针刺联合桑寄生汤治疗类风湿关节炎的疗效观察及对促炎细胞因子水平的影响

Observation of the therapeutic effect of acupuncture combined with Sang Ji Sheng Tang in the treatment of rheumatoid arthritis and its effect on the levels of pro-inflammatory factors

目的观察针刺联合桑寄生汤治疗类风湿关节炎(rheumatoid arthritis,RA)的临床疗效及对患者血清血管新生相关细胞因子水平和促炎细胞因子水平的影响。方法将100例RA患者按随机数字表法分为对照组和联合组,每组50例。对照组予口服桑寄生汤治疗,联合组予针刺联合桑寄生汤治疗。观察两组治疗前后晨僵时间和20 m步行时间以及疼痛数字评分法(numerical rating scale,NRS)评分、中医证候积分、RA患者病情评价(disease activity score 28,DAS28)评分和健康评估问卷残疾指数(health assessment questionnaire-disability index,HAQ-DI)评分的变化,观察两组治疗前后血清糖基磷脂酰肌醇(glycosylphosphatidy-linositol,GPI)、碱性成纤维生长因子(basic fibroblast growth factor,bFGF)、C反应蛋白(C reactive protein,CRP)、巨噬细胞集落刺激因子(macrophage colony stimulating factor,M-CSF)、白介素-32(interleukin-32,IL-32)、血管内皮生长因子(vascular endothelial growth factor,VEGF)、超氧化物歧化酶(superoxide dismutase,SOD)、活性氧(reactive oxygen species,ROS)、转化生长因子-β1(transforming growth factor-β,TGF-β1)、缓激肽(bradykinin,BK)和β内啡肽(β-endorphin,β-EP)水平的变化。比较两组临床疗效。结果治疗后,两组晨僵时间和20 m步行时间均缩短(P<0.05),且联合组均短于对照组(P<0.05);两组疼痛NRS评分、中医证候积分、RA DAS28评分和HAQ-DI评分均降低(P<0.05),且联合组均低于对照组(P<0.05);两组血清CRP、GPI、M-CSF、IL-32、ROS、BK、bFGF、VEGF和TGF-β1水平均降低(P<0.05),且联合组均低于对照组(P<0.05);两组血清SOD和β-EP水平均升高(P<0.05),且联合组均高于对照组(P<0.05)。联合组总有效率为98.0%,高于对照组的82.0%(P<0.05)。结论针刺联合桑寄生汤治疗RA可缓解患者临床症状,改善临床应答,提高患者生活质量,疗效优于单一口服桑寄生汤治疗;且能降低促炎因子水平,抑制机体炎症,提高抗氧化能力,减少血管新生相关细胞因子。

Objective To observe the clinical efficacy of acupuncture combined with Sang Ji Sheng Tang in the treatment of rheumatoid arthritis(RA)and its effect on serum levels of angiogenesis related cytokines and pro-inflammatory cytokines.Method A total of 100 patients with RA were randomly divided into a control group and a combination group,with 50 cases in each group.The control group was treated with Sang Ji Sheng Tang,and the combination group was treated with acupuncture combined with Sang Ji Sheng Tang.Before and after treatment,the changes of morning stiffness time,20 m walking time,pain numerical rating scale(NRS)score,TCM syndrome score,disease activity score 28(DAS28)of RA patients,and the health assessment questionnaire-disability index(HAQ-DI)score were observed in the two groups.The serum glycosyl phosphatidyl inositol(GPI),basic fibroblast growth factor(bFGF),C reactive protein(CRP),macrophage colony stimulating factor(M-CSF),interleukin-32(IL-32),vascular endothelial growth factor(VEGF),superoxide dismutase(SOD),reactive oxygen species(ROS),transforming growth factor-β1(TGF-β1),bradykinin(BK)andβ-endorphin(β-EP)levels were observed in the two groups before and after treatment.The clinical efficacy was compared between the two groups.Result After treatment,the morning stiffness time and 20 m walking time were shortened in the two groups(P<0.05),and those in the combination group were shorter than those in the control group(P<0.05).The NRS score,TCM syndrome score,RA DAS28 score and HAQ-DI score of the two groups were decreased(P<0.05),and those of the combination group were lower than those of the control group(P<0.05).The serum levels of CRP,GPI,M-CSF,IL-32,ROS,BK,bFGF,VEGF and TGF-β1 in the two groups were decreased(P<0.05),and those in the combination group were lower than those in the control group(P<0.05).The serum SOD andβ-EP levels were increased in the two groups(P<0.05),and those in the combination group were higher than those in the control group(P<0.05).The total effective rate of the combination group was 98.0%,which was higher than 82.0% of the control group(P<0.05).Conclusion Acupuncture combined with Sang Ji Sheng Tang in the treatment of RA can relieve the clinical symptoms,improve the clinical response,and improve the quality of life of patients,and the therapeutic effect is better than taking Sang Ji Sheng Tang alone.In addition,it can reduce the level of pro-inflammatory factors,inhibit inflammation,improve antioxidant capacity,and reduce angiogenesis related cytokines.