新风胶囊对类风湿关节炎患者肺功能的影响

Effect of Xinfeng Capsule on Improving Pulmonary Function in Rheumatoid Arthritis Patients

目的观察新风胶囊对类风湿关节炎(rheumatoid arthritis,RA)患者肺功能、外周血B、T淋巴细胞衰减因子(B and T lymphocyte attenuator,BTLA)及氧化应激的影响。方法 100例RA患者按随机数字表法分为治疗组和对照组,每组50例。治疗组予新风胶囊(0.5 g/粒,每次3粒,每日3次),对照组予来氟米特片(0.1 g/片,每次1片,每晚1次);两组均为1个疗程。检测患者肺功能参数:用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、最大呼气流量(peak expiratory flow,PEF)、25%肺活量位的最大呼气流量(25%maximal expiratory flow-volume,MEF25)、50%肺活量位的最大呼气流量(50%maximal expiratory flow-volume,MEF50)、25%~75%肺活量位的最大呼气流量(25%-75%maximal expiratory flow-volume,MEF25-75)。观察患者血沉(erythrocyte sedimentation rate,ESR)和超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平变化,以RA疾病活动性评分系统(disease activity score in 28 joints,DAS28)评定疾病活动度。检测BTLA表达,血清中氧化指标丙二醛(methane dicarboxylic aldehyde,MDA)、活性氧(reactive oxygen species,ROS)、超氧化物歧化酶(superoxide dismutase,SOD)、总抗氧化能力(total antioxidant capacity,TAOC)、IL-4、IL-35、IL-17和TNF-α水平。结果与本组治疗前比较,治疗后两组FEV1、PEF、MEF25-75、MEF50和MEF25均升高(P<0.05,P<0.01),ESR、hs-CRP和DAS28均降低(P<0.01),外周血BTLA^+、CD19^+、CD24^+、CD19^+CD24^+、CD24^+BTLA^+、SOD、TAOC、IL-4和IL-35水平升高(P<0.01,P<0.05),ROS、MDA、TNF-α和IL-17降低(P<0.01,P<0.05);与对照组比较,治疗组治疗后FVC、MEF25-75、MEF50和MEF25升高(P<0.05,P<0.01),ESR、hs-CRP和DAS28降低(P<0.05,P<0.01);治疗组治疗后外周血BTLA^+、CD24^+、CD19^+CD24^+、TAOC和TNF-α升高(P<0.05),CD24^+CD19^+、ROS和MDA降低(P<0.01,P<0.05)。结论 RA患者普遍存在肺功能降低和BTLA表达的减弱,且疾病活动性与机体BTLA表达减弱,氧化应激失衡密切相关。新风胶囊在改善RA患者关节症状的同时,可通过提高BTLA表达,减轻免疫炎症和氧化应激对组织的损伤,从而影响患者肺功能。

Objective To observe the effect of Xinfeng Capsule（XFC） on pulmonary function, peripheral blood B and T lymphocyte attenuator（BTLA）, and oxidative stress in rheumatoid arthritis（RA） patients. Methods Totally 100 RA patients were assigned to the treatment group and the control group according to random digit table, 50 in each group. Patients in the treatment group took XFC（0. 5 g/pill, 3 pills each time, 3 times per day）, while those in the control group took Leflunomide（LEF） Tablet（0. 1 g/tablet 1, tablet each time, once every evening）. The therapeutic course for all was 90 days. Pulmonary functions were detected including forced vital capacity（FVC）, forced expira-tory volume in one second（FEV1）, peak expiratory flow（PEF）, 25% maximal expiratory flow-volume（MEF25）, 50%maximal expiratory flow-volume（MEF50）, 25%- 75% maximal expiratory flow-volume（MEF25- 75）. Levels of erythrocyte sedimentation rate（ESR） and high-sensitivity C-reactive protein（hs-CRP） were observed. The disease activity was assessed using disease activity score in 28 joints（DAS28）. The expression of BTLA, levels of methane dicarboxylic aldehyde（MDA）, reactive oxygen species（ROS）, superoxide dismutase（SOD）, total antioxidant capacity（TAOC）,and related cytokines（IL-17, TNF-α, IL-4, IL-35） were also detected. Results Compared with before treatment in the same group, post-treatment FEV1, PEF, MEF25-75, MEF50, and MEF25 were all increased（P 〈0. 05, P 〈0. 01）;ESR, hypersensitive C reactive protein（hs-CRP）, and DAS28 were all decreased（P 〈0. 01）, peripheral blood levels of BTLA~＋, CD19~＋, CD24~＋, CD19~＋CD24~＋, CD24~＋BTLA~＋, SOD, TAOC, IL-4, and IL-35 all increased（P 〈0. 01,P 〈0. 05）; levels of ROS, MDA, TNF-α, and IL-17 all decreased（P 〈0. 01, P 〈0. 05） in the two groups. Compared with the control group, levels of FVC, MEF25-75, MEF50, and MEF25 all increased（P 〈0. 05, P 〈0. 01）, and levels of ESR, hs-CRP, and DAS28 all decreased（P 〈0. 05, P 〈0. 01） in the treatment group after treatment. Peripheral blood levels of BTLA~＋, CD24~＋, CD19~＋CD24~＋, TAOC, and TNF-α all increased（P 〈0. 05）, and levels of CD24~＋CD19~＋, ROS, and MDA all decreased（P 〈0. 01, P 〈0. 05） in the treatment group after treatment. Conclusions Decreased pulmonary function and attenuated BTLA expression generally exist in RA patients. Besides, its disease activity was closely related with attenuated expression of BTLA and imbalanced oxidative stress. XFC could not only improve joint symptoms of RA patients, but also improve lung function by elevating BTLA expression, attenuating tissue damage from immunological inflammation and oxidative stress.