益气清络方对类风湿关节炎患者血管内皮生长因子和氧化应激的影响

Influence of Yiqi Qingluo Decoction on vascular endothelial growth factor and oxidative stress in patients with rheumatoid arthritis

目的:探讨益气清络方联合常规西药治疗对类风湿关节炎(RA)患者血管内皮生长因子(VEGF)及氧化应激指标的影响。方法:纳入62例RA患者,随机分为治疗组和对照组,每组各31例。两组患者均给予甲氨蝶呤(MTX)口服,治疗组患者在此基础上给予口服益气清络方,对照组患者在此基础上给予口服安慰剂,两组疗程均为12周。治疗前后,检测两组患者的VEGF、炎症指标[包括血沉(ESR)、C-反应蛋白(CRP)、白介素(IL)-6、IL-17、肿瘤坏死因子-α(TNF-α)]和氧化应激指标[包括丙二醛(MDA)、超氧化物歧化酶(SOD)、氧化低密度脂蛋白(ox-LDL)]水平。分析治疗前患者的血清VEGF、ox-LDL水平与炎症指标水平的相关性,比较治疗前后两组患者的血清VEGF及氧化应激指标水平的变化。结果:治疗前,RA患者的VEGF、ox-LDL水平分别与ESR、CRP、IL-6、IL-17、TNF-α水平呈正相关(P<0.05,P<0.01)。治疗后,两组患者的血清VEGF水平均明显降低(P<0.05),且治疗组患者的血清VEGF水平明显低于对照组(P<0.05);治疗组患者的SOD水平明显升高(P<0.05)、MDA及ox-LDL水平显著下降(P<0.05),而对照组患者的SOD、MDA、ox-LDL水平与治疗前比较差异均无统计学意义(P>0.05),且治疗组患者的SOD水平明显高于对照组(P<0.05)、MDA及ox-LDL水平明显低于对照组(P<0.05)。结论:益气清络方联合常规西药治疗可降低RA患者的血清VEGF水平,减轻氧化应激损伤,从而预防动脉粥样硬化及心血管并发症的发生。

Objective:To investigate the effects of Yiqi Qingluo Decoction combined with conventional western medicine on the vascular endothelial growth factor(VEGF) and oxidative stress indexes in patients with rheumatoid arthritis(RA). Methods:Sixty-two patients with RA were included and randomly divided into the treatment group and the control group, 31 cases in each group. The patients in both groups were orally treated with methotrexate(MTX), in addition, the patients in the treatment group were orally treated with Yiqi Qingluo Decoction and the patients in the control group were orally treated with placebo, with a course of 12 weeks. Before and after treatment, the levels of VEGF, inflammatory indexes including erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), interleukin( IL)-6,IL-17 and tumor necrosis factor-α( TNF-α),and oxidative stress indexes including malonaldehyde( MDA),superoxide dismutase( SOD) and oxidized low-density lipoprotein( ox-LDL) were detected. The correlation between the levels of VEGF and ox-LDL and the levels of inflammatory indexes were analyzed before treatment. Before and after treatment,the levels of serum VEGF and oxidative stress indexes were compared between the two groups. Results: Before treatment,the levels of VEGF and ox-LDL were positively correlated with the levels of ESR,CRP,IL-6,IL-17 and TNF-α in patients with RA respectively( P<0.05,P<0.01). After treatment,the levels of serum VEGF in both groups were significantly decreased( P<0.05),and the level of serum VEGF in the treatment group was obviously lower than that in the control group( P<0.05). After treatment,the level of SOD in the treatment group was obviously increased( P<0.05),and the levels of MDA and ox-LDL were significantly decreased( P<0.05);there were no statistically significant differences on the levels of SOD,MDA and ox-LDL in the control group between treatment before and after( P>0.05);and the level of SOD in the treatment group was higher than that in the control group( P<0.05),and the levels of MDA and ox-LDL in the treatment group were lower than those in the control group( P<0.05). Conclusion: Yiqi Qingluo Decoction combined with conventional western medicine could decrease the serum level of VEGF in patients with RA,and reduce the oxidative stress injury,thereby prevent the atherosclerosis and cardiovascular complications.