自拟治痹汤联合滑膜膏外敷对强直性脊柱炎患者活动度、B和T淋巴细胞衰减因子的影响

Effect of Self-made Zhibi Decoction Combined with Synovial Ointment on Activity and BTLA in Patients with Ankylosing Spondylitis

目的探讨强直性脊柱炎患者采用自拟治痹汤及滑膜膏外敷的联合疗法对其活动度及B和T淋巴细胞衰减因子(BTLA)的影响。方法2019年2月至2021年2月期间于驻马店市中心医院收治的78例强直性脊柱炎(AS)患者,采用随机数字表法分为对照组和观察组。对照组给予常规治疗以及滑膜膏外敷;观察组在对照组的基础上给予自拟治痹汤联合治疗,两组均治疗3个月。比较两组患者治疗效果。治疗前、治疗后两组Bath强直性脊柱炎疾病功能指数(BASFI)及Bath强直性脊柱炎疾病活动指数(BASDAI),BTLA中T淋巴细胞细胞亚群的参数,炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的水平,治疗前后的不良反应。结果治疗3个月后,观察组临床疗效明显优于对照组,总有效率前者高于后者(P<0.05);观察组治疗后中医证候积分均低于对照组(P<0.05);与对照组相比,观察组外周血CD3+T、CD4+T、CD8+T中BTLA细胞的表达水平明显升高,趋于正常值,与对照组差异有统计学意义(P<0.05)。对照组、观察组患者血清TNF-α、IL-6水平均降低,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)。结论自拟治痹汤联合外敷滑膜膏可以提高AS治疗效果以及减轻患者疼痛等不适症状,降低疾病活动度,减轻炎性因子反应,提高关节功能以及促进脊柱的恢复,且具有一定的安全性。

Objective To explore the combined therapy of self-made zhibi decoction and synovial ointment in patients with ankylosing spondylitis,and to analyze the effects on their activity and B and T lymphocyte attenuation factor(BTLA).Methods 78 patients with ankylosing spondylitis(AS)treated in Zhumadian Central Hospital from February 2019 to February 2021 were randomly divided into control group and observation group with 39 cases respectively.The control group was given routine treatment and synovial plaster external application;the observation group was treated with self-made zhibi decoction on the basis of the control group,and both groups were treated for 3 months.The curative effects of the two groups,bath ankylosing spondylitis disease function index(BASFI)and bath ankylosing spondylitis disease activity index(BASDAI)before and after treatment,parameters of BTLA T lymphocyte subsets,inflammatory factor tumor necrosis factor-α(TNF-α)、the level of interleukin-6(IL-6),adverse reactions before and after treatment were compared.Results After 3 months of treatment,the clinical efficacy of the observation group was significantly better than that of the control group,and the total effective rate of the former was higher than that of the latter(P<0.05);the TCM syndrome score of the observation group after treatment was lower than that of the control group(P<0.05);compared with the control group,the expression level of BTLA cells in peripheral blood CD3+T,CD4+T and CD8+T in the observation group increased significantly,tending to normal values,with a statistically significant difference from the control group(P<0.05);compared with the control group,serum TNF-α,the level of IL-6 in the observation group was lower(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The self-made zhibi decoction combined with external application of synovial ointment can improve the treatment effect of AS,reduce the discomfort symptoms such as pain,reduce the activity of disease,reduce the reaction of inflammatory factors,improve joint function and promote the recovery of spine,which has certain safety.