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[1]王笑青,張依山,王慶豐,等.滋陰益骨方在類風(fēng)濕關(guān)節(jié)炎合并骨質(zhì)疏松癥肝腎不足證治療中的應(yīng)用及作用機(jī)制研究[J].中醫(yī)正骨,2021,33(11):13-17.
　WANG Xiaoqing,ZHANG Yishan,WANG Qingfeng,et al.A clinical study of oral application of Ziyin Yigu Fang(滋陰益骨方)to treatment of rheumatoid arthritis and liver-kidney deficiency type osteoporosis and its mechanism of action[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(11):13-17.
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滋陰益骨方在類風(fēng)濕關(guān)節(jié)炎合并骨質(zhì)疏松癥肝腎不足證治療中的應(yīng)用及作用機(jī)制研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年11期
頁(yè)碼:
13-17
欄目:
臨床研究
出版日期:
2021-11-20

文章信息/Info

Title:
A clinical study of oral application of Ziyin Yigu Fang(滋陰益骨方)to treatment of rheumatoid arthritis and liver-kidney deficiency type osteoporosis and its mechanism of action
作者:
王笑青; 張依山; 王慶豐; 張萬(wàn)義; 張麗麗; 柳維; 沙莎
(河南省洛陽(yáng)正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽(yáng) 471002)
Author(s):
WANG Xiaoqing; ZHANG Yishan; WANG Qingfeng; ZHANG Wanyi; ZHANG Lili; LIU Wei; SHA Sha
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
關(guān)節(jié)炎; 類風(fēng)濕;  骨質(zhì)疏松癥;  滋陰益骨方;  肝腎不足;  核因子κB受體活化因子;  骨保護(hù)素;  臨床試驗(yàn)
Keywords:
arthritis; rheumatoid;  osteoporosis;  Ziyin Yigu Fang;  liver-kidney deficiency;  receptor activator of nuclear factor-kappa B;  osteoprotegerin;  clinical trial
摘要:
目的:探討滋陰益骨方在類風(fēng)濕關(guān)節(jié)炎合并骨質(zhì)疏松癥肝腎不足證治療中的應(yīng)用價(jià)值及作用機(jī)制。方法:將符合要求的90例類風(fēng)濕關(guān)節(jié)炎合并骨質(zhì)疏松癥肝腎不足證患者隨機(jī)分為2組,每組45例,分別采用常規(guī)藥物治療(常規(guī)藥物組)和滋陰益骨方聯(lián)合常規(guī)藥物治療(滋陰益骨方組)。常規(guī)藥物治療采用口服甲氨蝶呤片、硫酸羥氯喹片、美洛昔康片和利塞膦酸鈉片,其中甲氨蝶呤片,每周1次,每次10 mg; 硫酸羥氯喹片,每日2次,每次0.2 g; 美洛昔康片,每晚1次,每次15 mg; 利塞膦酸鈉片,每周1次,每次5 mg; 均連續(xù)服用12周。滋陰益骨方水煎服,每日1劑,早晚2次服用,連續(xù)服用12周。治療結(jié)束后比較2組患者的臨床療效,并分別于治療前和治療結(jié)束后記錄并比較2組患者核因子κB受體活化因子配體(receptor activator of nuclear factor-κB ligand,RANKL)和骨保護(hù)素(osteoprotegerin,OPG)血清含量。結(jié)果:①臨床療效。治療結(jié)束后,常規(guī)藥物組顯效7例、有效22例、無(wú)效16例,滋陰益骨方組顯效14例、有效26例、無(wú)效5例; 滋陰益骨方組的臨床療效優(yōu)于常規(guī)藥物組(Z=-2.762,P=0.006)。②OPG血清含量。治療前2組患者OPG血清含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(271.83±35.62)pg·mL-1,(274.36±31.23)pg·mL-1,t=-0.174,P=0.864]; 治療結(jié)束后,常規(guī)藥物組OPG血清含量低于滋陰益骨方組[(343.28±29.67)pg·mL-1,(396.81±27.73)pg·mL-1,t=-12.201,P=0.000],2組患者OPG血清含量均高于治療前(t=-12.817,P=0.000; t=-42.566,P=0.000)。③RANKL血清含量。治療前2組患者RANKL血清含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(177.34±22.63)pg·mL-1,(179.61±20.06)pg·mL-1,t=-0.286,P=0.776]; 治療結(jié)束后,常規(guī)藥物組RANKL血清含量高于滋陰益骨方組[(141.25±22.37)pg·mL-1,(111.42±23.57)pg·mL-1,t=19.304,P=0.000],2組患者RANKL血清含量均低于治療前(t=12.125,P=0.000; t=28.387,P=0.000)。結(jié)論:對(duì)于類風(fēng)濕關(guān)節(jié)炎合并骨質(zhì)疏松癥肝腎不足證患者,在口服常規(guī)藥物的基礎(chǔ)上聯(lián)合口服滋陰益骨方,療效確切。其作用機(jī)制可能是通過(guò)提高OPG血清含量和降低RANKL血清含量,抑制破骨細(xì)胞活性,從而減少骨量丟失,延緩疾病進(jìn)展。
Abstract:
