甘草附子汤对强直性脊柱炎(肾虚督寒型)血清SPARC、DKK-1的影响

Effect of Gancao Fuzi Tang on SPARC and DKK-1 in Serum of Patients with Ankylosing Spondylitis(Type of Kidney Deficiency and Governor Vessel Cold)

目的:观察甘草附子汤治疗肾虚督寒型强直性脊柱炎(AS)的临床疗效以及对血清半胱氨酸酸性分泌蛋白(SPARC)、Dickkopf-1蛋白(DKK-1)的影响。方法:选取144例AS患者,按随机数字表法分成对照组及观察组,每组72例。对照组给予柳氮磺吡啶治疗,观察组在对照组基础上给予甘草附子汤治疗。2组均连续治疗4周。观察2组治疗前后中医证候积分、晨僵时间、枕墙距、Schober、实验室指标[血沉(ESR)、血清SPARC、DKK-1、C-反应蛋白(CRP)、转化生长因子β1 (TGF-β1)、肿瘤坏死因子-α(TNF-α)],比较2组巴氏强直性脊柱炎功能指数(BASFI)、巴氏强直性脊柱炎疾病活动性指数(BASDAI)、强直性脊柱炎度量指数(BASMI)评分及腰椎功能优良率。结果:治疗后,2组中医证候积分、晨僵时间、枕墙距均较治疗前下降(P<0.05),Schober较治疗前上升(P<0.05),观察组中医证候积分、晨僵时间及枕墙距指标值均低于对照组(P<0.05),Schober高于对照组(P<0.05)。治疗后,2组ESR、血清CRP、TNF-α、TGF-β1、SPARC及DKK-1指标值均得到改善(P<0.05),观察组ESR、CRP、TNF-α、TGF-β1及DKK-1水平均低于对照组,SPARC水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组BASFI、BASDAI及BASMI评分均较治疗前降低,观察组3项评分均低于对照组(P<0.05)。治疗4周后,观察组腰椎功能优良率为90.3%,高于对照组76.4%,差异有统计学意义(P<0.05)。结论:甘草附子汤联合西药对AS患者骨质具有保护作用,可减少成骨细胞凋亡,改善骨质疏松情况,增强骨质,进而促进脊柱功能恢复。

Objective:To observe the clinical effect of Gancao Fuzi tang for ankylosing spondylitis(AS) of type of kidney deficiency and governor vessel cold,and its effect on secreted protein acidic and rich in cysteine(SPARC) and Dickkopf-1 protein(DKK-1) in serum. Methods:A total of 144 cases of patients with AS were selected and divided into the control group and the observation group according to the random number table method,72 cases in each group. The control group was given salazosulfapyridine,and the observation group was additionally given Gancao Fuzi tang based on the treatment of the control group. Both groups were continuously treated for four weeks. Before and after treatment, Chinese medicine syndrome score,the time of morning stiffness,occiput-to-wall distance,Schober,and laboratory indexes[erythrocyte sedimentation rate(ESR),serum SPARC,DKK-1,C-reactive protein(CRP),transforming growth factor β1(TGF-β1),and tumor necrosis factor-α(TNF-α)] were observed in the two groups. The scores of Bath ankylosing spondylitis functional index(BASFI), Bath ankylosing spondylitis disease activity index(BASDAI), and Bath ankylosing spondylitis metrological index(BASMI),as well as the excellent and good rate of the lumbar vertebral function were compared between the two groups.Results: After treatment, Chinese medicine syndrome scores, the time of morning stiffness, and occiput-to-wall distances in the two groups were decreased when compared with those before treatment(P<0.05), and Schober was increased(P<0.05). After treatment,Chinese medicine syndrome score,the time of morning stiffness,and occiput-towall distance in the observation group were lower than those in the control group(P<0.05),and Schober was higher(P<0.05).After treatment, the indexes of ESR, serum CRP, TNF-α, TGF-β1, SPARC, and DKK-1 in the two groups were improved(P<0.05);levels of ESR,CRP,TNF-α,TGF-β1 and DKK-1 in the observation group were lower than those in the control group, and levels of SPARC were higher;differences were significant(P<0.05). After treatment, scores of BASFI,BASDAI,and BASMI in the two groups were decreased when compared with those before treatment,and the three scores in the observation group were lower than those in the control group(P<0.05). After four-week treatment, the excellent and good rate of the lumbar vertebral function was 90.3% in the observation group,higher than that of 76.4% in the control group, the difference being significant(P<0.05). Conclusion: The therapy of Gancao Fuzi tang combined with western medicine has a protective effect on bone substance of patients with ankylosing spondylitis, which can relieve osteoblast apoptosis,improve osteoporosis,and enhance bone substance,thus promoting recovery of spinal function.