青藤碱治疗气阴两虚型类风湿关节炎的效果及对MyD88依赖性信号通路的影响

Effectiveness of Sinomenine in Treatment of Rheumatoid Arthritis Patients with Qi-yin Deficiency and Its Effect on MyD88 Dependent Signal Pathway

目的探讨青藤碱治疗气阴两虚型类风湿关节炎的效果,以及对髓样分化因子88(MyD88)依赖性信号通路的影响。方法选取2019年4—12月收治的88例气阴两虚型类风湿关节炎为研究对象,根据治疗方法不同分为观察组和对照组,每组44例。对照组雷公藤多苷和甲氨蝶呤治疗,观察组在对照组基础上联合青藤碱,均治疗3个月。比较两组临床疗效,治疗前后欧洲抗风湿联盟干燥综合征患者报告指数(ESSPRI)、欧洲抗风湿病联盟干燥综合征疾病活动指数(ESSDAI)、视觉模拟量表(VAS)评分、临床症状改善情况、IgG、C反应蛋白(CRP)、白细胞介素-17(IL-17)、IL-6、肿瘤坏死因子-α(TNF-α),以及外周血细胞MyD88依赖性信号通路相关蛋白mRNA表达。结果治疗后,两组ESSPRI、ESSDAI、肿胀关节数、压痛关节数、压痛评分、肿胀评分、IgG、CRP、IL-17、IL-6、TNF-α,以及MyD88依赖性信号通路相关蛋白mRNA表达均较治疗前降低,且观察组低于对照组(P<0.05)。治疗1、2、3个月后,两组VAS评分较治疗前降低,且观察组低于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论青藤碱治疗气阴两虚型类风湿关节炎的临床效果显著,可抑制MyD88依赖性信号通路,减轻炎症反应,从而改善症状,且安全性良好。

Objective To investigate the therapeutic effectiveness of Sinomenine in treatment of rheumatoid arthritis patients with Qi-yin deficiency and its effect on MyD88 dependent signaling pathway.Methods A total of 88 rheumatoid arthritis patients with Qi-yin deficiency from April to December 2019 were selected and divided into observation group(n=44)and control group(n=44)according to different therapeutic methods.Control group was treated with Tripterygium Glycosides and Methotrexate,while observation group was combined with Sinomenine on the basis of treatment for control group,and the two groups were all treated for 3 months.Clinical effectiveness was compared,and European League Against Rheumatism Sjgren's Syndrome Patient Reported Index(ESSPRI)scores,European League Against Rheumatism Sjgren's Syndrome Disease Activity Index(ESSDAI)scores,visual analog scale(VAS)scores,improvement conditions of clinical symptoms,IgG,C-reactive protein(CRP),interleukin-17(IL-17),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and mRNA expressions of proteins related to MyD88-dependent signaling pathway in peripheral blood cells before and after treatment were compared between two groups.Results After treatment,ESSPRI score,ESSDAI score,number of joint swelling,number of tenderness joints,tenderness score,the swelling score,IgG,CRP,IL-17,IL-6,TNF-αand mRNA expression of proteins related to MyD88-dependent signaling pathway were significantly lower than those before treatment in both groups,and the above indicators in observation group were significantly lower than those in control group(P<0.05).After treatment for 1,2,and 3 months,VAS scores were significantly lower than those before treatment in two groups,and the scores in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in incidence rate of adverse reactions between two groups(P>0.05).Conclusion Sinomenine may achieve significant clinical effectiveness,inhibit MyD88 dependent signaling pathway,reduce inflammatory reaction and ameliorate the symptoms with good safety in treatment of rheumatoid arthritis patients with Qi-yin deficiency.