| 周欢欢,李世超,陈琪,等.龙藤汤加减方治疗类风湿关节炎活动期超声下关节病理改变及对血清IL-6、IL-17、TNF-α水平的影响[J].浙江中医药大学学报,2021,45(6):641-645, 659. |
| 龙藤汤加减方治疗类风湿关节炎活动期超声下关节病理改变及对血清IL-6、IL-17、TNF-α水平的影响 |
| Investigation of the Ultrasonic Pathological Changes and Influence on Serum IL-6， IL-17 and TNF-a of Modified Longteng Decoction Combined with Leflunomide in the Treatment of Rheumatoid Athritis |
| DOI：10.16466/j.issn1005-5509.2021.06.014 |
| 中文关键词: 类风湿关节炎 龙藤汤加减方 TNF-?藁 IL-6 IL-17 DAS-28 关节超声 炎症因子 |
| 英文关键词: rheumatoid arthritis modified Longteng Decoction TNF-a IL-6 IL-17 DAS-28 ultrasound inflammatory factor |
| 基金项目:国家自然科学基金项目(81874401、81173228) |
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| 中文摘要: |
| [目的]研究来氟米特联合龙藤汤加减方对类风湿关节炎(rheumatoid athritis，RA)患者的临床疗效，对关节滑膜超声病理改变及血清白细胞介素-6(interleukin-6，IL-6)、白细胞介素-17(interleukin-17，IL-17)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)水平的影响。[方法]选取2018年1月至2019年6月北京中医药大学附属东直门医院确诊和收治的40例RA患者，采取随机数字表法将这些患者分为两组，每组各20例，一组为对照组，采用来氟米特单药治疗，另一组为试验组，在来氟米特的基础上服用龙藤汤，两组均连续给药24周。试验过程中以28个关节疾病活动度评分(disease activity score for 28 joints，DAS-28)显效率，关节疾病活动度，关节病理变化，血清IL-6、IL-17、TNF-α水平等为评价指标，比较两种疗法对RA活动期治疗作用的差异。[结果]经过24周的治疗，试验组患者DAS-28显效率高于对照组，差异有统计学意义(P＜0.05)。经过24周的治疗，两组患者滑膜增厚关节数量均显著减少(P＜0.05)，且试验组优于对照组，差异具有统计学意义(P＜0.05)；治疗后两组滑膜增厚厚度较前显著降低，试验组差异有统计学意义(P＜0.05)，对照组差异无统计学意义(P＞0.05)，且试验组优于对照组(P＜0.05)。经过24周的治疗，两组患者的血清炎症因子水平均较前降低(P＜0.05)，且试验组优于对照组，差异具有统计学意义(P＜0.05)。[结论]与单独采用来氟米特治疗比较，来氟米特联合龙藤汤加减方治疗RA效果更为显著，能够有效缓解RA的临床症状，显著改善关节滑膜的病理表现，机制可能与抑制IL-6、IL-17及TNF-α等因子的表达，从而减轻滑膜炎症反应有关。 |
| 英文摘要: |
| [Objective] To investigate the clinical effect of modified Longteng Decoction combined with Leflunomide on rheumatoid arthritis(RA) of active phase and its influence on ultrasonic pathological changes of joint and serum levels of interleukin-6(IL-6)， interleukin-17(IL-17) and tumor necrosis factor-α(TNF-α).[Methods] Totally 40 patients with RA were divided into trial group and control group with 20 cases in each according to the random number table. Patients in trial group were treated with modified Longteng Decoction combined with Leflunomide， while patients in control group were treated with Leflunomide along， and the treatment course lasted for 24 weeks. During the experiment， the diseases activity score for 28 joints(DAS-28) markedly effective rate， the ultrasonic pathological changes of joint， serum levels of IL-6， IL-17 and TNF-α were used as evaluation indexes to compare the therapeutic effects of the two groups.[Results] After the treatment for 24 weeks， the DAS-28 markedly effective rate in trial group was higher than control group， the difference was significant(P＜0.05). After the treatment for 24 weeks， the number of joints with thickened synovium was reduced in both groups compared with before treatment(P＜0.05)， and the trial group was more effictive than control group， the difference was statistically significant(P＜0.05). After the treatment for 24 weeks， the total thickness of thickening synovial was reduced in both groups compared with before treatment， and the difference was statistically significant in trial group(P＜0.05)， while not statistically significant in control group(P＞0.05)， and the trial group was more effictive than control group(P＜0.05). After the treatment for 24 weeks， compared with before treatment， the serum level decreased in both groups(P＜0.05)， and trial group was more effictive than control group， the difference was statistically significant(P＜0.05). [Conclusion]Compared with leflunomide alone， leflunomide combined with Longteng Decoction has more significant effect in the treatment of RA， which can effectively relieve the clinical symptoms of RA and significantly relieve the pathological manifestations of joint synovium. The mechanism may be related to inhibiting the expression of IL-6， IL-17， TNF-α and other factors， so as to reduce the synovial inflammatory reaction. |
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