昆仙胶囊治疗老年类风湿关节炎的疗效观察及对骨代谢的影响  

Effect of Kunxian capsule on elderly rheumatoid arthritis and its influence on bone metabolism

作　　者：许蓓[1] 黄彬彬 许冠华[1] 郝兵[3] 余叶 林进[1] XU Bei;HUANG Bin-bin;XU Guan-hua(Department of Rheumatology,First Affiliated Hospital of Zhejiang University College of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院风湿免疫科,310003 [2]常山县人民医院风湿免疫科,324200 [3]浙江大学医学院附属第一医院卫生部多器官联合移植研究重点实验室,310003

出　　处：《中国实用医药》2020年第34期14-17,共4页China Practical Medicine

基　　金：浙江省中医药管理局,中医药科研基金项目(项目编号:2018ZA070)。

摘　　要：目的观察昆仙胶囊治疗老年类风湿关节炎(RA)的疗效及对骨代谢的影响。方法选取60例老年RA患者作为RA组,随机分为甲氨蝶呤(MTX)组、昆仙胶囊组和联合治疗组,每组20例。另选取同期20例本院体检健康者作为健康对照组。MTX组在常规用药基础上加用MTX片剂治疗,昆仙胶囊组在常规治疗基础上加用昆仙胶囊治疗,联合治疗组在常规治疗基础上联合应用MTX片与昆仙胶囊治疗。比较RA组、对照组以及MTX组、昆仙胶囊组、联合治疗组治疗前后的骨代谢指标[血清骨保护素(OPG)、核因子κB受体活化剂配体(RANKL)];比较MTX组、昆仙胶囊组、联合治疗组治疗前后类风湿关节炎病情活动度评分表(DAS)28评分。结果 RA组患者的OPG(499.69±36.61)ng/L低于健康对照组的(1003.65±82.66)ng/L, RANKL(59.53±8.79)pmol/L高于健康对照组的(23.58±11.83)pmol/L,差异均具有统计学意义(P<0.05)。治疗12周后,联合治疗组DAS28评分(2.96±0.17)分显著低于MTX组的(3.83±0.18)分和昆仙胶囊组的(4.21±0.10)分,且MTX组DAS28评分低于昆仙胶囊组,差异均具有统计学意义(P<0.05)。治疗24周后,联合治疗组DAS28评分(2.85±0.19)分显著低于MTX组的(3.28±0.36)分和昆仙胶囊组的(3.31±0.20)分,差异具有统计学意义(P<0.05);但MTX组和昆仙胶囊组DAS28评分比较,差异无统计学意义(P>0.05)。治疗12、24周后三组患者RANKL水平均较治疗前降低, OPG水平均较治疗前升高,且联合治疗组的RANKL水平低于MTX组和昆仙胶囊组, OPG水平高于MTX组和昆仙胶囊组,差异均具有统计学意义(P<0.05)。MTX组与昆仙胶囊组治疗12、24周后OPG、RANKL水平比较,差异无统计学意义(P>0.05)。RA患者外周血OPG与DAS28评分呈负相关(r=-0.431, P<0.05),RANKL与DAS28评分呈正相关(r=0.503, P<0.05)。结论昆仙胶囊治疗老年PA可以通过调节NFκB受体激活剂(RANK)/RNAKL/OPG系统抑制炎症反应实现骨保护作用,昆仙胶囊和MTX联合应用�Objective To observe the effect of Kunxian capsule on elderly rheumatoid arthritis(RA) and its influence on bone metabolism. Methods A total of 60 elderly RA patients as RA group, and they were divided into methotrexate(MTX) group, Kunxian capsule group and combined treatment group according to random numerical table, with 20 cases in each group. Another 20 healthy subjects were taken as healthy control group. MTX group was treated with MTX tablets on the basis of conventional treatment, Kunxian capsule group was treated with Kunxian capsule on the basis of conventional treatment, and combined treatment group was treated with MTX tablets and Kunxian capsule on the basis of conventional treatment. Comparison was made on bone metabolism indexes [serum osteoprotegerin(OPG), receptor activator of the nuclear factor-kappa B ligand(RANKL)] in RA group, control group, MTX group, Kunxian capsule group and combined treatment group before and after treatment, disease activity scale(DAS) 28 score before and after treatment in MTX group, Kunxian capsule group and combined treatment group. Results OPG(499.69±36.61) ng/L of RA group was lower than(1003.65± 82.66) ng/L of healthy control group, and RANKL(59.53±8.79) pmol/L was higher than(23.58±11.83) pmol/L of healthy control group, and the difference was statistically significant(P<0.05). 12 weeks after treatment, DAS28 score(2.96±0.17) points of combined treatment group was significantly lower than(3.83±0.18) points of MTX group and(4.21±0.10) points of Kunxian capsule group, and DAS28 score of MTX group was lower than that of Kunxian capsule group, and the difference was statistically significant(P<0.05). 24 weeks after treatment, DAS28 score(2.85±0.19) points of combined treatment group was significantly lower than(3.28±0.36) points of MTX group and(3.31±0.20) points of Kunxian capsule group, and the difference was statistically significant(P<0.05). But there was no statistically significant difference in DAS 28 score between MTX group and Kunxian capsule group(P

关 键 词：类风湿关节炎 骨代谢 甲氨蝶呤 昆仙胶囊 

分 类 号：R593.22[医药卫生—内科学]