Application of sinomenine in rheumatic diseases

青藤碱广泛应用于多种风湿性疾病,过敏反应,消化道,血液,循环系统和神经系统等不良反应越来越受到重视.本文综述了青藤碱在类风湿性疾病中的应用及其副作用,为青藤碱制剂的安全有效应用提供参考.

A meta-analysis of randomized controlled trials of Yiyiren Decoction in the treatment of rheumatoid arthritis

目的：系统评价薏苡仁汤联合西药与西药治疗类风湿关节炎的有效性和安全性.方法：计算机检索中国期刊全文数据库、维普期刊资源整合平台、万方数据库、Pub Med、Medline、Cochrane library、Embase数据库;并手工检索纳入文献的参考文献,相关学位论文和会议论文集.检索时间为建库至2017年7月.由2名研究人员分别独立的进行文献的检索和筛选工作,各自独立依据Jadad评分量表对纳入的研究进行质量评价和数据的提取工作,用Rev Man5.3软件进行meta分析.结果：①共纳入7篇RCT,485例患者,其中试验组262例,对照组223例.3分的文献2篇,其余文献均为1～2分.纳入的研究均明确指出组间基线具有可比性.②薏苡仁汤联合西药组总有效率高于单纯西药组（RR=0.85,95%CI[0.78,0.92]）;关节压痛个数（MD=-2.79,95%CI[-3.47,-2.12]）、红细胞沉降率（MD=-9.5,95%CI[15.67,-3.33]）、C反应蛋白（MD=-3.36,95%CI[-5.45,-1.27]）改善情况均优于对照组.药物的不良反应及类风湿因子方面两组差异无统计学意义.结论：薏苡仁汤联合西药较单纯西药对类风湿关节炎患者的临床症状及实验室指标的改善上有-定优势,由于受纳入研究质量限制和可能存在的发表偏倚影响,尚需要大样本、多中心、随机双盲对照试验进一步证实.

Comparative study for cardiovascular risk factors of rheumatoid arthritis and osteoarthritis

目的：比较类风湿关节炎和骨关节炎患者心血管危险因素的差异.方法：回顾性比较44例类风湿关节炎患者（RA）和36例骨关节炎患者（OA）的心血管疾病相关影响因素的差异.包括性别、年龄、身体质量指数、病程、颈动脉超声相关指标、同型半胱氨酸、血脂水平、炎症相关指标及超声心动相关指标等.结果：（1）一般情况：两组患者在性别、年龄方面无明显差异（P〉0.05）,在体重指数方面,OA组体重指数显著高于RA组（P=0.018）,在病程方面,RA组病程显著长于OA组（P=0.024）;（2）实验室指标：RA组患者同型半胱氨酸水平显著高于OA组（P=0.002）;两组患者总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白B、高密度脂蛋白比较均无明显差异（P〉0.05）,但RA组载脂蛋白A1水平显著低于OA组（P〈0.001）,脂蛋白α水平显著高于OA组（P〈0.001）;RA组患者的血沉、C反应蛋白较OA组水平显著升高（P〈0.001）;（3）超声评价：在心脏超声方面,RA组患者每搏输出量、射血分数明显低于OA组（P=0.022,P=0.009）;两组患者主动脉内径、左心房内径、左室舒张末期内径、左室收缩末期内径、左室后壁厚度、左室短轴缩短率、右心室内径、右心房内径、及室间隔厚度比较均无明显差异（P〉0.05）;两组患者颈动脉斑发生率无明显差异（P〉0.05）,但两组患者颈动脉增厚的发生率及颈动脉中层厚度比较均有明显差异（P〈0.001）.结论：RA患者发生心血管事件的概率比OA高,积极控制RA病情,可能降低心血管事件的发生.

Based on Network Pharmacology to Explore the Action Mechanism of Caulis Sinomenii-Caulis Piperis Kadsurae Herb Pair in the Treatment of Rheumatoid Arthritis

Objective:By using the method of network pharmacology to explore the mechanism of action of Caulis Sinomenii-Caulis Piperis Kadsurae herb pair in the treatment of rheumatoid arthritis.Methods:Search and screen the active ingredients and targets of Qingfengteng(Caulis Sinomenii)and Haifengteng(Caulis Piperis Kadsurae)through the TCMSP database,and predict and supplement the target points of the active ingredients through the Swiss Target Prediction platform;collect rheumatoid arthritis disease targets through GeneCards,OMIM database,and DRUGBANK database,construct a Venn diagram,and obtain the key target of Caulis Sinomenii-Caulis Piperis Kadsurae herb pairs in the treatment of rheumatoid arthritis;use Cytoscape 3.7.1 to establish the effect of Caysaceae sylvestris and Rhizoma sibirica in the treatment of rheumatoid arthritis"Drug-active ingredient-target"network diagram,submit key targets to STRING11.0 database to construct a protein interaction network model to obtain core targets;perform the GO and KEGG enrichment analysis of key targets on the Metascape platform,and draw the network diagram of"active pharmaceutical ingredients-targets-pathways".Results:After screening,discover a total of 27 active ingredients of Caulis Sinomenii-Caulis Piperis Kadsurae herb pairs,which can act on 229 targets,1269 related targets for rheumatoid arthritis diseases.And obtain a total of 95 common targets for drug active ingredients and diseases,including PTGS2,EGFR,MMP9,CASP3,JUN,etc.The common targets are mainly enriched in signaling pathways such as Pathways in cancer,Th17 cell differentiation and Endocrine resistance etc.Conclusion:This study preliminarily explored the potential mechanism of Caulis Sinomenii-Caulis Piperis Kadsurae herb pairs in the treatment of rheumatoid arthritis.The Caulis Sinomenii-Caulis Piperis Kadsurae herb pair may regulate cancer-related pathways,Th17 cell differentiation,endocrine resistance and other pathways to treat rheumatoid arthritis by regulating targets such as PTGS2,EGFR,and MMP9,providing clues and ideas for follow-up experimental research.