类风湿关节炎血清肿瘤坏死因子α与骨密度的相关性及瓜蒌桂枝汤抗炎机制研究  

Study on the Correlation Between Tumor Necrosis Factor Alpha and Bone Mineral Density in Rheumatoid Arthritis Patients and Anti-inflammatory Mechanism of Gualou Guizhi Decoction

作　　者：赵红波 李国鲁 田晓滨 ZHAO Hong-Bo;LI Guo-Lu;TIAN Xiao-Bin(Guizhou Medical University,Guiyang 550025 Guizhou,China;Guizhou Provincial People's Hospital,Zunyi 563000 Guizhou,China)

机构地区：[1]贵州医科大学,贵州贵阳550025 [2]贵州省人民医院,贵州遵义563000

出　　处：《广州中医药大学学报》2023年第10期2472-2479,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81601368);贵州省科技计划项目(编号:黔科合支撑[2021]一般072)。

摘　　要：【目的】分析类风湿关节炎(rheumatoid arthritis,RA)患者血清肿瘤坏死因子α(TNF-α)与骨密度(BMD)的相关性以及瓜蒌桂枝汤的抗炎机制。【方法】将2020年1月至2022年1月在贵州省人民医院就诊的76例风湿热痹型RA患者设为观察组,将同期在该院体检中心体检的76例健康体检者设为正常对照组,比较观察组与正常对照组以及不同分期RA患者血清TNF-α、BMD的差异,比较不同骨密度RA患者血清TNF-α的差异,Pearson分析TNF-α与BMD的相关性。同时,根据治疗方法的不同,将76例RA患者分为西医组和中西结合组,每组38例,西医组给予常规西药治疗,中西结合组在西医组基础上给予瓜蒌桂枝汤加味治疗,疗程为4周。观察2组RA患者治疗前后疼痛视觉模拟量表(VAS)评分、晨僵时间、血清炎症因子、BMD的变化情况,评价2组患者临床疗效,探讨瓜蒌桂枝汤在治疗RA中的抗炎机制。【结果】(1)观察组RA患者血清TNF-α水平高于正常对照组,BMD低于正常对照组,差异均有统计学意义(P<0.01);Ⅳ期RA患者血清TNF-α水平高于Ⅲ期和Ⅱ期患者,BMD低于Ⅲ期和Ⅱ期患者,差异均有统计学意义(P<0.05);骨质疏松组患者血清TNF-α水平高于骨密度低下组和骨密度正常组,差异均有统计学意义(P<0.05);Pearson分析结果显示:TNF-α与BMD呈负相关性(r=-0.401),差异有统计学意义(P<0.05)。(2)治疗4周后,中西结合组的总有效率为94.74%(36/38),西医组为68.42%(26/38),组间比较,中西结合组的临床疗效明显优于西医组,差异有统计学意义(P<0.01)。(3)治疗后,2组RA患者的VAS评分均较治疗前降低(P<0.05),晨僵时间均较治疗前缩短(P<0.05),且中西结合组治疗后的VAS评分低于西医组,晨僵时间短于西医组,差异均有统计学意义(P<0.01)。(4)治疗后,2组RA患者的血清TNF-α、C反应蛋白(CRP)、白细胞介素6(IL-6)水平均较治疗前降低(P<0.05),且中西结合组治疗后的血清TNF-α、CRP、IL-6水�Objective To explore the correlation between serum tumor necrosis factor alpha(TNF-α)and bone mineral density(BMD)in patients with rheumatoid arthritis(RA)and to investigate the anti-inflammatory mechanism of Gualou Guizhi Decoction.Methods Seventy-six RA patients with wind-damp-heat bi-syndrome who attended the Guizhou Provincial People's Hospital from January 2020 to January 2022 were enrolled served as the observation group,and 76 healthy subjects who had a physical check-up at the physical examination centre of the hospital during the same period served as the normal control group.The differences in serum TNF-αand BMD between the observation group and the normal control group and in the patients with various stages of RA were compared,and the differences in serum TNF-αof RA patients with various values of BMD were investigated.And then Pearson analysis of the correlation between TNF-αand BMD was conducted.Moreover,76 RA patients were divided into western medicine group and integrated Chinese and western medicine group,38 cases in each group.The western medicine group was given conventional western medicine treatment,while the integrated Chinese and western medicine group was given Gualou Guizhi Decoction with additional flavors on the basis of treatment for the western medicine group.Both groups were treated for 4 weeks.Before and after treatment,the changes of pain visual analogue scale(VAS)scores,morning stiffness time,serum levels of inflammatory factors and BMD in the two groups were observed for the evaluation of the clinical efficacy and for the exploration of the anti-inflammatory mechanism of Gualou Guizhi Decoction in the treatment of RA.Results(1)The serum TNF-αlevel in the observation group was higher than that in the normal control group and the BMD was lower than that in the normal control group,and the differences were statistically significant(P<0.01).In RA patients of stageⅣ,the serum TNF-αlevel was higher and the BMD was lower than that in the RA patients of stageⅢandⅡ,and the dif

关 键 词：类风湿关节炎 风湿热痹型 肿瘤坏死因子Α 骨密度 瓜蒌桂枝汤 抗炎机制 

分 类 号：R259.322[医药卫生—中西医结合]