蠲痹汤对痛风湿热瘀阻证老年患者NLRP3炎性体的影响  

Juanbi Decoction on NLRP3 Inflammasome of Heat-Damp and Stasis Type of Gout in Elderly Patients

作　　者：黄正桥[1] 朱莹 宋洪娟[1] 

机构地区：[1]成都中医药大学,四川成都610075 [2]广东省中医医院,广东广州510120

出　　处：《辽宁中医杂志》2016年第4期696-700,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81303014)

摘　　要：目的:探讨采用蠲痹汤治疗湿热瘀阻型痛风的临床疗效,及其对外周血NLRP3炎性体的影响,以及安全性评价。方法:选择风湿内分泌科2012年6月—2015年1月收治的92例湿热瘀阻型急性痛风患者作为观察对象,随机分为两组,观察组n=47,对照组n=45;对照组予口服秋水仙碱和别嘌醇治疗,秋水仙碱口服1 mg/次,3次/d,直至关节症状缓解,改维持量为0.5 mg,2次/d,共维持治疗3周,别嘌醇初始量为50 m/次,2次/d,每周递增50 mg,至第三周最高可为150 mg,2次/d。每周测血尿酸和尿尿酸水平,若测时已达正常水平,则不再增量,如仍高可再递增,但日最大量不得超过600 mg;观察组在对照组的基础上加用中药汤剂蠲痹汤,1剂/d(早晚餐后分服),3周为1个疗程;均于1个疗程后评价两组治疗效果差异及不良反应发生情况,并检测两组患者的NLRP3炎性体表达差异。结果:观察组的有效率86.4%(51/59),明显高于对照组的有效率75.9%(44/58),差异具有统计学意义(P<0.05)。治疗后两组的PYCARD mRNA表达水平均有所下降,而观察组下降程度显著高于对照组(P<0.05);两组NLRP3、caspase-1 mRNA表达水平量均有所升高,观察组升高程度均较对照组明显(分别P<0.05,P<0.01)。治疗后两组的IL-1βmRNA的表达量均有所升高,而观察组升高程度显著大于对照组(P<0.05);血浆IL-1β、IL-18水平两组均有不同程度下降,而观察组均较对照组下降更为明显(P<0.05)。治疗后两组的IL-1βmRNA的表达量均有所升高,而观察组升高程度显著大于对照组(P<0.05);血浆IL-1β、IL-18水平两组均有不同程度下降,而观察组均较对照组下降更为明显(P<0.05)两组均未见到明显的不良反应发生。结论:NLRP3炎性体变化参与了痛风炎症过程,对IL-1β、IL-18等促炎因子的成熟和分泌具有复杂的调控作用,加用蠲痹汤可能会更好地调节患者NLRP3、PYCARD及caspase-1炎性体基因及其转录剪接mRNA在PBMCs中的表达,但Objective： To investigate the clinical efficacy of using Juanbi Decoction on heat-damp and stasis type of gout and its influence on peripheral NLRP3 inflammasome and safety evaluation. Methods： In Rheumatoid Endocrinology department during June 2012-January 2015,a total of 92 cases were as the observed object and randomly divided into two groups： the observation group,（ n = 47）,the control group（ n = 45）. The control group used oral colchicine 1 mg / time 3 times a day,until joint symptoms relief,dose changed 0. 5 mg,twice a day,a total of three weeks maintenance treatment. And allopurinol,the initial amount 50 m /time,twice a day,increasing weekly 50 mg,until the third week up to 150 mg,twice a day. Weekly measure blood uric acid and uric acid levels. If the results reached normal levels,no longer increment. If the level was still high,the daily maximum amount can be increased but not exceeding 600 mg. The observation group added Juanbi Decoction,one dose a day（ after meals in the morning and evening）,three weeks for a course. After a course of treatment,we evaluated the effect differences and adverse events and detected patients＇ inflammatory NLRP3 body expression differences. Results： The response rate was 86. 4%（ 51 /59） in the observation group,significantly higher than 75. 9%（ 44 /58） in the control group and the difference was statistically significant（ P〈0. 05）. After treatment,the PYCARD mRNA expression levels were decreased while the observation group＇s degree of decline was significantly higher（ P〈0. 05）. Two groups＇ NLRP3 and caspase-1 mRNA expression levels were increased and the observation group＇s increased degree was higher than that in the control group（ respectively P〈0. 05,P〈0. 01）. After treatment,the expression levels of IL-1β mRNA in two groups were increased while the increasing level of the observation group was significantly greater than that in the control group（ P〈0. 05）. Serum IL-1β and IL-18 levels in both groups decrease

关 键 词：蠲痹汤 痛风 湿热瘀阻证 NLRP3炎性体 

分 类 号：R971.1[医药卫生—药品]