[1]王笑青,张依山,王庆丰,等.滋阴益骨方在类风湿关节炎合并骨质疏松症肝肾不足证治疗中的应用及作用机制研究[J].中医正骨,2021,33(11):13-17.
　WANG Xiaoqing,ZHANG Yishan,WANG Qingfeng,et al.A clinical study of oral application of Ziyin Yigu Fang(滋阴益骨方)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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滋阴益骨方在类风湿关节炎合并骨质疏松症肝肾不足证治疗中的应用及作用机制研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年11期
页码:
13-17
栏目:
临床研究
出版日期:
2021-11-20

文章信息/Info

Title:
A clinical study of oral application of Ziyin Yigu Fang(滋阴益骨方)to treatment of rheumatoid arthritis and liver-kidney deficiency type osteoporosis and its mechanism of action
作者:
王笑青; 张依山; 王庆丰; 张万义; 张丽丽; 柳维; 沙莎
(河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 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
关键词:
关节炎; 类风湿;  骨质疏松症;  滋阴益骨方;  肝肾不足;  核因子κB受体活化因子;  骨保护素;  临床试验
Keywords:
arthritis; rheumatoid;  osteoporosis;  Ziyin Yigu Fang;  liver-kidney deficiency;  receptor activator of nuclear factor-kappa B;  osteoprotegerin;  clinical trial
摘要:
目的:探讨滋阴益骨方在类风湿关节炎合并骨质疏松症肝肾不足证治疗中的应用价值及作用机制。方法:将符合要求的90例类风湿关节炎合并骨质疏松症肝肾不足证患者随机分为2组,每组45例,分别采用常规药物治疗(常规药物组)和滋阴益骨方联合常规药物治疗(滋阴益骨方组)。常规药物治疗采用口服甲氨蝶呤片、硫酸羟氯喹片、美洛昔康片和利塞膦酸钠片,其中甲氨蝶呤片,每周1次,每次10 mg; 硫酸羟氯喹片,每日2次,每次0.2 g; 美洛昔康片,每晚1次,每次15 mg; 利塞膦酸钠片,每周1次,每次5 mg; 均连续服用12周。滋阴益骨方水煎服,每日1剂,早晚2次服用,连续服用12周。治疗结束后比较2组患者的临床疗效,并分别于治疗前和治疗结束后记录并比较2组患者核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)和骨保护素(osteoprotegerin,OPG)血清含量。结果:①临床疗效。治疗结束后,常规药物组显效7例、有效22例、无效16例,滋阴益骨方组显效14例、有效26例、无效5例; 滋阴益骨方组的临床疗效优于常规药物组(Z=-2.762,P=0.006)。②OPG血清含量。治疗前2组患者OPG血清含量比较,差异无统计学意义[(271.83±35.62)pg·mL-1,(274.36±31.23)pg·mL-1,t=-0.174,P=0.864]; 治疗结束后,常规药物组OPG血清含量低于滋阴益骨方组[(343.28±29.67)pg·mL-1,(396.81±27.73)pg·mL-1,t=-12.201,P=0.000],2组患者OPG血清含量均高于治疗前(t=-12.817,P=0.000; t=-42.566,P=0.000)。③RANKL血清含量。治疗前2组患者RANKL血清含量比较,差异无统计学意义[(177.34±22.63)pg·mL-1,(179.61±20.06)pg·mL-1,t=-0.286,P=0.776]; 治疗结束后,常规药物组RANKL血清含量高于滋阴益骨方组[(141.25±22.37)pg·mL-1,(111.42±23.57)pg·mL-1,t=19.304,P=0.000],2组患者RANKL血清含量均低于治疗前(t=12.125,P=0.000; t=28.387,P=0.000)。结论:对于类风湿关节炎合并骨质疏松症肝肾不足证患者,在口服常规药物的基础上联合口服滋阴益骨方,疗效确切。其作用机制可能是通过提高OPG血清含量和降低RANKL血清含量,抑制破骨细胞活性,从而减少骨量丢失,延缓疾病进展。
Abstract:
Objective:To explore the applied values and mechanism of action(MoA)of oral application of Ziyin Yigu Fang(滋阴益骨方,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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备注/Memo

备注/Memo:
基金项目:洛阳市科技计划项目(1503004A-4)
更新日期/Last Update: 1900-01-01