益肾消痹汤对强直性脊柱炎肾虚督寒证炎性因子及骨代谢的影响

Effect of Yishen Xiaobi Decoction on Inflammatory Factors and Bone Metabolism in Patients with Kidney Deficiency and Du-han Syndrome of Ankylosing Spondylitis

目的:观察益肾消痹汤治疗强直性脊柱炎肾虚督寒证的临床疗效及对肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症因子水平及骨代谢指标的影响。方法:将患者随机分为对照组、观察组各35例,对照组患者采用美洛昔康片和柳氮磺胺吡啶片进行常规治疗,观察组患者在此基础上加用益肾消痹汤加减内服,疗程为6个月。分别于治疗前后评价患者脊柱疼痛视觉模拟评分(VAS)、炎症活动指数(BASDAI)、巴氏AS功能指数(BASFI)、胸廓活动度、腰椎活动度(Schober试验)、"4"字试验、枕-墙距、指-地距、患者整体评分(PGA)以及中医证型评分等指标;检测治疗前后血沉(ESR)、C反应蛋白(CRP)、TNF-α、IL-6、降钙素(HCT)、骨钙素(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)等指标水平,同时进行安全性评价。结果:治疗后,观察组总有效率为81.8%,显著高于对照组的68.7%,差异具有统计学意义(P<0.05);两组患者治疗后证候评分、VAS评分、BASFI、BASDAI、PGA、"4"字试验评分均较治疗前明显下降(P<0.05),患者胸廓活动度增加,枕-墙距、指-地距缩短;观察组患者治疗后腰椎活动度明显改善(P<0.01),对照组腰椎活动度较治疗前改善不明显(P>0.05);观察组患者治疗后证候评分、VAS评分、BASFI、BASDAI、PGA、"4"字试验评分均显著低于对照组(P<0.01),枕-墙距、指-地距均显著短于对照组(P<0.01),胸廓活动度和Schober均显著大于对照组(P<0.05);两组患者治疗后TNF-α、ESR、IL-6、CRP水平均明显低于治疗前(P<0.05),观察组患者治疗后TNF-α、ESR、IL-6、CRP水平显著低于对照组(P<0.01);治疗后两组患者PTH水平显著低于治疗前(P<0.01),但组间比较差异无统计学意义(P>0.05);治疗后两组患者BGP水平显著高于治疗前(P<0.01),且观察组患者BGP水平明显高于对照组(P<0.05)。观察组患者不良反应发生情况少于对照组。结论:益肾消痹汤能缓解强直性脊柱炎患者症状,改善患者运动能力,且能下调炎性因子水平,防治骨量丢失,临床疗效好,安全性高。

Objective:To observe the clinical effect of Yishenxiaobi decoction on TNF-α,IL-6 and bone metabolism in patients with kidney deficiency and Du-han Syndrome of ankylosing spondylitis.Methods:the patients with AS were randomly divided into control group and observation group,each group 35 cases.The control group was treated with MELOXICAM and sulfasalazine tablets.In the observation group,Yishen Xiaobi decoction was taken orally.The course of treatment is 6 months.Before and after treatment,patients were evaluated on spine visual analogue scale,Vas,Basfi,Basdai,thoracic mobility,lumbar mobility,Schober test,occipitalwall distance,finger-ground distance,"4"Word Test and PGA and Tcm Syndrome scores;ESR,CRP,TNF-α,IL-6,calcitonin HCT,BGP,Parathyroid hormone,bone Alkaline phosphatase were measured before and after treatment.and conduct a safety evaluation.Results:after treatment,the total effective rate of the observation group was 81.8%higher than that of the Control Group(66.7%,P<0.05);The scores of syndrome,VAS,Basfi,Basdai,PGA and"4"word test in the two groups were significantly lower than those before treatment(P<0.05),Schober increased(P<0.01)in the observation group,but in the control group,lumbar mobility did not significantly improve(P>0.05);The Syndrome score,VAS score,Basfi,Basdai,PGA,"4"Word Test Scores in the observation group were significantly lower than those in the control group(P<0.01),The occipital-wall distance,finger-ground distance in the observation group were significantly shorter than those in the control group(P<0.01),and the Thoracic Mobility and Schober were significantly higher than those in the control group(P<0.05);ESR,CRP,IL-6,TNF-αin the two groups were significantly lower than those before treatment(P<0.05),and Esr,CRP,TNF-α,IL-6 in the observation group were significantly lower than those in the control group(P<0.01);The level of PTH decreased significantly(P<0.01),and there was no significant difference between the two groups(P>0.05);The level of BGP in the observation group was significantly higher than that in the control group(P<0.05).The adverse reactions in the observation group were less than those in the control group.Conclusion:Yishenxiaobi decoction can relieve the symptoms of AS,improve the ability of movement,reduce inflammatory factors,prevent bone loss,showing good clinical efficacy and high-level safety.