Objective:To explore the applied values and mechanism of action(MoA)of oral application of Ziyin Yigu Fang(滋陰益骨方,ZYYGF)in treatment of rheumatoid arthritis(RA)and liver-kidney deficiency type osteoporosis(OP).Methods:Ninety patients with RA and liver-kidney deficiency type OP were enrolled in the study and were randomly divided into conventional medication group and ZYYGF group,45 cases in each group.The patients in conventional medication group were treated with oral applications of methotrexate(MTX)tablets(once a week,10 mg at a time),hydroxychloroquine(HCQ)sulfate tablets(twice a day,0.2 g at a time),meloxicam tablets(once every night,15 mg at a time)and risedronate sodium(RS)tablets(once a week,5 mg at a time)for consecutive 12 weeks; while the ones in ZYYGF group with oral applications of MTX tablets,HCQ sulfate tablets,meloxicam tablets,RS tablets and ZYYGF decoctions(one dose a day in the morning and evening respectively)for consecutive 12 weeks.The clinical curative effects were compared between the 2 groups after the end of the treatment.The serum levels of receptor activator of nuclear factor-κB ligand(RANKL)and osteoprotegerin(OPG)were recorded and compared between the 2 groups before the treatment and after the end of the treatment respectively.Results:①After the end of the treatment,7 patients got a good result,22 fair and 16 poor in conventional medication group; while 14 patients got a good result,26 fair and 5 poor in ZYYGF group.The ZYYGF group surpassed conventional medication group in clinical curative effects(Z=-2.762,P=0.006).②There was no statistical difference in serum level of OPG between the 2 groups before the treatment(271.83±35.62 vs 274.36±31.23 pg/mL,t=-0.174,P=0.864).The serum level of OPG was lower in conventional medication group compared to ZYYGF group after the end of the treatment(343.28±29.67 vs 396.81±27.73 pg/mL,t=-12.201,P=0.000),and increased in the 2 groups after the end of the treatment compared to pre-treatment(t=-12.817,P=0.000; t=-42.566,P=0.000).③There was no statistical difference in serum level of RANKL between the 2 groups before the treatment(177.34±22.63 vs 179.61±20.06 pg/mL,t=-0.286,P=0.776).The serum level of RANKL was higher in conventional medication group compared to ZYYGF group after the end of the treatment(141.25±22.37 vs 111.42±23.57 pg/mL,t=19.304,P=0.000),and decreased in the 2 groups after the end of the treatment compared to pre-treatment(t=12.125,P=0.000; t=28.387,P=0.000).Conclusion:Oral applications of conventional medications combined with ZYYGF has reliable curative effects in treatment of RA and liver-kidney deficiency type OP.It can inhibit osteoclast activity through increasing the serum level of OPG and decreasing the serum level of RANKL,which may be the MoA for reducing the bone loss and delaying the disease progression.

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基金項(xiàng)目:洛陽(yáng)市科技計(jì)劃項(xiàng)目(1503004A-4)
更新日期/Last Update: 1900-01-01