白芍总苷胶囊联合他克莫司胶囊治疗系统性红斑狼疮的疗效分析及其作用机制研究

Efficacy and mechanism of total glucosides of paeony capsule combined with tacrolimus capsule in the treatment of patients with systemic lupus erythematosus

摘要:

目的 研究白芍总苷胶囊联合他克莫司胶囊治疗系统性红斑狼疮（SLE）患者的疗效及其对哺乳动物雷帕霉素靶蛋白（mTOR）信号通路的调控作用。方法 选取2016年1月—2019年1月武汉市第一医院收治的96例SLE患者，依据治疗方案不同分为对照组、观察组，每组48例。两组患者均行常规治疗，并使用他克莫司胶囊，观察组在对照组基础上服用白芍总苷胶囊。比较两组疗效，并检测患者治疗前后外周血免疫蛋白水平、mTOR信号通路相关蛋白相对表达量，同时比较不良反应发生情况和复发率。结果 观察组总有效率高于对照组（93.75% VS 79.17%）（P <0.05）。观察组治疗前后SLEDAI评分及糖皮质激素用量的差值大于对照组（P <0.05）。观察组治疗前后血清免疫蛋白水平的差值大于对照组（P <0.05）。观察组治疗前后mTOR信号通路相关蛋白相对表达量的差值大于对照组（P <0.05）。患者主要不良反应为恶心、发热、腹泻。两组不良反应发生率比较，差异无统计学意义（P >0.05），观察组患者复发率低于对照组（10.86% VS 28.89%）（P <0.05）。结论 白芍总苷胶囊联合他克莫司胶囊治疗SLE患者疗效显著，可通过抑制mTOR信号通路，改善患者免疫功能，从而降低复发率和减少糖皮质激素用量，安全性较好。

关键词:系统性红斑狼疮;白芍总苷;他克莫司;哺乳动物雷帕霉素靶蛋白

Abstract:

Objective To study the efficacy of total glucosides of paeony capsule combined with tacrolimus capsule in the treatment of systemic lupus erythematosus (SLE) patients and its regulatory effect on mTOR signaling pathway.Methods The 96 SLE patients admitted to our hospital from January 2016 to January 2019 were selected and divided into control group and observation group according to the random number table method, with 48 cases in each group. Both groups were treated with routine treatment and tacrolimus capsules, while the observation group took total glucosides of paeony capsule on the basis of control group. The therapeutic effects of the two groups were compared, and the levels of peripheral blood immune proteins and molecules associated with the mammalian target of rapamycin (mTOR) signaling pathway before and after the treatment were detected. The incidence of adverse reactions and recurrence rate were also compared between the groups.Results The overall effective rate of the observation group was higher than that of the control group (93.75% VS 79.17%) (P < 0.05). The differences of SLEDAI score and average daily dose of glucocorticoids before and after the treatment were greater in the observation group than those in the control group (P < 0.05). The differences of the levels of peripheral blood immune proteins before and after the treatment in the observation group were higher than those in the control group (P < 0.05). In addition, the differences of the protein levels of the molecules associated with the mTOR signaling pathway (p-Akt, p-PI3K, p-mTOR) before and after the treatment in the observation group were higher than those in the control group (P < 0.05). The major adverse reactions were nausea, fever and diarrhea. There was no difference in the incidence of adverse reactions between the two groups (P > 0.05). The recurrence rate of the observation group was lower than that of the control group (10.86% VS 28.89%) (P < 0.05).Conclusions The total glucosides of paeony capsule combined with tacrolimus capsule is safe and effective in the treatment of SLE patients. It can improve the immune function of patients by inhibiting the mTOR signaling pathway, thereby reducing the recurrence rate and the dose of glucocorticoids.

Key words:systemic lupus erythematosus;total glucosides of paeony;tacrolimus;mammalian target of rapamycin