清热益肾定脊汤联合阿达木单抗对早期强直性脊柱炎肾虚湿热证患者的效果及对炎性因子、腰椎功能的影响

Effect of Qingre Yishen Dingji Decoction Combined with Adalimumab on the Syndromeof Kidney Deficiency and Damp-Heat of Early Ankylosing Spondylitis and onInflammatory Factors and Lumbar Function of the Patients

目的:观察清热益肾定脊汤联合阿达木单抗对早期强直性脊柱炎肾虚湿热证患者的效果及对炎性因子、腰椎功能的影响。方法:选取南京中医药大学徐州附属医院风湿肾病科2019年10月—2022年10月收治的87例早期强直性脊柱炎患者为研究对象,采用信封法随机分为阿达木单抗组(41例)和联合组(46例)。阿达木单抗组给予阿达木单抗治疗,联合组在阿达木单抗组基础上联合清热益肾定脊汤治疗。比较两组炎症因子、体征情况的差异,评估两组Bath强直性脊柱炎疾病活动指标(BASDAI)评分、中医症状评分、Bath强直性脊柱炎功能指标(BASFI)评分、Bath强直性脊柱炎综合指数评分(BAS-G)、加拿大脊柱骨关节炎研究协会(SPARCC)评分的水平。结果:治疗前,两组炎症因子水平比较,差异无统计学意义(P>0.05)。治疗后两组的白细胞介素6(IL-6)、白细胞介素12(IL-12)、肿瘤坏死因子-α(TNF-α)、 C-反应蛋白(CRP)、白介素-17A(IL-17A)水平及指地距、枕墙距、臀地距均较治疗前下降,且联合组低于阿达木单抗组(P<0.05);两组的脊柱活动度较治疗前升高,且联合组高于阿达木单抗组(P<0.05)。治疗前,两组相关评分的比较,差异无统计学意义(P>0.05)。治疗后两组的BASDAI评分、BASFI评分、中医症状评分、BAS-G评分、SPARCC评分均较治疗前下降,且联合组低于阿达木单抗组(P<0.05)。结论:清热益肾定脊汤联合阿达木单抗可减轻早期强直性脊柱炎肾虚湿热证患者炎症反应,改善腰椎功能,减轻疾病对健康产生的影响。

Objective:To observe the effect of Qingre Yishen Dingji Decoction(QYDD)combined with adalimumab on the syndrome of kidney deficiency and damp-heat of early ankylosing spondylitis and on inflammatory factors and lumbar function of the patients.Methods:A total of 87 patients with early ankylosing spondylitis admitted to the Rheumatology and Nephrology Department of Xuzhou Traditional Chinese Medicine Hospital,Xuzhou from October 2019 to October 2022 were selected as subjects.The patients were randomly divided into adalimumab group(n=41)and combination group(n=46)by envelope method.The adalimumab group was treated with adalimumab,and the combination group was treated with QYDD decoction in addition to adalimumab.We compared the differences of inflammatory factors and physical signs between the two groups,evaluated the two groups the levels of Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)score,TCM symptom score,Bath Ankylosing Spondylitis Function Index(BASFI)score,Bath Ankylosing Spondylitis Composite Index(BAS-G)score and Canadian Spine Osteoarthritis Research Association(SPARCC)score.Results:Before the treatment,there was no statistically significant difference in the levels of inflammatory cytokines between the two groups(P>0.05).The levels of interleukin 6(IL-6),interleukin12(IL-12),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-17A(IL-17A),digital ground distance,occipital wall distance,and hip ground distance in both groups were decreased compared with those before the treatment,and they are lower in combination group than in adalimumab group(P<0.05).Range of spinal motion after the treatment was higher in both groups than that before the treatment,and was higher in the combination group than in the adalimumab group(P<0.05).Before the treatment,there was no significant difference in relevant scores between the two groups(P>0.05).However,after the treatment,BASDAI score,BASFI score,TCM symptom score,BAS-G score and SPARCC score of the two groups were all decreased,and these scores in combined group were lower than those of adalimumab group(P<0.05).Conclusion:QYDD combined with adalimumab can reduce inflammatory response in patients with kidney deficiency and damp-heat syndrome of early ankylosing spondylitis,improve lumbar function and reduce the impact of the disease on health people.