益肾通督方治疗强直性脊柱炎临床疗效及相关机制初步探讨

Clinical effect and related mechanism of Yishen Tongdu Formula on ankylosing spondylitis

关键词:  强直性脊柱炎  肾虚湿热  中药  益肾通督方

Key words:  ankylosing spondylitis  kidney deficiency and dampness-heat  traditional Chinese medicine  Yishen Tongdu Formula

摘要:

[目的] 探讨中药益肾通督方治疗强直性脊柱炎（AS）疗效，初步分析其治疗机制。[方法] 选择首都医科大学附属北京中医医院2019年1月—2021年12月期间收治的AS患者82例，按照随机数字表法随机分为治疗组和对照组，各41例。对照组口服塞来昔布胶囊，治疗组在此基础上口服中药益肾通督方，疗程均为12周。比较两组治疗前后脊柱痛评分、夜间痛评分、Bath强直性脊柱炎活动指数（BASDAI）、Bath强直性脊柱炎功能指数（BASFI）、指地距、枕墙距、胸廓活动度、Schober试验、中医证候评分，应用国际AS评分工作组（ASAS）推荐的方案评估疗效；比较两组治疗前后红细胞沉降率（ESR）、血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-17（IL-17）、可溶性白细胞相关免疫球蛋白样受体-1（LAIR-1）水平，并比较两组外周血单个核细胞（PBMC）中miR-155、miR-223相对表达量。[结果] 治疗后治疗组BASDAI、BASFI、脊柱痛评分、夜间痛评分、指地距、枕墙距、中医证候评分均低于对照组（P<0.01），胸廓活动度、Schober试验高于对照组（P<0.01）；治疗组ASAS 20、ASAS 40、ASAS 5/6、BASDAI 50均高于对照组（P<0.05）；ESR、血清CRP、TNF-α、IL-17、LAIR-1水平及PBMC miR-155、miR-223相对表达量均低于对照组（P<0.01）。[结论] 益肾通督方可减少炎症因子分泌，减缓炎症进展，改善症状体征和中医证候评分，治疗AS效果确切，安全性好，其机制可能与调节血清LAIR-1、PBMCmiR-155、 miR-223表达有关。

Abstract:

[Objective] To investigate the therapeutic effect of Yishen Tongdu Formula on ankylosing spondylitis（AS） and to analyze its therapeutic mechanism. [Methods] The 82 AS patients admitted to our hospital from January 2019 to December 2021 were selected and divided into treatment group and control group according to the random number table method，with 41 cases in each group. The control group were given celecoxib capsules，while the treatment group were given Yishen Tongdu Formula，a traditional Chinese medicine（TCM），the treatment was for 12 weeks. Spinal pain score，night pain score，Bath ankylosing spondylitis Activity index （BASDAI），Bath ankylosing spondylitis Function index （BASFI），finger ground distance，occipital wall distance，thoracic motion，Schober test and TCM syndrome score were compared between the two groups before and after treatment. Efficacy was evaluated with the protocol recommended by the International Working Group on the International AS Scoring Working Group （ASAS）. Erythrocyte sedimentation rate （ESR），serum C-reactive protein （CRP），tumor necrosis factor-α （TNF-α），interleukin-17 （IL-17），and soluble leukocyte associated immunoglobulin like receptor-1 （AIR-1） levels were compared between the two groups before and after treatment. The relative expression levels of miR-155 and miR-223 in peripheral blood mononuclear cells （PBMC） were compared between the two groups. [Results] BASDAI，BASFI，spinal pain score，nocturnal pain score，digital ground distance，occipital wall distance，TCM syndrome score of the treatment group were lower than those of the control group （P<0.01）；thoracic motion and Schober test were higher than that of the control group （P<0.01），ASAS 20，ASAS 40，ASAS 5/6 and BASDAI 50 of treatment groups were higher than those of the control group （P<0.05）；the levels of ESR，serum CRP，TNF-α，IL-17 and AIR-1，and the relative expression levels of miR-155 and miR-223 of PBMC were lower than those of the control group （P<0.01）. [Conclusion] Yishen Tongdu Formula can reduce the secretion of inflammatory factors，slow down the progression of inflammation，improve symptoms and signs and TCM syndrome scores，and it is effective and safe in the treatment of AS. The mechanism may be related to regulating the expression of serum LAIR-1，PBMC miR-155，and miR-223.