]蒋叶,吕伟,余书勤,等.艾拉莫德对脂多糖激活大鼠肺泡巨噬系统系TNFα产生及NF-κB活性的抑制作用[J].药学学报,2006,41(5):401-405.
[26]张娜,付学锋,陈筱筱,等,干燥综合征108例临床分析[J].中国皮肤性病学杂志,2015,29(4):368-371.
[27]韦三华,刘昕阳,张婧.123例干燥综合征患者自身抗体及免疫球蛋白和补体检测分析[J].国际检验医学杂志,2010,31(7):648-649,652.
[28]江维,赵毅,林辉,等.艾拉莫德治疗原发性干燥综合征疗效观察[J].西部医学,2014,26(6):719-721,724.
[29]YAN Q,DU F,HUANG X,et al.Prevention of immune nephritis by the small molecular weight immunomodulator iguratimod in MRL/lpr mice[J].PLo S One,2014,9(10):e108273.
[2]BRANDT J E,PRIORI R,VALESINI G,et al.Sex differenc-es in Sj9gren's syndrome:a comprehensive review of immune mechanisms[J].Biol Sex Differ,2015,3(6):19.
[3]STOTT D I,HIEPE F,HUMMEL M,et al.Antigen-driven clonal proliferation of B cells within the target tissue of an autoimmune disease.The salivary glands of patients with Sj9gren's syndrome[J].J Clin Invest,1998,102(5):938-946.
[4]SALOMONSSON S,JONSSON M V,SKARSTEIN K,et al.Cellular basis of ectopic germinal center formation and autoantibody production in the target organ of patients with Sjogren's syndrome[J].Arthritis Rheum,2003,48(11):3187-3201.
[5]PROCHOREC-SOBIESZEK M,WAGNER T,LOUKAS M,et al.Histopathological and immunohistochemical analysis of lymphoid follicles in labial salivary glands in primary and secondary Sjogren's syndrome[J].Med Sci Monit,2004,10(4):BR115-BR121.
[6]史群,赵岩,李玲,等.羟氯喹治疗原发性干燥综合征前瞻性临床研究初[J].中华风湿病学杂志,2008,12(4):258-260,插2.
[7]WU T,TREVISAN M,GENCO R J,et al.Periodontal disease and risk of cerebrovascular disease:the first national health and nutrition examination survey and its follow-up study[J].Arch Intern Med,2000,160(18):2749-2755.
[8]罗辉,韩梅,刘建平.中药治疗干燥综合征随机对照试验的系统评价和Meta分析[J].中西医结合杂志,2014,9(3):257-274.
[9]侯雷,马武开,姚血明.中西医结合治疗干燥综合征疗效的文献荟萃分析[J].风湿病与关节炎,2013,2(8):49-54.
[10]王宁,张国.中药雾化吸入治疗咽部干燥症[J].新疆中医药杂志,2007,2(4):48.
[11]SEROR R,RAVAUD P,BOWMAN S J,et al.EULAR Sj9gren's syndrome disease activity index:Development of aconsensus systemic disease activity index for primary Sj9gren's syndrome[J].Ann Rheum Dis,2013,69(6):1103-1109.
[12]BOUAZIZ J D,YANABA K,TEDDER T F.Regulatory B cells as inhibitors of immune responses and inflammation[J].Immunol Rev,2008,224:201-214.
[13]蔡丽敏,陈志强.B细胞活化因子与干燥综合征[J].国际皮肤性病学杂志,2007,33(2):95-97.
[14]BASSET C,DURAND V,JAMIN C,et al.Increased N-linked glycosylation leading to oversialylation of monomeric immunoglobulin A1from patients with Sj9gren's syndrome[J].Scand J Immunol,2000,51(3):300-306.
[15]OMMA A,KUCUKSAHIN O,SANDIKCI S C,et al.Can the mean plateletvolume be a predictor of disease activity in primary Sjogren syndrome[J]?Int J Res Med Sci,2016,4(4):1237-1241.
[16]姜敏,周学平.干燥综合征的中医研究概况[J].中医药学刊,2003,21(8):1390-1391.
[17]路志正,焦树德.实用中医风湿病学[M].北京:人民卫生出版社,2001:269-281,490-496.
[18]王新昌,曹灵勇,范永升,等.干燥综合征中医病因病机刍议[J].浙江中医药大学学报,2013,35(5):643-644.
[19]崔向宁,冯兴华.冯兴华辨治干燥综合征经验[J].中医杂志,2017,58(3):202-204,213.
[20]王亚黎,刘健,杨佳,等.新安健脾益气通络法对干燥综合征的疗效、心肺功能影响及免疫学机制研究[J].风湿病与关节炎,2014,3(12):5-9.
[21]李成荫,平凡,朱丰林,等.肺肠合治法治疗干燥综合征探讨[J].中医杂志,2015,56(2):174-175.
[22]张可可.“肺肠合治法”调控神经肽VIP治疗干燥综合征的实验研究[D].南京:南京中医药大学,2016.
[23]EKSTRM SMEDBY K,VAJDIC C M,FALSTER M,et al.Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes:Apooled analysis within the Inter Lymph Consortium[J].Blood,2014,111(8):4029-4038.
[24]MUCKE H A.Iguratimod:a new disease-modifying antirheumatic drug[J].Drugs Today,2014,48(9):577-586.
[25]蒋叶,吕伟,余书勤,等.艾拉莫德对脂多糖激活大鼠肺泡巨噬系统系TNFα产生及NF-κB活性的抑制作用[J].药学学报,2006,41(5):401-405.
[26]张娜,付学锋,陈筱筱,等,干燥综合征108例临床分析[J].中国皮肤性病学杂志,2015,29(4):368-371.
[27]韦三华,刘昕阳,张婧.123例干燥综合征患者自身抗体及免疫球蛋白和补体检测分析[J].国际检验医学杂志,2010,31(7):648-649,652.
[28]江维,赵毅,林辉,等.艾拉莫德治疗原发性干燥综合征疗效观察[J].西部医学,2014,26(6):719-721,724.
[29]YAN Q,DU F,HUANG X,et al.Prevention of immune nephritis by the small molecular weight immunomodulator iguratimod in MRL/lpr mice[J].PLo S One,2014,9(10):e108273.