青风藤汤联合甲氨蝶呤对类风湿关节炎患者滤泡辅助性T细胞及白介素-21的影响

发布时间：2018-04-21 23:21

本文选题：类风湿关节炎 + 青风藤汤　；参考：《中国中西医结合杂志》2017年07期

【摘要】：目的观察青风藤汤联合甲氨蝶呤(MTX)对初诊类风湿关节炎(rheumatoid arthritis,RA)患者滤泡辅助性T细胞(follicular helper T cell,Tfh)、白介素-21(IL-21)及病情活动度的影响。方法将72例初诊RA患者随机分为对照组和观察组,每组36例。两组均予MTX,10 mg/周;塞来昔布0.2 g,每日2次口服治疗,根据临床症状逐渐减停塞来昔布。观察组加青风藤汤口服。连续用药12周。治疗前及治疗4、8、12周检测患者红细胞沉降率(erythrocyte sedimentation rate,ESR),并计算患者28个关节病情活动指数(disease activity score in 28 joints,DAS28)。治疗前及治疗12周采用流式细胞术检测外周血Tfh细胞数量,采用酶联免疫吸附法检测治疗前后血清IL-21、抗环瓜氨酸(anti-cyclic citrullinated peptide antibody,抗CCP)抗体。结果两组患者治疗4、8、12周时ESR及DAS28均有降低(P0.01)。治疗12周时,观察组DAS28较对照组同期更低(P0.01)。治疗前及治疗12周两组患者抗CCP抗体无明显差异(P0.05)。与健康人群比较,治疗前两组患者Tfh/CD_4~+ T细胞比例、IL-21水平均明显升高(P0.01)。与治疗前比较,治疗12周时两组患者Tfh/CD_4~+ T细胞比例、IL-21水平均明显降低,且观察组低于对照组(P0.01,P0.05)。结论青风藤汤联合MTX可降低RA患者的Tfh及IL-21水平,并改善患者的临床症状。
[Abstract]:Objective to observe the effects of Qingfengteng decoction combined with methotrexate (MTX) on follicular helper T cell follicular follicular helper T cell TfhU, interleukin-21 (IL-21) and disease activity in newly diagnosed rheumatoid arthritis (RA) patients. Methods 72 newly diagnosed RA patients were randomly divided into control group and observation group with 36 cases in each group. Both groups were given MTX for 10 mg/, celecoxib 0.2 g, oral treatment twice a day, and celecoxib was gradually reduced according to clinical symptoms. Observation group plus Qingfengteng oral. The patients were treated continuously for 12 weeks. The erythrocyte sedimentation rate and erythrocyte sedimentation activity index of 28 joints were measured before treatment and 12 weeks after treatment, and the disease activity score in 28 joints were calculated. Flow cytometry was used to detect the number of Tfh cells in peripheral blood before and after treatment. Serum IL-21 and anti-cyclic citrullinated peptide antibody (anti-CCPs) antibody were detected by enzyme-linked immunosorbent assay (Elisa) before and after treatment. Results both ESR and DAS28 were significantly decreased in both groups at 12 weeks after treatment (P 0.01). After 12 weeks of treatment, DAS28 in the observation group was lower than that in the control group (P 0.01). There was no significant difference in anti CCP antibody between the two groups before and after 12 weeks of treatment (P 0.05). The levels of IL-21 in Tfh / CD4T cell ratio and IL-21 were significantly increased in the two groups before treatment compared with the healthy population. After 12 weeks of treatment, the levels of Tfh / CD4T cells and IL-21 in the observation group were significantly lower than those in the control group. Conclusion Qingfengteng decoction combined with MTX can decrease the levels of Tfh and IL-21 and improve the clinical symptoms of RA patients.
【作者单位】：南京中医药大学第一临床医学院;南京中医药大学附属中西医结合医院风湿免疫科;南京中医药大学第一附属医院风湿免疫科;
【基金】：中国中医科学院江苏分院开放课题项目(No.FY201509)
【分类号】：R593.22

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