化积散结散联合温针灸治疗类风湿关节炎合并肺间质病变的疗效及对类风湿因子、免疫应答和抗CCP抗体、CCL19的影响

Effects of Huaji Sanjie Powder Combined with Warm-Needling Moxibustion in the Treatment of Rheumatoid Arthritis Complicated with Interstitial Lung Disease and Its Effects on Rheumatoid Factor,Immune Response,Anti-CCP Antibody and CCL19

目的:探讨化积散结散联合温针灸治疗类风湿关节炎合并肺间质病变患者的疗效及对类风湿因子、免疫应答和抗环瓜氨酸肽(CCP)抗体、趋化因子配体19(CCL19)的影响。方法:选择2020年4月至2023年4月中国中医科学院广安门医院保定医院和中国人民解放军陆军第八十二集团军医院收治的类风湿关节炎合并肺间质病变患者98例,采用随机数字表法分为两组。西医组49例患者进行常规西医治疗,联合组49例患者在西医组的基础上给予化积散结散联合温针灸治疗。治疗3个月后比较两组患者的临床疗效,观察治疗前后的中医证候评分、类风湿关节炎疾病活动评分(DAS-28)及肺脏高分辨率CT(HRCT)评分,检测类风湿因子(RF)、抗CCP抗体、CCL19、白细胞介素4(IL-4)、肿瘤坏死因子α(TNF-α)水平及Th1/Th2。结果:联合组患者的总有效率为97.96%(48/49),高于西医组的81.63%(40/49),差异有统计学意义(P<0.05)。治疗后,联合组患者中医证候评分较西医组降低,DAS-28、HRCT评分较西医组降低,差异均有统计学意义(P<0.05)。治疗后,联合组患者Th1/Th2、TNF-α水平低于西医组,IL-4水平高于西医组,RF、抗CCP抗体和CCL19水平低于西医组,差异均有统计学意义(P<0.05)。结论:化积散结散联合温针灸用于类风湿关节炎合并肺间质病变患者,可调节机体免疫应答,抑制炎症,降低类风湿因子、抗CCP抗体和CCL19水平,改善临床症状及中医证候评分,提升临床疗效。

OBJECTIVE:To probe into the efficacy of Huaji Sanjie powder combined with warm-needling moxibustion in the treatment of rheumatoid arthritis complicated with interstitial lung disease and its effects on rheumatoid factor,immune response,anti-cyclic citrullinated peptide(CCP)antibody and chemokine ligand(CCL19).METHODS:A total of 98 patients with rheumatoid arthritis complicated with interstitial lung disease admitted into Baoding Hospital of Guang’anmen Hospital of Chinese Academy of Chinese Medical Sciences and the 82nd Group Military Hospital of the Chinese People’s Liberation Army from Apr.2020 to Apr.2023 were extracted to be divided into two groups via the random number table method.Forty-nine patients in Western medicine group was given conventional Western medicine,while the 49 patients in the combined group was given Huaji Sanjie powder combined with warm-needling moxibustion based on the Western medicine group.After 3 months of treatment,the clinical efficacy were compared between two groups,traditional Chinese medicine(TCM)symptom scores,rheumatoid arthritis disease activity scores(DAS-28)and lung high-resolution CT(HRCT)scores before and after treatment were observed,the rheumatoid factor(RF),anti-CCP antibody,CCL19,interleukin 4(IL-4),tumor necrosis factorα(TNF-α)levels and Th1/Th2 were detected.RESULTS:The total effective rate of the combined group was 97.96%(48/49),higher than 81.63%(40/49)of the Western medicine group,with statistically significant difference(P<0.05).After treatment,the TCM symptom score,DAS-28 and HRCT scores in combined group were lower than those in Western medicine group,with statistically significant differences(P<0.05).After treatment,the Th1/Th2 and TNF-αlevels were lower,the IL-4 level was higher,the RF,anti-CCP antibody and CCL19 levels were lower in the combined group than those in the Western medicine group,with statistically significant differences(P<0.05).CONCLUSIONS:Huaji Sanjie powder combined with warm-needling moxibustion in the treatment of rheumatoid arthritis complicated with interstitial lung disease can regulate immune response,inhibit inflammation,reduce rheumatoid factors,anti-CCP antibody and CCL19 levels,improve clinical symptoms and TCM syndrome scores,and promote clinical efficacy.