甲氨喋呤联合健脾通络方治疗类风湿性关节炎患者的疗效及其对血清HMGB1水平的影响  

Effects of Methotrexate Combined with Jianpi Tongluo Decoction on Serum HMGB1 in Patients with Rheumatoid Arthritis

作　　者：杨广训 姚丽君 曹云祥[1] 张文婷 朱杰 邹小蜂 YANG Guang-xun;YAO Li-jun;CAO Yun-xiang;ZHANG Wen-ting;ZHU Jie;ZOU Xiao-feng(Department of Rheumatology,The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei Anhui 230038;Department of Integrated Traditional Chinese and Western Medicine,The Taihe Hospital of Wannan Medical College,Taihe Anhui 236608)

机构地区：[1]安徽中医药大学第一附属医院风湿病科,安徽合肥230038 [2]皖南医学院附属太和医院中西医结合科,安徽太和236608

出　　处：《世界中西医结合杂志》2022年第10期2072-2076,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：安徽省自然科学基金项目(gxyq2018028)。

摘　　要：目的观察甲氨喋呤联合健脾通络方治疗类风湿性关节炎(Rheumatoid Arthritis,RA)患者的疗效及其对血清高迁移率族蛋白B1(High Mobility Group protein B1,HMGB1)水平的影响。方法选取2020年4月—2021年4月期间皖南医学院附属太和医院收治的125例RA患者,按照区组随机化分组法将其分为对照组62例和观察组63例。对照组使用甲氨喋呤进行治疗,观察组则在其基础上联合健脾通络方进行治疗。治疗1个月后,观察比较两组患者证候疗效,治疗前后中医症状积分变化(关节疼痛、关节肿胀、屈伸不利、晨僵),血清标志物[类风湿因子(Rheumatoid Factor,RF)、抗环瓜氨酸肽抗体(anti-Cyclic Citrullinated Peptide antibody,抗CCP抗体)]及血清相关指标[高迁移率族蛋白B1(HMGB1)、超敏C-反应蛋白(high-sensitivity C-Reactive Protein,hs-CRP)、转化生长因子-β(Transforming Growth Factor-β,TGF-β)]水平及不良反应情况。结果治疗1个月后,观察组总有效率90.48%(57/63)明显高于对照组77.42%(48/62),差异有统计学意义(P<0.05)。治疗1个月后,两组患者中医症状积分较治疗前均明显降低,差异有统计学意义(P<0.05);且观察组中医症状积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗1个月后,两组患者RF、抗CCP抗体水平较治疗前均明显降低,差异有统计学意义(P<0.05);且观察组RF、抗CCP抗体水平明显低于对照组,差异有统计学意义(P<0.05)。治疗1个月后,两组患者HMGB1、hs-CRP水平均较治疗前明显降低,TGF-β水平均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组HMGB1、hs-CRP水平均明显低于对照组,TGF-β水平明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论甲氨喋呤联合健脾通络方治疗RA临床效果良好,能改善患者临床症状,降低患者血清HMGB1水平,抑制炎症反应的发生,且药物安全�Objective To observe the effects of methotrexate combined with Jianpi Tongluo Decoction on the level of serum high mobility group protein B1(HMGB1)in patients with rheumatoid arthritis(RA).Methods A total of 125 RA patients treated in The Taihe Hospital of Wannan Medical College from April 2020 to April 2021 were taken as the research subjects.According to the block randomization,the patients were divided into a control group(62 cases)and an observation group(63 cases).The control group was treated with methotrexate,and the observation group was combined with Jianpi Tongluo Decoction on this basis.After 1 month of treatment,the clinical efficacy,and score of traditional Chinese medicine(TCM)symptoms(joint pain,joint swelling,inhibited bending and stretching,morning stiffness),levels of serum markers[rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(anti-CCP antibody)]and serum-relatedindicators[high mobility group protein B1(HMGB1),high-sensitivity C-reactive protein(hs-CRP),transforming growth factor-β(TGF-β)]before and after treatment were compared between the two groups.The incidence of adverse drug reactions in the two groups was statistically analyzed after treatment.Results After 1 month of treatment,the total effective rate of observation group was higher than that in control group[90.48%(57/63)vs 77.42%(48/62)](P<0.05).The TCM symptomscore,and levels of RF,anti-CCP antibody,HMGB1 and hs-CRP of the two groups were decreased and the level of TGF-βwas increased compared with those before treatment(all P<0.05),and the observation group had more decrease or increase than the control group(P<0.05).There was no statistical difference in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusion Methotrexate combined with Jianpi Tongluo Decoction had a good clinical effect in the treatment of RA.It could improve the clinical symptoms,reduce the level of serum HMGB1 and inhibit the occurrence of inflammatory response,with high safety,which was beneficial to the treatment of

关 键 词：甲氨喋呤 健脾通络方 类风湿性关节炎 高迁移率族蛋白B1 类风湿因子 抗环瓜氨酸肽抗体 

分 类 号：R593.22[医药卫生—内科学]