雷公藤双层片联合甲泼尼龙脉冲治疗系统性红斑狼疮的临床研究
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摘要
目的观察雷公藤双层片联合甲泼尼龙脉冲治疗系统性红斑狼疮(SLE)的临床疗效并分析其治疗机制。方法将2017年1月至2018年1月该院收治的173例SLE患者按入院先后顺序采用随机对照原则分为对照组(85例)和观察组(88例)。对照组采用甲泼尼龙脉冲治疗,观察组采用雷公藤双层片联合甲泼尼龙脉冲治疗。比较两组患者外周血单核细胞趋化蛋白-4、血清白细胞介素-2(IL-2)、IL-4,以及外周血T淋巴细胞亚群CD3~+、CD4~+、CD8~+、CD4~+/CD8~+变化情况;采用酶联免疫吸附试验检测两组患者细胞间黏附分子-1、血管黏附分子-1表达,并采用SLE专属生活质量量表评价两组患者生活质量及疗效。结果观察组患者治疗后CD8~+、外周血单核细胞趋化蛋白-4、IL-2、IL-4、细胞间黏附分子-1、血管黏附分子-1均明显降低,CD4~+、CD4~+/CD8~+明显升高,与对照组比较,差异均有统计学意义(P<0.05)。观察组患者SLE专属生活质量量表总分及6个维度中症状、治疗方面、心情和自我形象评分均明显低于对照组,有效率明显高于对照组,差异均有统计学意义(P<0.05)。结论雷公藤双层片可增强甲泼尼龙脉冲治疗SLE的临床疗效,在改善SLE临床症状方面优于单用甲泼尼龙脉冲疗法。
Objective To observe the clinical efficacy of Tripterygium wilfordii double-layer tablets combined with methylprednisolone pulse therapy in the treatment of systemic lupus erythematosus(SLE)and analyze the therapeutic mechanism.Methods 173 cases of SLE from January 2017 to January 2018 were divided into the control group(n=85)and the observation group(n=88)according to the random control principle.The control group was treated with methylprednisolone pulse therapy and the observation group was added with Tripterygium wilfordii double-layer tablets.Peripheral blood monocyte chemoattractant protein-4(MCP-4),interleukin-2(IL-2),IL-4,and changes of CD3~+,CD4~+,CD8~+and CD4~+/CD8~+ratios in peripheral blood T lymphocyte subsets were compared.ELISA method was used to detect the intercellular adhesion molecule-1(ICAM-1)and the Vascular adhesion molecule-1.SLE-specific quality of life scale was used to evaluate the quality of life and efficacy of two groups.Results The percentage of CD8~+,MCP-4,IL-2,IL-4,ICAM-1 and VCAM-1 decreased and the percentage of CD4~+and CD4~+/CD8~+increased significantly in the observation group compared with the control group,and the difference was statistically significant(P<0.05).The overall score of SLE-specific quality of life scale symptoms,self-image and mood scores 6 dimensions of observation group were lower than those of control group and the effective rate was higher than that in control group,and the difference was statistically significant(P<0.05).Conclusion Tripterygium wilfordii double-layer tablets can enhance the clinical efficacy of methylprednisolone pulse therapy for SLE,and is better than single methylprednisolone pulse therapy improve the clinical symptoms of SLE.
Objective To observe the clinical efficacy of Tripterygium wilfordii double-layer tablets combined with methylprednisolone pulse therapy in the treatment of systemic lupus erythematosus(SLE)and analyze the therapeutic mechanism.Methods 173 cases of SLE from January 2017 to January 2018 were divided into the control group(n=85)and the observation group(n=88)according to the random control principle.The control group was treated with methylprednisolone pulse therapy and the observation group was added with Tripterygium wilfordii double-layer tablets.Peripheral blood monocyte chemoattractant protein-4(MCP-4),interleukin-2(IL-2),IL-4,and changes of CD3~+,CD4~+,CD8~+and CD4~+/CD8~+ratios in peripheral blood T lymphocyte subsets were compared.ELISA method was used to detect the intercellular adhesion molecule-1(ICAM-1)and the Vascular adhesion molecule-1.SLE-specific quality of life scale was used to evaluate the quality of life and efficacy of two groups.Results The percentage of CD8~+,MCP-4,IL-2,IL-4,ICAM-1 and VCAM-1 decreased and the percentage of CD4~+and CD4~+/CD8~+increased significantly in the observation group compared with the control group,and the difference was statistically significant(P<0.05).The overall score of SLE-specific quality of life scale symptoms,self-image and mood scores 6 dimensions of observation group were lower than those of control group and the effective rate was higher than that in control group,and the difference was statistically significant(P<0.05).Conclusion Tripterygium wilfordii double-layer tablets can enhance the clinical efficacy of methylprednisolone pulse therapy for SLE,and is better than single methylprednisolone pulse therapy improve the clinical symptoms of SLE.
