温阳活血通络法联合醋酸泼尼松治疗系统性硬化症的临床及实验研究

发布时间：2018-06-13 22:44

本文选题：系统性硬化症 + 温阳活血通络法　；参考：《湖北民族学院》2014年硕士论文

【摘要】：目的：通过临床药物验证的方法观察温阳活血通络法联合醋酸泼尼松治疗系统性硬化症的临床疗效，并初步探讨其作用机理，为临床应用提供可靠、客观、科学的理论依据。方法：1.收集SSc患者临床标本，并随机分为温阳活血通络法联合醋酸泼尼松治疗组（中西药治疗组）和醋酸泼尼松治疗组（西药治疗组），治疗8周后，观察其有效率、皮肤积分、关节压痛积分及安全性评定指标；2.将SSc患者和与之匹配的健康体检者，清晨空腹抽取上肢静脉血2ml，提取分离外周血单个核细胞，逆转录cDNA，实时荧光定量聚合酶链（RT-PCR）技术检测TGF-β1、CCL2/MCP-1、CCL5/RANTES在系统性硬化症患者外周血单个核细胞中mRNA的表达，并与正常对照组进行比较，了解上述致病因子在SSc患者PBMC中mRNA的表达及病情发展相关性，为明确温阳活血通络法联合醋酸泼尼松治疗本病的作用机理奠定基础，同时将参与临床药物验证的SSc患者，通过检测治疗前后上述致病因子mRNA表达变化情况，来阐述其作用机理。结果：1临床观察①参与临床观察的系统性硬化症患者35例，中西药治疗组20例，男性3例，女性17例，平均年龄为（47.2±11.2），，西药治疗组15例，全为女性，平均年龄为（40.8±4.76），两组患者治疗前基本情况比较差异无统计学意义（p＞0.05）；②两组患者治疗后，其临床疗效中西药治疗组20例痊愈0(0)%，显效3（15%），有效14（70%），无效3（15%），总有效率为85%，西药对照组15例，痊愈0(0)%，显效0（0），有效8例（53.3%），无效7例（46.7%），总有效率为53.3%，明显低于中西药治疗组（85%），差异有统计学意义(p＜0.05)；③两组患者治疗前皮肤积分、关节压痛积分差异无统计学意义（p＞0.05），治疗后皮肤积分、关节积分均有一定程度降低，但中西药组要优于西药治疗组，且差异有统计意义（p＜0.05）；④两组患者经药物治疗后，实验室指标检查血沉均有明显下降，中西药组治疗前后血沉下降差异有统计学意义（p＜0.05），两组治疗后血沉差异有统计学意义（p＜0.05）；⑤两组患者治疗后均未出现明显的不良反应和毒副作用，安全性指标也均未出现异常。 2实验研究结果①检测52例SSc患者及健康体检者PBMC中TGF-β1、MCP-1、RANTES mRNA的表达RQ值分别为（1.95±1.58）、（0.98±0.63）、（1.33±0.81），均高于健康对照组（1.10±0.54）、（0.90±0.25）、（1.04±0.34），且差异有统计学意义（p＜0.05）；②进一步分析其表达高低与SSc病情相关性发现，血沉、C反应蛋白在RQ值高的组大于RQ值低的组，且差异有统计学意义（p＜0.05），补体C3、C4、抗核抗体阳性率、抗Scl-70抗体阳性率、抗Jo-1抗体阳性率、肺间质纤维化等在RQ值表达高的组大于RQ值表达低的组，但差异无统计学意义(p＞0.05)；③对两组患者治疗前后转化生长因子、趋化因子差值进行比较，发现两组患者治疗8周后均能降低其表达，但中西药组要优于西药治疗组，且差异具有统计学意义（p＜0.05），而TGF-β1在两组患者中治疗前后差值无统计学意义（p＞0.05）。结论：1温阳活血通络法联合醋酸泼尼松治疗系统性硬化症在改善和控制皮肤硬化、关节疼痛、红细胞沉降率等方面有一定疗效，且安全性较好；2.转化生长因子（TGF-β1）、趋化因子（MCP-1、RANTES）在SSc患者外周血单个核细胞（PBMC）中mRNA的表达上调可促进SSc的发生与进展；3温阳活血通络法联合醋酸泼尼松治疗SSc可能是通过抑制趋化因子（MCP-1、RANTES）的表达而起作用，其抑制MCP-1、RANTES的表达可能为其抗纤维化的机制之一。
[Abstract]:Objective: To observe the clinical efficacy of Wenyang Huoxue Tongluo method combined with prednisone acetate in the treatment of systemic sclerosis by clinical drug validation, and to explore its mechanism of action and provide a reliable, objective and scientific basis for clinical application.
Methods: 1. the clinical specimens of SSc patients were collected, and they were randomly divided into two groups: Warm Yang activating blood circulation method combined with prednisone acetate treatment group (Chinese and Western medicine treatment group) and prednisone acetate treatment group (Western medicine treatment group). After 8 weeks of treatment, the efficiency, skin integral, joint pressure pain score and safety assessment index were observed. 2. the matched health of patients with SSc and the health were matched. The examiners took the upper limb venous blood 2ml early in the morning, extracted the peripheral blood mononuclear cells, reverse transcriptase cDNA, real-time fluorescence quantitative polymerase chain (RT-PCR) technique to detect the expression of TGF- beta 1, CCL2/MCP-1, CCL5/RANTES in the peripheral blood mononuclear cells of patients with systemic sclerosis, and compared with the normal control group to understand the above pathogenicity. The relationship between the expression of mRNA and the development of the disease in the PBMC of SSc patients is the basis for determining the mechanism of the action of prednisone acetate with the method of Warming Yang activating blood circulation and collaterals. At the same time, the SSc patients who are involved in the clinical drug validation are examined by the changes of the mRNA table of the above pathogenic factors before and after the treatment.
