类风湿性关节炎关节滑膜组织中水通道蛋白1表达与透痹转气法的影响

Effect of Tou-Bi-Zhuan-Qi on the expression of aquaporin-1 in the synovial tissue of joint in patients with rheumatoid arthritis

背景:水通道蛋白在类风湿性关节炎关节软骨、滑液、滑膜细胞异常表达可能对类风湿性关节炎产生影响。目的:实验拟观察透痹转气法对类风湿性关节炎疗效及对水通道蛋白1的影响。设计、时间及地点:对比观察,于2005-09/2007-09在解放军广州军区广州总医院完成。参试者:选择活动期类风湿性关节炎患者和膝关节骨关节炎患者各15例。类风湿性节炎组男5例,女10例,年龄20～66岁;骨关节炎组男4例,女11例,年龄56～75岁。透痹逐邪方药物组成:马钱子1g,掌牛仔15g,细辛3g,白蒺藜15g,全蝎3g,桂枝5g,竹沥10mL等。方法:类风湿性关节炎组应用透痹转气法治疗,3个月为1个疗程,治疗2个疗程后观察临床疗效及肿瘤坏死因子α、C-反应蛋白、血沉等指标变化。骨关节炎组只进行治疗前的水通道蛋白1测定,未进行疗效观察及治疗后水通道蛋白1检测。主要观察指标:类风湿性关节炎组治疗前、后及骨关节炎组治疗前关节滑膜水通道蛋白1基因表达。结果:类风湿性关节炎组临床症状明显改善,与治疗前相比,炎症指标明显降低(P<0.01,P<0.05);水通道蛋白1在膝关节滑膜细胞有表达,类风湿性关节炎组治疗前较治疗后及骨关节炎组水通道蛋白1基因表达明显增强(P<0.05)。结论:透痹转气法明显改善类风湿性关节炎患者的症状,降低炎症指标;水通道蛋白1高表达可能是类风湿性关节炎关节肿痛机制之一。

BACKGROUND： The abnormal expression of water channel protein in articular cartilage, synovial fluid and synovial cells of patients with rheumatoid arthritis may have influence on rheumatoid arthritis. OBJECTIVE： To observe the therapeutic effect of Tou-Bi-Zhuan-Qi on rheumatoid arthritis and its effect on the aquaporin-1 in the patients with rheumatoid arthritis. DESIGN, TIME AND SETTING： Contrast observation was carded out at General Hospital of Guangzhou Military Area Command of Chinese PLA between September 2005 and September 2007. PARTICIPANTS： Fifteen patients with active rheumatoid arthritis and fifteen patients with knee osteoarthritis. Rheumatoid arthritis group： 5 male, 10 female, age ranged from 20 to 66 years; osteoarthritis group： 4 male, 11 female, age ranged from 56 to 75 years. The drug composition of Tou-Bi-Zhuan-Qi： 1 g curare, 15 g Zhanniuzai, 3 g manchurian wildginger, 15 g tribulus terrestris, 3 g scorpion, 5 g ramulus cinnamomi, 10 ml succus bambusae. METHODS： The rheumatoid arthritis group was treated with Tou-Bi-Zhuan-Qi for 6 months as 2 therapeutic courses, and then clinical effect and changes of tumor necrosis factor- α, C-reactive protein and erythrocyte sedimentation rate were observed. In osteoarthritis group, only aquaporin-1 was determined before treatment, the clinical effect and aquaporin-1 after treatment were not determined. MAIN OUTCOME MEASURES： The gene expression of aquaporin-1 in the synovial tissue of joint of rheumatoid arthritis group before and after the treatment and that of osteoarthritis group before treatment. RESULTS： The clinical symptoms of rheumatoid arthritis group improved significantly, and the inflammatory indices decreased markedly than that before treatment （P 〈 0.01, P 〈 0.05）; The aquaporin-1 was also found in the synovial cells of knee, the gene expression of aquaporin-1 of rheumatoid arthritis group before treatment increased markedly as compare to that of rheumatoid arthritis group after treatment and that of osteoarthritis group before treatment （P 〈 0.05）. CONCLUSION： Tou-Bi-Zhuan-Qi could markedly improve the symptom of patients with rheumatoid arthritis and decrease inflammatory indices; high expression of aquaporin-1 maybe one of the mechanisms leading to arthrocele and arthralgia of rheumatoid arthritis.