中西医结合治疗类风湿关节炎疗效及其对糖皮质激素受体的影响

Efficacy of Integrative Medicine for the Treatment of Rheumatoid Arthritis and Its Effect on Glucocorticoid Receptor Expression

目的探讨风湿康治疗类风湿关节炎(RA)的疗效及作用机制。方法将38例中医辨证为湿热痹阻证类风湿关节炎患者随机分为两组,中药组20例,用风湿康联合甲泼尼龙治疗;西药组18例,用氨甲喋呤联合甲泼尼龙治疗,两组均治疗1个月。分别检测治疗前后类风湿因子(RF)、C反应蛋白(CRP)、血沉(ESR)及hGRαmRNA、hGRβmRNA的表达水平,并与20名健康对照组进行比较。结果 1个月后中药组及西药组RF、CRP均较治疗前显著降低(P<0.05),两组比较差异有统计学意义(P<0.05);而两组ESR治疗前后及组间比较,差异均无统计学意义(P>0.05);RA患者GRα和GRβ表达水平显著高于健康对照组(P<0.01),治疗后两治疗组hGRαmRNA均显著降低(P<0.01),中药组hGRβmRNA较治疗前显著降低(P<0.01),而西药组hGRβmRNA与治疗前比较,差异无统计学意义(P>0.05)。结论风湿康联合甲泼尼龙治疗可有效控制RA患者炎症反应,降低hGRα、hGRβ表达水平,提高RA的临床疗效。

Objective To investigate the efficacy and mechanism of Fengshikang （FSK） in treating rheumatoid arthritis （RA）. Methods Thirty-eight patients with RA of damp-heat block syndrome type in Chinese medicine （CM）, were randomized into two groups. They all received glucocorticoid therapy for 1 month, but FSK was administered to the 20 patients in the CM group in addition, while to the 18 in the WM group, MTX was given. Besides, a normal control group with 20 healthy subjects was set up. Blood levels of RA related indices were measured and compared. Results After treatment, the levels of rheumatoid factor （RF） and C-reactive protein （CRP） were significantly reduced in both groups （P0.05）, but the reduction was more significant in the CM group （P0.05）. No significant change was found in the level of ESR after treatment and showed no significant difference between groups （P0.05）. Both hGRα mRNA and hGRβ mRNA expressions were significantly higher in the patients than in the normal controls （P0.01）, they were lowered after treatment in the CM group （P0.01）, but significant reduction could only be found in level of hGRβ mRNA in the control group （P0.01）. Conclusion FSK combined with glucocorticoid can effectively control the inflammatory reaction, decrease the level of hGRα and hGRβ expressions and enhance the clinical efficacy in treating RA.