独活寄生汤调节炎性因子表达干预类风湿关节炎患者骨破坏的作用机制

Action Mechanism of Duhuo Jisheng Decoction Intervening Bone Destruction in Patients with RA by Regulating Expressions of Inflammatory Factors

目的:观察独活寄生汤治疗肝肾不足寒湿痹阻型RA患者的临床疗效,揭示其通过控制炎性细胞因子表达干预骨破坏的作用机制。方法:完成随访的48例肝肾不足寒湿痹阻型RA患者随机分为治疗组和对照组各24例,对照组给予西医常规治疗,治疗组在此基础上加用独活寄生汤散剂口服,疗程24周。记录治疗前后两组患者的DAS28评分、HAQ评分、VAS评分、Sharp评分,测定CRP、ESR的水平,ELISA检测血清IL-17、IL-6、IL-1β、TNF-α、RANKL、OPG的表达水平。结果:(1)两组患者疗后DAS28评分、HAQ评分、VAS评分明显改善,Sharp总分进展速率明显减慢,且治疗组优于对照组(P<0.05或P<0.01)。(2)两组疗后TNF-α、IL-1β、IL-6、IL-17水平都较疗前降低且治疗组优于对照组(P<0.05)。(3)两组疗后RANKL的水平都较疗前降低,OPG、OPG/RANKL升高,且治疗组优于对照组(P<0.05)。结论:独活寄生汤联合西药常规治疗可以有效改善RA患者的临床症状,其机制是通过下调炎性因子的表达,影响OPG/RANKL的水平,抑制破骨细胞活性改善骨破坏。

Objective:To observe the clinical effect of Duhuo Jisheng Decoction in treating RA patients with deficiency of Liver and Kidney and cold dampness impediment,and to reveal the intervening mechanism in bone destruction by controlling the expressions of inflammatory cytokines.Methods:48 cases of RA met the inclusion criteria were randomly divided into the treatment group(n=24)and the control group(n=24).The control group was treated with routine western medication;on which basis,the treatment group was also treated with Duhuo Jisheng Decoction.The treatment duration was 24 weeks.VAS scores,HAQ scores,DAS28 scores and Sharp scores were recorded before and after the treatment in the two groups.The CRP was measured by scattering turbidimetry,ESR was detected by Westergren method,and the expression levels of IL-17,IL-6,IL-1β,TNF-α,RANKL and OPG were detected by ELISA method.Results:The DAS28 scores,HAQ scores and VAS scores were significantly improved,and the total progression rate of Sharp slowed down significantly after the treatment in the two groups(P<0.05,P<0.01);of which the improvements in the treatment group were more significant(P<0.05,P<0.01).The levels of TNF-α,IL-β,IL-6 and IL-17 decreased significantly after the treatment in the two groups(P<0.01),and the decreases in the treatment group were more significant(P<0.05,P<0.01).The RANKL level decreased,the levels of OPG and OPG/RANKL increased significantly after the treatment in the two groups(P<0.01);of which the improvements in the treatment group were more significant(P<0.05).Conclusion:Duhuo Jisheng Decoction combined with routine western medication can effectively improve the clinical symptoms and improve bone destruction of the RA patients.The mechanism is to reduce the expression levels of inflammatory cytokines,influence the level of OPG/RANKL and inhibit the activity of osteoclast.