仙灵骨葆胶囊联合金钙尔奇预防类风湿关节炎继发骨质疏松的初步临床观察

发布时间：2018-04-27 16:01

本文选题：类风湿关节炎 + 骨质疏松　；参考：《郑州大学》2015年硕士论文

【摘要】：目的初步探讨仙灵骨葆胶囊联合金钙尔奇预防类风湿关节炎(Rheumatoid Arthritis,RA)继发骨质疏松(Osteoporosis,OP)的效果及可能机制。方法将64例在我院接受诊治的RA患者随机分为对照组和观察组,每组32例。对照组男13例,女19例,平均年龄(50.8±6.9)岁,平均病程(68.8±13.5)月;观察组男11例,女21例,平均年龄(51.1±6.8)岁,平均病程(67.4±15.2)月。两组患者的一般情况具有可比性(P0.05)。在常规RA治疗的基础上,对照组患者口服金钙尔奇;观察组患者口服金钙尔奇和仙灵骨葆胶囊。两组观察期均为3个月。于观察前后记录两组的晨僵时间、关节肿胀指数、关节压痛指数、关节功能指数、血小板计数(Platelet Count,PLT)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、类风湿因子(Rheumatoid Factor,RF)、C反应蛋白(C Reactive Protein,CRP)、抗环瓜氨酸肽(Anti-cyclic Citrullinated Peptide,anti-CCP)抗体、血钙、血磷、血清碱性磷酸酶(Alkaline Phosphatase,ALP)、骨钙素(Osteocalcin,OC)、I型前胶原氨基末端前肽(Procollagen Type I Amino-terminal Propeptide,PINP)、抗酒石酸酸性磷酸酶-5b(Tartrate-resistant Acid Phosphatase-5b,TRACP-5b)和I型胶原交联羧基末端肽(C-terminal Telopeptides of Type I Collagen,CTX)、骨保护素(Osteoprotegerin,OPG)、细胞核因子-κB受体活化因子配体(Receptor Activator of Nuclear Factor-κB Ligand,RANKL)以及腰椎、股骨颈、Ward三角、大转子骨密度。结果1两组药物干预前晨僵时间、关节压痛指数、关节肿胀指数以及关节功能指数无明显区别(P0.05);经药物干预后,两组晨僵时间明显缩短,关节压痛指数、关节肿胀指数以及关节功能指数明显降低(P0.05);经药物干预后,观察组晨僵时间明显短于对照组(P0.05),关节压痛指数、关节肿胀指数以及关节功能指数均低于对照组。2两组药物干预前PLT、ESR、RF、CRP、抗CCP抗体、血钙以及血磷无明显区别(P0.05);经药物干预后,两组PLT、ESR、RF、CRP、抗CCP抗体明显降低(P0.05),血钙和血磷增加;经药物干预后,观察组PLT、ESR、RF、CRP、抗CCP抗体低于对照组,血钙和血磷高于对照组。3两组药物干预前ALP、OC、PINP、TRACP-5b和CTX无明显区别(P0.05);经药物干预后,两组ALP、TRACP-5b、CTX降低,OC和PINP增加;经药物干预后,观察组ALP、TRACP-5b、CTX低于对照组,OC和PINP高于对照组。4两组药物干预前OPG和RANKL水平无明显区别(P0.05);经药物干预后,两组OPG升高,RANKL降低;经药物干预后,观察组OPG明显高于对照组,RANKL明显低于对照组(P0.05)。5两组药物干预前腰椎、股骨颈、Ward三角以及大转子骨密度无明显区别(P0.05);经药物干预后,对照组骨密度明显降低(P0.05),观察组骨密度无明显变化,观察组骨密度明显高于对照组(P0.05)。结论在金钙尔奇基础上联合应用仙灵骨葆胶囊能够有效减轻RA病情,改善患者临床症状、骨代谢,抑制骨密度降低,预防RA继发OP发生发展,可能与其调节OPG和RANKL水平相关。
[Abstract]:Objective to investigate the effect and possible mechanism of Xianling Gubao capsule combined with Jincaolai capsule in the prevention of osteoporosis secondary to rheumatoid arthritis (RA). Methods 64 RA patients in our hospital were randomly divided into two groups: control group (n = 32) and observation group (n = 32). There were 13 males and 19 females in the control group, with an average age of 50.8 卤6.9 years and an average course of disease of 68.8 卤13.5 months, while in the observation group, there were 11 males and 21 females, with an average age of 51.1 卤6.8 years and an average course of 67.4 卤15.2months. The general conditions of the two groups were comparable (P 0.05). On the basis of routine RA treatment, the patients in the control group were treated with Jincailqi, and the patients in the observation group were treated with the capsule of Jincalqi and Xianling Gubao. The observation period was 3 months in both groups. Morning stiffness time, joint swelling index, joint tenderness index and joint function index were recorded before and after observation. Platelet count, erythrocyte sedimentation rate, erythrocyte Sedimentation, erythrocyte sedimentation rate, rheumatoid factoroid factor, rheumatoid factoroid, Sedimentation, C-reactive protein, C-reactive protein, anti-cyclic Citrullinated peptide anti-CCP-antibody, blood calcium, blood phosphorus, erythrocyte sedimentation rate, Rheumatoid Factoroid rDNA, C Reactive protein in CRP, Anti-cyclic Citrullinated Peptidine Anti-CCPP antibody, blood calcium, blood phosphorus, Serum Alkaline Phosphatase, osteocalcin I procollagen Type I Amino-terminal propeptidePIN, tartrate-resistant Acid phosphatase-5bTRACP-5b) and type I collagen cross-linked carboxyl terminal