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  

Immunological analysis of different syndromes of osteoarthritis and intervention of Biqi capsule

作　　者：李芳[1] 姚建华[2] 任秀英[1] 闫永龙[1] 郑桂敏[1] 张风肖[1] LI Fang;YAO Jianhua;REN Xiuying;YAN Yonglong;ZHENG Guimin;ZHANG Fengxiao(Hebei General Hospital,Shijiazhuang 050051,Hebei,China;The Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北省人民医院,河北石家庄050051 [2]河北医科大学第二医院,河北石家庄050000

出　　处：《现代中西医结合杂志》2019年第16期1719-1723,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省中医药管理局科研计划项目(2015136)

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

关 键 词：骨关节炎 痹祺胶囊 免疫学 肝肾不足、筋脉瘀滞型 脾肾两虚、湿注骨节型 肝肾亏虚、痰瘀交阻型 

分 类 号：R684.3[医药卫生—骨科学]