| 1 ObjectiveTo observe the changes of complement, complement regulatory proteins, cytokines, quality of life, anxiety and depression in patients with systemic lupus erythematosus,and the intervention effect of strengthening the spleen and complement the kidney,from the point of complement and complement regulatory proteins to further explore the possible effect mechanism of strengthening the spleen and complement the kidney intervene SLE. 2 Methods 2.1 Theoretical researchTo analysis of the relationship between the complement system in SLE disease and the TCM deficiency of spleen and kidney, summary of TCM etiology and pathogenesis in the disease of the complement system in SLE by a large amount of literature research, in oder to interpretation of the basic theoretical for the disease of the complement system with SLE from the treatment of spleen and kidney. 2.2 Clinical research 2.2.1 Changes and correlation of laboratory indexes with the disease of the complement system in SLEALL the 20 health people were selected from the First Affiliated Hospital of Anhui University of Chinese medicine. The general data of age, sex were matched with SLE group, all of them were healthy, without obvious organic disease. The expression of complement regulatory protein CD59 and CD55 in peripheral blood were detected by flow cytometry(FCM) in healthy control group and SLE patients. The changes of TNF-?, IFN-? and anti-C1 q were detected by enzyme-linked immunosorbent assay(ELISA) in healthy control group and SLE patients. Using automatic blood analyzer were measured in patients with SLE and healthy red blood cells, white blood cells, hemoglobin, platelet index. Using the “Westergren method” measure ESR levels of healthy people and patients with SLE. Using automatic biochemical analyzer Creactive protein were measured in patients with SLE and healthy, immunoglobulin A, immunoglobulin G, immunoglobulin M, complement C3, complement C4, urine albumin and urine ?2-microglobulin, general laboratory indicators 24 h urinary protein quantitation.Statistical analysis was performed using SPSS17.0 software. 2.2.2 The effect of clinical curative effect, related laboratory indexes and quality of life from the TCM of strengthening the spleen and complement the kidney intervene the SLE.According to the random number table, the 60 cases of SLE patients were divided into study group(strengthening the spleen and complement the kidney+ hydroxychloroquine sulfate+Prednisone Acetate) and control group(hydroxychloro quine sulfate+Prednisone Acetate), 30 cases in each group. Observe the effect of the quality of life, anxiety depression, TCM symptoms integral, disease activity a nd complement regulatory proteins CD55, CD59, complement C3, C4, anti-C1 q a ntibody and related laboratory parameters of improvement by SF-36,SAS,SDS, Qu antitative criteria for symptom classification of Chinese Medicine,SLEDAI and rel ated experiment method in the two groups before and after treatment. 3 Results 3.1 The results of theoretical research 3.1.1 The complement system plays an important role in the pathogenesis of SLE; 3.1.2 The TCM symptoms of " Spleen and Kidney Deficiency" is due to the complement system disorders; 3.1.3 The TCM pathogenesis of SLE involves "Spleen and Kidney Deficiency "; 3.1.4 The method of strengthening the spleen and complement the kidney is one of the TCM key treatment of SLE. 3.2 The results of clinical research 3.2.1 The changes of peripheral blood complement regulatory protein CD55 and CD59 in SLEThe SLE group of peripheral blood complement regulatory protein CD55 and CD59 were significantly lower than that of the control group, the difference was statistically significant(P <0.01). 3.2.2 The changes of serum complement C3, C4 and anti C1 q antibody in SLEThe SLE patients with C3, C4 were lower than the healthy control group, the difference was statistically significant(P<0.01), anti C1 q antibody was higher than the healthy control group, the difference was statistically significant(P<0.01). 3.2.3 The changes of urinary albumin, urinary beta 2 micro albumin and 24 h urinary protein in SLEThe urine micro albumin, urinary beta 2 micro albumin and 24 h urinary protein in SLE patients were significantly higher than those in healthy control group, and the difference was statistically significant(P<0.01). 