蠲痹汤加减对风寒湿痹型类风湿关节炎患者关节液中炎症因子,血清MMP-3,OPG及RANKL的影响  

Effect of Modified Juanbitang on Inflammatory Factors and Serum MMP-3,OPG and RANKL in Synovial Fluid of Patients with Wind-cold-wetness Type Rheumatoid Arthritis

作　　者：李建[1] 荣兵[1] 贾峻[1] 潘明柱[1] LI Jian RONG Bing JIA Jun PAN Ming-zhu(First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China)

机构地区：[1]天津中医药大学第一附属医院,天津300193

出　　处：《中国实验方剂学杂志》2017年第22期165-170,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：天津市卫生局中医;中西医结合科研项目(07061)

摘　　要：目的:探讨风寒湿痹型类风湿关节炎(RA)应用蠲痹汤加减治疗的临床效果,及对患者关节液中炎症因子、生活质量的影响。方法:选取天津中医药大学第一附属医院2015年1月—2017年1月收治的134例RA患者,采用随机数字表法均分为两组。两组患者均给予相同的非药物治疗,对照组在此基础上予以美洛昔康+甲氨喋呤治疗,观察组予蠲痹汤加减治疗。比较两组患者中医证候疗效,治疗前后理化指标、关节液炎症因子水平、生活质量评分及血清基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3),骨保护素(osteoprotegerin,OPG)及核转录因子-κB受体活化因子(receptor activator for nuclear factor-κB ligand,RANKL)表达水平,并观察不良反应。结果:治疗12周后,观察组中医证候疗效有效率为94.0%,对照组为82.1%,观察组优于对照组(P<0.05)。与治疗前比较,两组患者治疗12周后红细胞沉降率(erythrocyte sedimentation tate,ESR)值及血清C反应蛋白(C-reactive protein,CRP),类风湿因子(rheumatoid factor,RF)水平均明显降低(P<0.05),且观察组下降更明显(P<0.05)。两组患者治疗12周后关节液肿瘤坏死因子(tumor necrosis factor,TNF)-α,白细胞介素(interleukin,IL)-17水平均明显低于治疗前(P<0.05),观察组降低更明显(P<0.05)。与治疗前相比,两组患者治疗12周后生理健康总评(physical component summary,PCS),心理健康总评(mental component summary,MCS)评分均明显上升(P<0.05),观察组升高更明显(P<0.05),与治疗前比较,两组患者治疗后MMP-3及RANKL水平降低,OPG水平升高(P<0.05)。与对照组比较,观察组治疗后RANKL水平明显降低(P<0.05)。结论:风寒湿痹型RA应用蠲痹汤加减治疗更能有效缓解或消除患者的症状体征、减轻机体炎症反应,延缓病情进展,提高生活质量,疗效更优。Objective： To explore the clinical effect of modified Juanbitang on patients with wind-coldwetness type rheumatoid arthritis（ RA） and its effect on inflammatory factors and quality of life. Method： The 134 cases with RA treated at our hospital from January 2015 to January 2017 were selected as research objectives,and randomly divided into two groups. The same nonpharmacological treatment was provided to both groups. The control group was additionally given meloxicam ＋ methotrexate,and the observation group was treated with modified Juanbitang. Two groups＇ traditional Chinese medicine（ TCM） syndrome,physical and chemical indicators before and after treatment,synovial fluid inflammatory factor level,quality of life,serum matrix metalloproteinase-3（ MMP-3）,bone protection element osteoprotegerin（ OPG） and receptor activator for nuclear factor-κB ligand（ RANKL） expression were recorded and compared. Adverse reactions were also observed. Result： After treatment for 12 weeks,the overall effective rate of TCM syndrome in observation group was 94. 0%,which was significantly higher than 82. 1% in control group. The observation group was superior to control group. The two group＇s erythrocyte sedimentation rate erythrocyte sedimentation rate（ ESR）,serum C-reactive protein（ CRP）,rheumatoid factor（ RF） after treatment for 12 weeks were significant lower than those before treatment（ P〈0. 05）,and those in observation group were decreased more significantly（ P〈0. 05）. Two groups＇ joint fluid tumor necrosis factor（ TNF）-α,and interleukin interleukin-17（ IL^-17） after treatment for 12 weeks were significant lower than those before treatment（ P〈0. 05）,and those in observation group were decreased more significantly（ P〈0. 05）. Two groups＇ physical component summary（ PCS） and mental component summary（ MCS） after treatment for 12 weeks were significant higher than those before treatment（ P〈0. 05）,and those in observation group were increase

关 键 词：类风湿关节炎 风寒湿痹型 蠲痹汤 炎症因子 生活质量 基质金属蛋白酶-3 

分 类 号：R287[医药卫生—中药学]