升麻鳖甲汤治疗阴虚内热型系统性红斑狼疮90例临床观察
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摘要
目的:观察升麻鳖甲汤治疗阴虚内热型系统性红斑狼疮的临床疗效。方法:将90例阴虚内热型系统性红斑狼疮患者随机分为治疗组和对照组,每组45例。对照组予甲泼尼龙片治疗,治疗组在对照组治疗基础上加服升麻鳖甲汤,2组均治疗12周。比较2组患者治疗后临床疗效,治疗前后中医证候评分和患者焦虑、抑郁心理状态的变化,检测2组治疗前后自身抗体、细胞因子表达水平、补体C3的变化情况。结果:2组患者治疗后,治疗组总效率为88. 89%,对照组为75. 56%,治疗组明显优对照组(P<0. 05); 2组治疗前后中医证候评分均显著降低,且治疗组优于对照组,差异有统计学意义(P<0. 05);焦虑自评量表(SAS)、汉密尔顿抑郁量表(HAMD)治疗前后评分比较,差异有统计学意义(P<0. 05),且治疗组优于对照组;与对照组比较,治疗组ANA、抗ds DNA抗体、抗Sm抗体、Auu A、抗r RNP抗体阳性率水平明显下降,血清IL-2、IL-6、IL-10、TNF-α水平明显下降,差异有统计学意义(P<0. 05);补体C3水平显著升高,差异有统计学意义(P<0. 05)。结论:升麻鳖甲汤治疗阴虚内热型系统性红斑狼疮疗效显著,通过降低自身抗体的阳性率,改善细胞因子的变化,提高C3水平,从而维持机体的免疫平衡,且改善患者的心理状态。
Objective: To observe the clinical efficacy of Shengma Biejia Decoction in treating systemic lupus erythematosus with Yin deficiency and internal heat. Methods: 90 patients with systemic lupus erythematosus due to Yin deficiency and internal heat were randomly divided into treatment group and controlled group,45 cases in each group. The controlled group was treated with Methylene Nylon Tablets,and the treatment group was additionally given Shengma Biejia Decoction on the basis of the controlled group. The 2 groups were treated for 12 weeks. The clinical effects of the 2 groups were compared,TCM syndrome score before and after treatment and changes in the state of anxiety and depression in patients,the changes of autoantibody,cytokine expression and complement C3 were detected before and after treatment in the 2 groups. Results: After treatment,the total effective rate of the 2 groups was 88. 89% and 77. 78% respectively,and the treatment group was significantly better than that of the controlled group( P < 0. 05). The scores of TCM syndromes in the 2 groups before and after treatment were significantly decreased,and the treatment group was better than the controlled group,with a statistically significant difference( P < 0. 05).There was a statistically significant difference between the self rating Anxiety Scale( SAS) and the Hamilton Depression Scale( HAMD) before and after treatment( P < 0. 05). Compared with the controlled group,the positive rate of ANA,anti ds DNA antibody,anti Sm antibody,Auu A and anti r RNP antibody in the treatment group decreased significantly,serum levels of IL-2,IL-6,IL-10 and TNF-alpha decreased significantly( P < 0. 05). The level of complement C3 increased significantly,and the difference was statistically significant( P < 0. 05). Conclusion: The therapeutic effect of Shengma Biejia Tang is significant in treating systemic lupus erythematosus with Yin deficiency and internal heat. By reducing the positive rate of autoantibodies,improving the change of cytokine and improving the level of C3,so as to maintain the immune balance of the body and improve the psychological state of the patients.
Objective: To observe the clinical efficacy of Shengma Biejia Decoction in treating systemic lupus erythematosus with Yin deficiency and internal heat. Methods: 90 patients with systemic lupus erythematosus due to Yin deficiency and internal heat were randomly divided into treatment group and controlled group,45 cases in each group. The controlled group was treated with Methylene Nylon Tablets,and the treatment group was additionally given Shengma Biejia Decoction on the basis of the controlled group. The 2 groups were treated for 12 weeks. The clinical effects of the 2 groups were compared,TCM syndrome score before and after treatment and changes in the state of anxiety and depression in patients,the changes of autoantibody,cytokine expression and complement C3 were detected before and after treatment in the 2 groups. Results: After treatment,the total effective rate of the 2 groups was 88. 89% and 77. 78% respectively,and the treatment group was significantly better than that of the controlled group( P < 0. 05). The scores of TCM syndromes in the 2 groups before and after treatment were significantly decreased,and the treatment group was better than the controlled group,with a statistically significant difference( P < 0. 05).There was a statistically significant difference between the self rating Anxiety Scale( SAS) and the Hamilton Depression Scale( HAMD) before and after treatment( P < 0. 05). Compared with the controlled group,the positive rate of ANA,anti ds DNA antibody,anti Sm antibody,Auu A and anti r RNP antibody in the treatment group decreased significantly,serum levels of IL-2,IL-6,IL-10 and TNF-alpha decreased significantly( P < 0. 05). The level of complement C3 increased significantly,and the difference was statistically significant( P < 0. 05). Conclusion: The therapeutic effect of Shengma Biejia Tang is significant in treating systemic lupus erythematosus with Yin deficiency and internal heat. By reducing the positive rate of autoantibodies,improving the change of cytokine and improving the level of C3,so as to maintain the immune balance of the body and improve the psychological state of the patients.
