桂芍知母汤对类风湿关节炎患者血清TNF-α和趋化因子CX3CL1的影响

Effect of Guishao Zhimu Decoction on serum TNF-α and chemokine CX3CL1 in rheumatoid arthritis patients

摘要:

目的探讨桂芍知母汤对类风湿关节炎（RA）患者血清肿瘤坏死因子α（TNF-α）和趋化因子CX3CL1水平的影响。方法选取2012年1月-2014年1月该院门诊就医的64例RA患者为研究对象，并随机分为观察组和对照组，两组各32例。对照组给予美洛昔康15 mg/次，1次/d和甲氨蝶呤15 mg/次，1次/周；观察组患者在此基础上加用桂芍知母汤1 剂/d，500 ml水煎服。比较两组治疗前后血清TNF-α和CX3CL1 水平。结果治疗12周后，观察组血清TNF-α和CX3CL1分别为（39.3±21.3）和（76.2±35.4）pg/ml，低于治疗前的（75.3±47.2）和（160.7±58.3）pg/ml（p <0.05），低于对照组治疗12 周后的（54.9±35.2）和（131.8±50.6）pg/ml（p <0.05）。而对照组治疗前后比较，差异无统计学意义（p >0.05）。观察组达ACR70、ACR50、ACR20 标准及无效的比例分别为9.4%、28.1%、56.3%和6.3%，优于对照组的3.1%、18.8%、50.0%和28.1%，差异有统计学意义（p <0.05）。服药期间所有患者未发生严重不良反应，观察组、对照组不良反应发生率分别为3.1%和0.0%，两组比较，差异无统计学意义（p >0.05）。结论桂芍知母汤可降低RA 患者血清TNF-α和CX3CL1 水平，抑制关节的滑膜炎症反应，提高临床疗效，安全可靠。

Abstract:

Objective To investigate the impact of Guishao Zhimu Decoction on serum TNF -α and chemokine CX3CL1 in patients with rheumatoid arthritis (RA). Methods In the study 64 RA patients treated in the Outpatient Department of our hospital from January 2012 to January 2014 were enrolled and randomly divided into observation group and control group with 32 cases in each group. The patients in the control group were given Meloxicam (15 mg, once a day) and Methotrexate (15 mg, once a week). Based on that, the cases in the observation group were given Guishao Zhimu Decoction (a daily dose, 500 ml water for decoction). Serum TNF-α and CX3CL1 levels before and after treatment were compared between the two groups. Results After 12 weeks of treatment, serum TNF-α and CX3CL1 levels of the observation group were(39.3 ±21.3) and (76.2 ±35.4) pg/ml respectively, which were significantly lower than those before treatment [(75.3 ±47.2) and (160.7 ±58.3) pg/ml,p < 0.05], and also significantly lower than those of the control group 12 weeks after treatment [(54.9 ±35.2) and (131.8 ±50.6) pg/ml,p < 0.05]. In the control group, there was no significant difference in serum TNF-α or CX3CL1 level before and after treatment (p > 0.05). The proportions of achieving ACR70, ACR50 and ACR20 criteria and ineffectiveness in the observation group were 9.4%,28.1%, 56.3% and 6.3% respectively, which were significantly better than 3.1%, 18.8%, 50.0% and 28.1% in the control group (p < 0.05). The incidences of adverse reactions in the observation group and the control group were 3.1% and 0.0% respectively, there was no significant difference (p > 0.05). Conclusions Guishao Zhimu Decoction could significantly reduce serum TNF-α and CX3CL1 levels of RA patients, then inhibit inflammation of articular synovium and improve the clinical efficacy. It is safe and reliable.