摘要
目的:探讨益气养阴通痹方治疗类风湿关节炎合并肺间质病变(RA-ILD)的疗效及对血清基质金属蛋白酶-9(MMP-9),MMP-1,转化生长因子-β+1(TGF-β+1)和Ⅱ型肺泡表细胞表面抗原(KL-6)水平的影响。方法:120例患者采用区组随机按数字表法分为对照组和观察组各60例。对照组口服塞来昔布胶囊,0.2 g/次,2次/d;和口服环磷酰胺片,100 mg/次,1次/隔日;和泼尼松龙片,30 mg/次,1次/d,晨服,起效后按规律减量。观察组在对照组治疗的基础上采用益气养阴通痹方内服,1剂/d,两组疗程均为6个月。进行治疗前后高分辨率CT(HRCT)检查及评分,进行治疗前后症状、体征评分;检测治疗前后肺功能,包括肺总量(TLC),用力肺活量(FVC),1秒用力肺活量(FEV_1),每分钟肺泡最大通气量(MVV)和一氧化碳弥散量(DLCP)等指标;检测治疗前后MMP-9,MMP-1,TGF-β1和KL-6水平。结果:治疗后观察组HRCT评分和症状、体征评分均低于对照组(P<0.01);治疗后观察组TLC,FVC,FEV1%,MVV和DLCP均高于对照组(P<0.05,P<0.01);治疗后观察组血清MMP-9,TGF-β+1和KL-6水平均低于对照组,MMP-1水平高于对照组(P<0.01)。结论:在免疫抑制剂和激素治疗的基础上,益气养阴通痹方能下降HRCT评分,减小肺间质病变的面积和程度,并能改善肺功能,减轻临床症状,其作用机制可能是通过调节患者的MMP-9,TGF-β+1,KL-6和MMP-1等纤维化调节因子水平来实现的。
Objective : To discuss the efficacy of Yiqi Yangyin Tongbi prescription for rheumatoid arthritis and pulmonary interstitial lesions (RA-ILD) and investigate its effects on serum matrix metalloproteinases-9 ( MMP- 9), MMP-1, transforming growth factor-β1 (TGF-β1) and surface antigen of Ⅱ type alveolar table cells (KL-6). Method: One hundred and twenty patients were randomly divided into control group (60 cases) and observation group (60 cases ) by random number table and randomized block design. Patients in control group orally took celecoxib capsules, 0.2 g/time, 2 times/day. Cyclophosphamide tablets, 100 mg/time, 1 time/every 2 days.Prednisolone tablets, 30 mg/time, 1 time/day on every morning, and the dose was decreased after taking effect. Based on the treatment of control group, patients in observation group added Yiqi Yangyin Tongbi prescription, 1 dose/day. The treatment course was 6 months for both groups. Before and after treatment, high resolution-CT (HRCT) was conducted and graded, and symptoms and signs were graded. Lung function, total lung capacity (TLC), forced vital capacity (FVC) , forced vital capacity per minute (FEV1) , maximal voluntary ventilation per minute (MVV) and carbon monoxide diffusion capacity (DLCO) were detected before and after treatment. Levels of MMP-9, MMP-1, TGF-β1 and KL-6 were detected before and after treatment. Result: After treatment, scores of HRCT, symptoms and signs of patients in observation group were lower than those in control group (P 〈 0.01 ). Levels of TLC, FVC, FEV1% , MVV and DLCO in observation group were higher than those in control group after treatment (P 〈 0.05, P 〈 0. 01 ). The levels of MMP-9, TGF-β1 and KL-6 were lower than those in control group, and level of MMP-1 was higher than that in control group (P 〈 0.01 ). Conclusion: Yiqi Yangyin Tongbi prescription based on the immunosuppressive agents and hormone therapy can reduce score of HRCT, reduce area and degree of interstitial lung disease, ameliorate patients lung function, and relieve clinical symptoms. The mechanism may be associated with regulating levels of MMP-9, TGF-β1, KL-6 and MMP-1.
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2017年第7期185-190,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(81573952)