顽痹清丸对类风湿关节炎湿热痹阻证患者血清细胞焦亡相关因子表达的影响  

Effect of Wanbiqing Pills(顽痹清丸)on the Expression of Serum Pyroptosis-related Factors in Rheumatoid Arthritis Patients with Damp-heat Obstruction Syndrome

作　　者：王秋苑 岳辰 刘又文 郭珈宜 侯宏理 张雪 WANG Qiuyuan;YUE Chen;LIU Youwen;GUO Jiayi;HOU Hongli;ZHANG Xue(Henan University of Chinese Medicine,Zhengzhou,450046;Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital)

机构地区：[1]河南中医药大学,河南省郑州市郑东新区450046 [2]河南省洛阳正骨医院(河南省骨科医院)

出　　处：《中医杂志》2023年第12期1240-1247,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82004396)。

摘　　要：目的观察顽痹清丸对类风湿关节炎(RA)湿热痹阻证患者的临床疗效,并从细胞焦亡的角度探讨其可能作用机制。方法84例RA湿热痹阻证患者随机分为治疗组和对照组,每组42例。对照组患者口服甲氨蝶呤片每次10 mg,每周1次;塞来昔布胶囊每次0.2 g,每日1次。治疗组在对照组药物的基础上口服顽痹清丸,每次6 g,每日2次。两组均连续治疗4周。于治疗前及治疗2、4周后进行类风湿关节炎疾病活动度(DAS28)评分、疼痛视觉模拟(VAS)评分、中医症状积分评分,检测红细胞沉降率(ESR)及C反应蛋白(CRP)水平、血清中细胞焦亡相关因子[包括NOD样受体蛋白3(NLRP3)炎性小体、半胱氨酸天冬氨酸蛋白酶1(Caspase-1)、白细胞介素1β(IL-1β)和白细胞介素18(IL-18)]表达水平。治疗4周后比较两组患者的临床疗效及不良反应发生率。结果最终完成研究81例,治疗组41例,对照组40例。治疗组总有效率为63.41%(26/41),对照组总有效率为47.50%(19/40),两组比较差异无统计学意义(P>0.05)。治疗2周后,对照组患者的中医症状积分和VAS评分较治疗前降低(P<0.05或P<0.01);治疗组患者的中医症状积分、VAS评分、DAS28评分较治疗前降低(P<0.05或P<0.01),且均低于对照组(P<0.05或P<0.01)。治疗4周后,对照组患者的中医症状积分和VAS评分较治疗前降低(P<0.01),治疗组患者的中医症状积分、VAS评分、DAS28评分、CRP和ESR水平均较治疗前降低(P<0.01),且均低于对照组同期(P<0.05或P<0.01)。治疗2周及4周后,两组患者血清NLRP3、Caspase-1、IL-1β和IL-18水平均较治疗前降低(P<0.01)。治疗组患者治疗2周及4周后血清NLRP3、Caspase-1、IL-1β和IL-18水平低于对照组同期(P<0.05或P<0.01)。治疗组不良反应发生率为12.20%(5/41),对照组为30.00%(12/40),治疗组低于对照组(P<0.05)。结论顽痹清丸可能通过参与调节血清细胞焦亡相关因子,降低炎症水平,从而改善RA湿热痹阻证患者临Objective To observe the clinical effect of Wanbiqing Pills(顽痹清丸)on rheumatoid arthritis(RA)patients with damp-heat obstruction syndrome,and to explore its possible mechanism from the perspective of pyropto⁃sis.Methods Eighty-four cases of RA patients with damp-heat obstruction syndrome were randomly divided into treatment group and control group,with 42 cases in each group.The control group was orally administered with metho⁃trexate tablets,10 mg each time,once a week,and celecoxib capsules,0.2 g each time,once a day.The treatment group was additionally given Wanbiqing Pills orally,6 g each time,twice a day.Both groups were treated continuous⁃ly for four weeks.Before treatment and after 2-and 4-week treatment,the disease activity score in 28 joints(DAS28)and pain visual analog scale(VAS)score were assessed,and erythrocyte sedimentation rate(ESR),C-reactive pro⁃tein(CRP)level,and expression levels of pyroptosis-related factors in serum including NOD-like receptor protein 3(NLRP3)inflammasome,cysteine aspartic acid protease 1(Caspase-1),leukocyte Interleukin 1β(IL-1β)and inter⁃leukin 18(IL-18)were detected.The clinical effect and the incidence of adverse reactions were evaluated and compared between the two groups after 4-week treatment.Results Finally,81 cases completed the study,includ⁃ing 41 cases in the treatment group and 40 cases in the control group.The total effective rate of the treatment group was 63.41%(26/41),while that of the control group was 47.50%(19/40),with no significant difference between the groups(P>0.05).After 2-week treatment,the traditional Chinese medicine(TCM)symptom scores and VAS scores in the control group significantly decreased(P<0.05 or P<0.01),as well as the TCM symptom scores,DAS28 scores and VAS scores in the treatment group(P<0.05 or P<0.01);and the scores were lower in the treat⁃ment group than those in the control group(P<0.05 or P<0.01).After 4-week treatment,the TCM symptom scores and VAS scores in the control group significantly decreased compared t

关 键 词：类风湿关节炎 湿热痹阻证 细胞焦亡 炎症因子 顽痹清丸 

分 类 号：R259[医药卫生—中西医结合]