引文
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[15] Ye L,Hu Z,Du G,et al. Antidepressant-like effects of theextract from Cimicifuga foetida L.[J]. J Ethnopharmacol,2012,144(3):683~691
[16]刘如秀,刘宇,汪艳丽,等.当归的药理作用[J].西部中医药,2014,27(11):354
[17]乔建卫,王慧铭.鳖甲的药用现状[J].浙江中西医结合杂志,2009,19(1):45
[18]王朴.生地黄的现代药理研究与临床应用[J].中国中医药现代远程教育,2008,6(8):986
[19] LI T,CHEN H,WEI N,et al. Anti-inflammatory and immu-nomodulatory mechanisms of artemisinin on contact hypersensitivity[J]. IntImmunopharmacol,2012,12(1):144~150
[20]罗艳琴,马云,宋路瑶,等.菝葜有效成分及其药理作用研究概述[J]. 2013,3(36):502
[21]周永芹,韩莉.中药蜈蚣的研究进展[J].中药材,2008,(2):315~319
[22]徐芳.环磷酰胺结合白芍总苷治疗系统性红斑狼疮的临床效果研究[J].陕西医学杂志,2015,44(8):1081~1082
[2]陆前进,张建中,邓丹琪.红斑狼疮:从基础到临床[M].北京:北京大学医学出版社,2013:3
[3]熊浪平.昆母汤联合激素治疗风湿痹阻型系统性红斑狼疮的临床观察[D].广州:广州中医药大学,2017
[4] HOCHBERG M C. Updating the American College of Rheumatol-ogy revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum,1997,40(9):1725
[5]中华医学会风湿病学分会.系统性红斑狼疮诊治指南(2003年)[J].现代实用医学,2003,15(12):764~769
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:111
[7]陈红凤.中医外科学[M].上海:上海科学技术出版社,2007:239
[8]王长虹,丛中.临床心理治疗学[M].北京:人民军医出版社,2001:575~578
[9]张明园.精神科评定量表手册[M]. 2版.长沙:湖南科学技术出版社,1998:34~38,122~127
[10]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:111~115
[11]娄玉铃.中国风湿病学[M].北京:人民卫生出版社,2001:2117~2118
[12] LEE KM,STOTT RT,ZHAO G,et al. TGF-B-producingregulatory B cells induce regulatory T cells and promote transplantation toler-ance[J]. Eur J Immunol,2014,44(6):1728~1736
[13] TEDDER TF. BIO cells:a functionally defined regulatory Bcell subset[J]. J Immunol,2015,194(4):1395~1401
[14]卢君健.红斑狼疮中西医结合诊治[M].北京:人民卫生出版社,2007,3
[15] Ye L,Hu Z,Du G,et al. Antidepressant-like effects of theextract from Cimicifuga foetida L.[J]. J Ethnopharmacol,2012,144(3):683~691
[16]刘如秀,刘宇,汪艳丽,等.当归的药理作用[J].西部中医药,2014,27(11):354
[17]乔建卫,王慧铭.鳖甲的药用现状[J].浙江中西医结合杂志,2009,19(1):45
[18]王朴.生地黄的现代药理研究与临床应用[J].中国中医药现代远程教育,2008,6(8):986
[19] LI T,CHEN H,WEI N,et al. Anti-inflammatory and immu-nomodulatory mechanisms of artemisinin on contact hypersensitivity[J]. IntImmunopharmacol,2012,12(1):144~150
[20]罗艳琴,马云,宋路瑶,等.菝葜有效成分及其药理作用研究概述[J]. 2013,3(36):502
[21]周永芹,韩莉.中药蜈蚣的研究进展[J].中药材,2008,(2):315~319
[22]徐芳.环磷酰胺结合白芍总苷治疗系统性红斑狼疮的临床效果研究[J].陕西医学杂志,2015,44(8):1081~1082