通痹颗粒治疗类风湿关节炎相关肺间质病变的疗效及对TGF-β1、KL-6的影响

Research of Treating Rheumatoid Arthritis Associated Interstitial Lung Disease with Tongbi Granules and its Effect on TGF-β1 and KL-6

目的观察通痹颗粒治疗类风湿关节炎相关肺间质病变(RA-ILD)的临床疗效及对转化生长因子-β1(TGF-β1)和Ⅱ型肺泡表细胞表面抗原(KL-6)的影响。方法60例患者随机分为治疗组和对照组各30例,对照组口服甲泼尼龙片,20 mg,每日1次,起效后逐渐减量;联合环磷酰胺片口服,100 mg,隔天1次。治疗组在对照组的基础上加用通痹颗粒冲服,6 g,每日2次。以3个月为1疗程,2个疗程后比较2组治疗前后的症状、体征变化;血清学血沉(ESR)、C反应蛋白(CRP)、TGF-β1及KL-6变化;肺功能检查,包括肺总量(TLC)、用力肺活量(FVC)、1秒用力呼气量(FEV1)和最大分钟通气量(MVV)的变化;放射学肺部HRCT评分变化及有无不良反应。结果治疗后2组患者症状、体征均有改善,治疗组的总有效率为83.3%,优于对照组的73.3%(P<0.05);治疗后2组患者ESR、CRP和DSA28均较治疗前明显改善(P<0.01),治疗组的指标好转情况优于对照组(P<0.05);治疗后2组患者TLC、FVC、FEV1、MVV及肺部HRCT积分均较治疗前有不同程度改善(P<0.01),治疗组TLC、FVC及肺部HRCT积分好转情况优于对照组(P<0.05);治疗后2组患者血清TGF-β1、KL-6均较治疗前明显改善(P<0.01),治疗组的好转情况优于对照组(P<0.05),且无明显不良反应。结论在西医规范治疗的基础上,联合使用通痹颗粒可有效缓解患者的症状、体征,改善炎症活动度,提高肺部功能,其机制可能是通过调节TGF-β1、KL-6等纤维因子实现的。

Objective To observe the clinical effect on treatment of rheumatoid arthritis associated interstitial lung disease by tongbi granules and its effect on the transforming growth factor beta 1(TGF-β1)and krebs von den lungen 6(KL-6).Methods Sixty patients were randomly divided into the control group received methylprednisolone tablets combined with cyclophosphamide tablet,and the treatment group was treated with tongbi granules on the basis of the control group.The symptoms and signs of the two groups were compared before and after treatment.Changes in ESR,CRP,TGF-β1 and KL-6;Lung function examination,including changes in total lung volume(TLC),forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1)and maximum minute ventilation volume(MVV);Radiological changes of HRCT score in the lungs and the presence or absence of adverse reactions.Results The total effective rate of the treatment group was 83.3%,better than that of the control group(P<0.05).After treatment,ESR,CRP and DSA28 in the two groups were significantly improved compared with that before treatment(P<0.01),and the improvement of indexes in the treatment group was better than that in the control group(P<0.05).After treatment,TLC,FVC,FEV1,MVV and lung HRCT scores in the two groups were improved to different degrees than before treatment(P<0.01).TLC,FVC and lung HRCT scores in the treatment group were better than those in the control group(P<0.05).After treatment,serum TGF-β1 and KL-6 in the two groups were significantly improved compared with that before treatment(P<0.01).The improvement in the treatment group was better than that in the control group(P<0.05)without significant adverse reactions.Conclusion On the basis of standard treatment in western medicine,the combined use of tongbi granule can effectively alleviate the symptoms and signs of patients,improve inflammatory activity and improve lung function,and the mechanism may be achieved by regulating TGF-β1,KL-6 and other fibrous factors.