温针灸联合中药对类风湿关节炎患者血清miR-335-5p和miR-141表达的影响

Effects of Needle Warming Therapy and Chinese Medication on the Expression of Serum mi R-335-5p and mi R-141 in Rheumatoid Arthritis Patients

目的观察温针灸联合桂枝芍药知母汤对类风湿关节炎患者血清微小RNA-335-5p(miR-335-5p)和微小RNA-141(miR-141)表达的影响。方法选取156例类风湿关节炎患者作为研究对象,随机分为对照组和研究组,每组78例。两组均进行常规治疗,对照组口服桂枝芍药知母汤治疗,研究组在对照组口服中药基础上联合温针灸治疗。观察两组治疗前后血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、肿瘤坏死因子-α(TNF-α)、白介素-37(IL-37)和白介素-6(IL-6)水平以及miR-335-5p和miR-141表达的变化。观察两组治疗前后关节压痛个数、关节肿胀个数、僵硬时间、握力水平和中医证候积分的变化。比较两组临床疗效与不良反应发生率。结果与治疗前比较,两组治疗后血清IgA、IgG和IgM水平均降低;研究组治疗后均低于对照组(P<0.05)。与治疗前比较,治疗后两组血清TNF-α、IL-37和IL-6水平均降低;研究组治疗后均低于对照组(P<0.05)。与治疗前比较,治疗后两组miR-335-5p表达升高(P<0.05),miR-141表达降低(P<0.05);研究组治疗后miR-335-5p表达高于对照组(P<0.05),miR-141表达低于对照组(P<0.05)。与治疗前比较,两组治疗后关节压痛个数与关节肿胀个数均减少(P<0.05),晨僵时间均缩短(P<0.05),握力水平均提高(P<0.05),中医证候积分均降低(P<0.05);研究组治疗后上述指标均优于对照组(P<0.05)。研究组总有效率高于对照组(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)。结论在常规治疗基础上,温针灸联合桂枝芍药知母汤治疗类风湿关节炎可减少关节压痛个数与关节肿胀个数,降低患者血清炎症因子水平,提高患者握力,可能与调控miR-335-5p和miR-141表达有关。

Objective To observe the effects of needle warming therapy plus Gui Zhi Shao Yao Zhi Mu decoction on the expression of serum microRNA-335-5p(miR-335-5p)and microRNA-141(miR-141)in patients with rheumatoid arthritis(RA).Method A total of 156 RA patients were recruited as subjects and randomly divided into a control group and a research group,with 78 cases in each group.Conventional treatment was given to both groups.Besides,the control group received oral Gui Zhi Shao Yao Zhi Mu decoction,and the research group received the same oral Chinese medication combined with needle warming therapy.Before and after the treatment,the expression levels of serum immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM),tumor necrosis factor-α(TNF-α),interleukin-37(IL-37),interleukin-6(IL-6),miR-335-5p,and miR-141 were observed.The numbers of joint tenderness and swelling,time of stiffness,level of hand strength,and symptom score of traditional Chinese medicine(TCM)were observed before and after the treatment.Clinical efficacy and adverse reaction rate were also compared between the two groups.Result The serum IgA,IgG,and IgM levels declined after the intervention in both groups and were lower in the research group than in the control group(P<0.05).The levels of serum TNF-α,IL-37,and IL-6 dropped after the treatment in both groups and were lower in the research group than in the control group(P<0.05).The expression level of mi R-335-5p increased(P<0.05),and the level of mi R-141 decreased(P<0.05)in the two groups after the intervention;after the treatment,the level of miR-335-5p in the research group was higher than that in the control group(P<0.05),and its level of miR-141 was lower than that in the control group(P<0.05).The numbers of joint tenderness and swelling dropped after the treatment in the two groups(P<0.05),along with shortened stiffness time(P<0.05),elevated hand strength(P<0.05),and declined TCM symptom score(P<0.05);the research group was superior to the control group in comparing the measures mentioned above(P<0.05).The research group obtained a higher total effective rate than the control group(P<0.05).There was no significant difference in comparing the adverse reaction rate between the two groups(P>0.05).Conclusion Based on the conventional intervention,needle warming therapy plus Gui Zhi Shao Yao Zhi Mu decoction can reduce the numbers of joint tenderness and swelling,down-regulate the levels of serum inflammatory factors,and enhance hand strength in treating RA;the mechanism may be associated with modulating the expression of miR-335-5p and miR-141.