Results: 1 in clinical observation, there were 35 patients with systemic sclerosis, 20 cases in Chinese and Western medicine, 3 in men and 17 in women, with the average age of (47.2 + 11.2), and 15 in the western medicine treatment group. The average age was (40.8 + 4.76). The basic situation of the two groups before treatment was not statistically significant (P > 0.05); (2) two groups After the treatment, 20 cases in the treatment group were cured by 0 (0)%, 3 (15%), 14 (70%), 3 (15%), 85% in the total, 15 in the western medicine control group, 20 in the control group. (3) there was no statistical difference between the two groups before treatment and the score of joint pressure pain was not statistically significant (P > 0.05). After treatment, the skin integral and joint integral were reduced to a certain extent, but the Chinese and Western medicine groups were superior to the western medicine treatment group, and the difference was statistically significant (P < 0.05). (4) after the drug treatment, the laboratory indexes were obvious. There was significant difference between the Chinese and Western medicine group before and after treatment (P < 0.05), and the difference in the two groups after treatment was statistically significant (P < 0.05). 5. After treatment, there were no obvious adverse reactions and side effects in the two groups, and the safety indexes were also not abnormal.
2 test results (1) the expression of TGF- beta 1, MCP-1, RANTES mRNA in 52 SSc patients and healthy subjects was (1.95 + 1.58), (0.98 + 0.63) and (1.33 + 0.81), respectively higher than that of the healthy control group (1.10 + 0.54), (0.90 + 0.25), and the difference was statistically significant (P < p). Secondly, the expression level and SSc disease were further analyzed. It was found that the group of C reactive protein in the group with high RQ value was higher than that of the low RQ value group, and the difference was statistically significant (P < 0.05), the complement C3, C4, the positive rate of anti nuclear antibody, the positive rate of anti Scl-70 antibody, the positive rate of anti Jo-1 antibody and pulmonary interstitial fibrosis were higher than the low expression of RQ value in the group of RQ (P), but the difference was not statistically significant (P) > 0.05); (3) comparing the TGF and chemokine difference between the two groups before and after treatment, it was found that the two groups were able to reduce their expression after 8 weeks of treatment, but the Chinese and Western medicine group was better than the western medicine group, and the difference was statistically significant (P < 0.05), while the difference of TGF- beta 1 was not statistically significant before and after treatment in the two groups (P > 0.05).
Conclusion: 1 the treatment of systemic sclerosis with prednisone acetate and warming yang in combination with prednisone acetate is effective in improving and controlling skin sclerosis, joint pain and erythrocyte sedimentation rate, and has good safety. 2. the expression of TGF- (MCP-1, RANTES) and mRNA expression in peripheral blood mononuclear cells (PBMC) of SSc patients Up regulation can promote the occurrence and progress of SSc; 3 the treatment of SSc with prednisone acetate and warm yang activating blood circulation method may play a role by inhibiting the expression of MCP-1 (RANTES), which inhibits the expression of MCP-1, and the expression of RANTES may be one of the mechanisms of anti fibrosis.
【学位授予单位】：湖北民族学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.51

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