温脾活血汤辅助治疗结核性胸膜炎的疗效及对富含丝氨酸和精氨酸的剪接因子6和miR-506-3p的影响

Effect of triple therapy on tuberculous pleurisy and its influence on serum SRSF6 and miR-506-3p levels

目的探讨温脾活血汤辅助治疗结核性胸膜炎的疗效,以及对富含丝氨酸/精氨酸的剪接因子6(SRSF6)和miR-506-3p的影响。方法选取2021年1月至2023年2月收治的98例结核性胸膜炎患者,随机分为对照组(49例)与研究组(49例),对照组采用胸腔穿刺抽液术+抗结核药物治疗,研究组采用温脾活血汤+胸腔穿刺抽液术+抗结核药物治疗,2组均连续治疗2个月。比较2组的临床疗效和不良事件发生情况;比较2组治疗前后的中医证候评分、胸膜厚度以及胸腔积液中炎症因子、腺苷脱氨酶(ADA)、转化生长因子β_(1)(TGF-β_(1)),SRSF6水平和miR-506-3p表达水平。结果研究组总有效率(93.88%)高于对照组(79.59%),差异有统计学意义(P<0.05)。2组不良事件总发生率比较差异无统计学意义(P>0.05)。治疗后,2组中医证候评分和胸膜厚度均低于治疗前(P<0.05),并且研究组低于对照组(P<0.05);2组胸腔积液中干扰素诱导蛋白10(IP-10)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)、ADA、TGF-β_(1)和SRSF6水平均低于治疗前(P<0.05),并且研究组低于对照组(P<0.05);2组胸腔积液中的miR-506-3p表达水平均高于治疗前(P<0.05),并且研究组高于对照组(P<0.05)。结论温脾活血汤可提高结核性胸膜炎患者的临床疗效,改善临床症状,减轻炎症反应,其机制可能与温脾活血汤能够调节SRSF6和miR-506-3p的水平有关。

AIM To explore the efficacy of Wenpi Huoxue Decoction in the treatment of tuberculous pleurisy and the impact of serine/arginine-rich splicing factor 6(SRSF6)and microRNA-506-3p(miR-506-3p).METHODS A total of 98 patients with tuberculous pleurisy in the hospital from January 2021 to February 2023 were selected and randomly divided into control group(49 patients)and study group(49 patients).The control group was treated with pleural aspiration and anti-tuberculosis drugs,and the study group was treated with triple therapy(a combination of pleural aspiration,anti-tuberculosis drugs and Wenpi Huoxue decoction),and both groups were treated continuously for 2 months.The clinical efficacy and adverse events of 2 groups were compared.Traditional Chinese medicine(TCM)syndrome scores and pleural thickness before and after treatment in 2 groups were compared.Levels of inflammatory factors,adenosine deaminase(ADA),transforming growth factor-beta1(TGF-β_(1)),and SRSF6 in the pleural effusions of 2 groups before and after treatment were compared.The expression levels of miR-506-3p in the pleural effusions of 2 groups before and after treatment were compared.RESULTS The total effective rate of the study group(93.88%)was higher than that of the control group(79.59%),with a significant difference(P<0.05).There was no significant difference in adverse reactions between 2 groups(P>0.05).After treatment,the TCM syndrome score and pleural thickness of 2 groups were lower than before treatment, and the study group was lower than the control group (P < 0.05).After treatment, the level of SRSF6 in 2 groups was lower than that before treatment, and the level of miR-506-3p washigher than that before treatment, and the change range in the study group was larger than that in the control group (P <0.05). After treatment, levels of interferon-induced protein 10 (IP-10), interferon-γ (IFN-γ), tumor necrosis factor-α(TNF-α), interleukin -17 (IL-17), ADA and TGF-β_(1) in 2 groups were lower than those before treatment, and those in thestudy group were lower than those in the control group (P < 0.05). CONCLUSION The auxiliary treatment with WenpiHuoxue decoction can improve the clinical efficacy, alleviate clinical symptoms and reduce inflammatory responses inpatients with tuberculous pleuritis. The mechanism underlying the effect might be associated with the ability of WenpiHuoxue decoction to regulate levels of SRSF6 and miR-506-3p.