引文
[1]方永光,陈楠楠,李岩,等.基于数据挖掘分析黄世林教授治疗重症系统性红斑狼疮的用药规律[J].中国中医急症,2017,26(6):947-951.
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[9]陆茂,叶俊儒,樊元春,等.血管细胞黏附分子-1、甚晚抗原-4在特应性皮炎皮损中的表达及意义[J].实用医学杂志,2017,27(19):3515-3517.
[10]赵俊芳,李桂珍,李孟娟,等.内皮细胞黏附分子及抗C1q抗体与系统性红斑狼疮活动度的相关性[J].广东医学,2017,38(10):1565-1566.
[11]SKEOCH S,HAQUE S,PEMBERTON P,et al.Cell adhesion molecules as potential biomarkers of nephritis,damage and accelerated atherosclerosis in patients with SLE[J].Lupus,2014,23(8):819-824.
[12]高丽霞.环磷酰胺与人免疫球蛋白联合治疗系统性红斑狼疮的临床效果及其对患者血清IL-4与MCP-4的影响[J].吉林医学,2016,37(11):2763-2765.
[13]夏嘉,江春春,苏晓,等.系统性红斑狼疮中医病因病机及辨证分型的研究进展[J].医学综述,2015,21(3):500-502.
[14]陈楠楠,方永光,黄世林,等.黄世林论治系统性红斑狼疮经验[J].中医杂志,2013,54(24):2090-2091.
[15]高敏,韩迎东.论雷公藤治疗系统性红斑狼疮之疗效简笺[J].中国中医药现代远程教育,2016,14(18):116-118.
[16]KASITANON N,WANGKAEW S,PUNTANA S,et al.The reliability,validity and responsiveness of the Thai version of systemic lupus erythematosus quality of life(SLEQOL-TH)instrument[J].Lupus,2013,22(3):289-296.
[2]谷三炜,马宁,赵令,等.系统性红斑狼疮患者和mRNA的表达及其与临床特征的关系[J].中国现代医学杂志,2017,27(1):55-59.
[3]靳慧,赵明,陆前进,等.红斑狼疮患者1006例临床特征研究:来自中国人群红斑狼疮多中心病例对照研究(LEMCSC)[J].中华皮肤科杂志,2016,49(1):6-11.
[4]王钢,李向培.糖皮质激素在系统性红斑狼疮目标治疗中的应用进展[J].安徽医科大学学报,2017,52(11):1739-1743.
[5]石连杰,李春,朱佳鑫,等.系统性红斑狼疮最新分类标准诞生[J].中华风湿病学杂志,2012,16(10):713-714.
[6]王书雅,田微,陈亮,等.系统性红斑狼疮疾病专属量表联合普适性量表在系统性红斑狼疮患者中的应用[J].中华风湿病学杂志,2014,18(3):190-194.
[7]OSNES LT,NAKKEN B,BODOLAY E,et al.Assessment of intraeellular cytokines and regulatory cells in patients with autoimmune diseases and primary immunodeficieneies novel tool for diagnostics and patient follow-up[J].Autoimmun Rev,2013,12(10):967-971.
[8]郭梦如,何东仪.雷公藤治疗类风湿关节炎的研究进展[J].风湿病与关节炎,2013,2(2):58-63.
[9]陆茂,叶俊儒,樊元春,等.血管细胞黏附分子-1、甚晚抗原-4在特应性皮炎皮损中的表达及意义[J].实用医学杂志,2017,27(19):3515-3517.
[10]赵俊芳,李桂珍,李孟娟,等.内皮细胞黏附分子及抗C1q抗体与系统性红斑狼疮活动度的相关性[J].广东医学,2017,38(10):1565-1566.
[11]SKEOCH S,HAQUE S,PEMBERTON P,et al.Cell adhesion molecules as potential biomarkers of nephritis,damage and accelerated atherosclerosis in patients with SLE[J].Lupus,2014,23(8):819-824.
[12]高丽霞.环磷酰胺与人免疫球蛋白联合治疗系统性红斑狼疮的临床效果及其对患者血清IL-4与MCP-4的影响[J].吉林医学,2016,37(11):2763-2765.
[13]夏嘉,江春春,苏晓,等.系统性红斑狼疮中医病因病机及辨证分型的研究进展[J].医学综述,2015,21(3):500-502.
[14]陈楠楠,方永光,黄世林,等.黄世林论治系统性红斑狼疮经验[J].中医杂志,2013,54(24):2090-2091.
[15]高敏,韩迎东.论雷公藤治疗系统性红斑狼疮之疗效简笺[J].中国中医药现代远程教育,2016,14(18):116-118.
[16]KASITANON N,WANGKAEW S,PUNTANA S,et al.The reliability,validity and responsiveness of the Thai version of systemic lupus erythematosus quality of life(SLEQOL-TH)instrument[J].Lupus,2013,22(3):289-296.