peptide C-terminal Telopeptides of Type I collagen CTX, osteoprotegerin Osteoprotegerin Osteoprotegerin Osteoprotegerin I, osteoprotegerin Osteoprotegerin Osteoprotegerin Osteoprotegerin OPGG, nuclear factor- 魏 B Receptor Activator of Nuclear Factor- 魏 B Ligand RANKL and lumbar vertebrae, Femoral neck Ward triangle, greater trochanter bone mineral density. Results 1there was no significant difference in morning stiffness time, joint tenderness index, joint swelling index and joint function index between the two groups before drug intervention, but after drug intervention, the morning stiffness time was significantly shortened and the joint tenderness index was decreased. The joint swelling index and joint function index significantly decreased P0.05, the morning stiffness time of the observation group was significantly shorter than that of the control group, and the joint tenderness index was significantly shorter than that of the control group. The joint swelling index and joint function index were lower than those in the control group before intervention (P 0.05), but there was no significant difference between the two groups in anti CCP antibody, blood calcium and blood phosphorus. After drug intervention, the levels of anti CCP antibody and anti CCP antibody were significantly decreased, and serum calcium and phosphorus were increased in the two groups. After drug intervention, the levels of anti CCP antibody and serum calcium and phosphorus in the observation group were lower than those in the control group, and the levels of serum calcium and phosphorus were higher than those in the control group before drug intervention. There was no significant difference between the two groups before and after drug intervention (P 0.05); after drug intervention, the levels of OC and PINP in the two groups were decreased, and after drug intervention, the levels of OC and PINP were increased in the two groups. The levels of OPG and RANKL in the observation group were lower than those in the control group (P < 0.05), but the levels of OPG and RANKL in the two groups were lower than those in the control group (P < 0.05). After drug intervention, the levels of OPG in the two groups were higher than those in the control group (P < 0.05), and the levels of OPG in the two groups were lower than those in the control group (P < 0.05). The OPG of the observation group was significantly higher than that of the control group (P 0.05). The bone mineral density of lumbar vertebrae, femoral neck Ward's triangle and greater trochanter had no significant difference between the two groups before and after drug intervention, and after drug intervention, there was no significant difference between the two groups in bone mineral density (BMD). The BMD of the control group was significantly lower than that of the control group (P 0.05), but the BMD of the observation group had no significant change, and the BMD of the observation group was significantly higher than that of the control group. Conclusion combined application of Xianling Gubao capsule on the basis of Jincailqi can effectively alleviate the condition of RA, improve clinical symptoms, bone metabolism, inhibit the decrease of bone density, prevent the development of secondary op in RA, and may be related to its regulation of OPG and RANKL levels.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.22;R580

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