生地苦参汤加减联合塞来昔布对类风湿性关节炎患者骨代谢及免疫功能的影响

Effects of Modified Shendi Kushen Decoction Combined with Celecoxib on Bone Metabolism and Immune Function in Patients with Rheumatoid Arthritis

【目的】探究生地苦参汤加减联合塞来昔布治疗类风湿性关节炎(rheumatoid arthritis,RA)湿热痹阻证患者的临床疗效及对骨代谢和免疫功能指标的影响。【方法】将110例RA湿热痹阻证患者随机分为对照组和联合组,每组各55例。对照组给予塞来昔布治疗,联合组给予生地苦参汤加减联合塞来昔布治疗,疗程为3个月。观察2组患者治疗前后中医证候积分、疼痛程度视觉模拟量表(VAS)评分、匹兹堡睡眠质量指数(PSQI)评分、疾病活动指数28项(disease activity score 28,DAS28)评分及血清炎性因子、骨代谢、免疫功能指标的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗3个月后,联合组的总有效率为91.73%(51/55),对照组为72.73%(40/55),组间比较,联合组的疗效明显优于对照组(P<0.01)。(2)中医证候积分方面,治疗后,2组患者的关节压痛、晨僵、关节灼热、肌肤麻木不仁等中医证候积分均较治疗前明显降低(P<0.05),且联合组的降低幅度均明显优于对照组(P<0.01)。(3)疼痛程度、睡眠质量、关节活动度方面,治疗后,2组患者的疼痛程度VAS评分、睡眠质量PSQI评分以及关节活动度DAS28评分均较治疗前明显降低(P<0.05),且联合组的降低幅度均明显优于对照组(P<0.01)。(4)炎性因子、骨代谢、免疫功能指标方面,治疗后,2组患者血清γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α)、人1型胶原羟基端肽β降解产物(β-CTX)及免疫球蛋白(Ig)A、IgG、IgM水平均较治疗前明显降低(P<0.05),血清白细胞介素4(IL-4)、骨钙素(N-MID)、人总1型胶原氨基端延长肽(T-P1NP)水平均较治疗前明显升高(P<0.05),且联合组对血清IFN-γ、TNF-α、β-CTX、IgA、IgG、IgM水平的降低幅度及对血清IL-4、N-MID、T-P1NP水平的升高幅度均明显优于对照组(P<0.01)。【结论】生地苦参汤加减联合塞来昔布治疗RA湿热痹阻证患者临床疗效显著,可有效改善患者中医证候,降低患者疼痛程度,提高患者睡眠质量和关节活动度,减轻机体炎症情况,改善相关骨代谢及免疫功能指标。

Objective To investigate the clinical efficacy of modified Shendi Kushen Decoction in treating rheumatoid arthritis(RA)of damp-heat obstruction type and to observe its effect on bone metabolism and immune function indexes of the patients.Methods A total of 110 patients with RA of damp-heat obstruction type were randomly divided into the control group and the combination group,with 55 cases in each group.The control group was treated with Celecoxib orally,and the combination group was treated with modified Shendi Kushen Decoction combined with Celecoxib orally for 3 months.The changes of traditional Chinese medicine(TCM)syndrome scores,Visual Analogue Scale(VAS)score of pain level,Pittsburgh Sleep Quality Index(PSQI)score,disease activity score of 28 joints(DAS28),and the levels of serum indicators of inflammatory factors,bone metabolism,and immune function in the two groups were observed before and after the treatment.Moreover,the clinical efficacy of the two groups was evaluated.Results(1)After 3 months of treatment,the total effective rate of the combination group was 91.73%(51/55),and that of the control group was 72.73%(40/55),and the intergroup comparison showed that the therapeutic efficacy of the combination group was significantly superior to that of the control group(P<0.01).(2)After treatment,the TCM syndrome scores of joint pressure pain,morning stiffness,joint burning,and numbness and insensitivity of the skin in the two groups were significantly decreased compared with those before treatment(P<0.05),and the degree of the decrease in the combination group was significantly superior to that in the control group(P<0.01).(3)After treatment,the pain VAS score,sleep quality PSQI score,and DAS28 score for the joint range of motion in the two groups were significantly decreased compared with those before treatment(P<0.05),and the degree of the decrease in the combination group was significantly superior to that in the control group(P<0.01).(4)After treatment,the serum levels of inflammatory factors,bone metabolism,and immune function indexes such asγ-interferon(IFN-γ),tumor necrosis factorα(TNF-α),human typeⅠcollagen cross-linked C-telopeptide(β-CTX),immunoglobulin(Ig)A,IgG,and IgM in the two groups were significantly decreased compared with those before treatment(P<0.05),while the levels of serum interleukin 4(IL-4),osteocalcin N-MID,and human procollagen type 1 intact N-terminal pro-peptide(TP1NP)were significantly increased compared with those before treatment(P<0.05).And the changing range of above serum levels in the combination group was significantly superior to that in the control group(P<0.01).Conclusion The combination of modified Shendi Kushen Decoction and Celecoxib exerts certain effect in treating patients with RA of damp-heat obstruction type.It can effectively relieve TCM syndromes,reduce the degree of pain,improve the quality of sleep and joint range of motion,alleviate the inflammation,and improve the related bone metabolism and immune function indexes.