3.2.4 The changes of serum cytokine TNF-? and IFN-? in SLEThe serum level of cytokine TNF-? and IFN-? in SLE group was significantly higher than that in healthy control group, and the difference was statistically significant(P<0.01). 3.2.5 The changes of blood analysis indexes(RBC, WBC, HGB, PLT) in SLEThe blood analysis index(RBC, WBC, HGB, PLT) of SLE patient was significantly lower than that in the healthy control group, the difference was statistically significant(P<0.01). 3.2.6 The changes of blood immunology indexes(ESR, CRP, Ig G, Ig A, Ig M) in SLEThe blood immunology indexes(ESR, CRP, Ig G, Ig A, Ig M,) of SLE patients was significantly higher than that in the healthy control group, the difference was statistically significant(P<0.01 or P<0.05). 3.2.7 The changes of anxiety and depression in SLE groupThe SLE patients with anxiety and depression self rating scores were higher than the healthy control group, the difference was statistically significant(P <0.01). 3.2.8 The correlation of peripheral blood complement regulatory protein CD55, CD59 and various parameters in SLE(1) Correlation analysis of peripheral blood complement regulatory protein CD55, CD59 and complement C3, C4 and anti C1 q antibody in patients with SLECorrelation analysis showed that SLE patients erythrocyte complement regulatory protein CD55 and complement C3 and C4 levels were positively correlated(P < 0.05), and anti-C1 q antibody level was negatively correlated(P < 0.05); red blood cell complement regulatory protein CD59 and complement C3 and C4 levels were positively correlated(P < 0.01), and anti-C1 q antibody levels were negative correlation(P < 0.05); granulocyte complement regulatory protein CD55 and the level of C3 and C4 levels of positive and negative correlation(P < 0.05 or P < 0.01), and anti-C1 q antibody levels were negative correlation(P < 0.05); granulocyte complement regulatory protein CD59 and complement C3 and C4 levels were positively correlated(P < 0.05), and anti-C1 q antibody levels were negative correlation(P < 0.05).(2) Correlation analysis of peripheral blood complement regulatory protein CD55, CD59 and urinary micro albumin, urinary beta 2 micro albumin and 24 h urinary protein in patients with SLECorrelation analysis showed that SLE patients erythrocyte complement regulating protein CD55 level and urinary albumin, urine beta 2 microspheres protein and 24 h urinary protein was negative correlation(P < 0.05); erythrocyte complement regulatory protein CD59 and urine beta 2 microglobulin showed a negative correlation(P < 0.05); granulocyte complement regulating proteins CD55 levels and urinary micro albumin and urine beta 2 microspheres protein showed a negative correlation(P < 0.05 or P < 0.01); granulocyte complement regulating protein CD59 and urinary albumin, urine beta 2 microspheres protein and 24 h urine protein was negatively correlated(P < 0.05).(3) Correlation analysis of peripheral blood complement regulatory protein CD55, CD59 and blood analysis indexes in patients with SLECorrelation analysis showed that SLE patients erythrocyte complement regulatory protein CD55 and RBC levels were positively correlated(P < 0.01); erythrocyte complement regulatory protein CD59 and RBC levels were positively correlated(P < 0.01); granulocyte complement regulatory protein CD55 level and WBC levels were positively related(P < 0.05); granulocyte complement regulatory protein CD59 and WBC levels were positively related(P < 0.05).(4) Correlation analysis of peripheral blood complement regulatory protein CD55, CD59 and serum immunological indexes in SLECorrelation analysis showed that SLE patients erythrocyte complement regulating protein CD55 and ESR, CRP, Ig G, SLEDAI was negative correlation(P < 0.05 or P < 0.01); complement regulatory protein CD59 and ESR, CRP, Ig G, SLEDAI was negative correlation(P < 0.05 or P < 0.01); granulocyte complement regulating protein CD55 and ESR, CRP, Ig G, SLEDAI was negative correlation(P < 0.05 or P < 0.01); granulocyte complement regulating protein CD59 and ESR, CRP, Ig G, SLEDAI was negatively correlated(P < 0.05 or P < 0.01).(5) Correlation analysis of peripheral blood complement regulatory protein CD55, CD59 and serum cytokines TNF-? and IFN-? in SLECorrelation analysis showed that SLE patients erythrocyte complement regulation protein CD55, CD59 and cytokines TNF-? and IFN-? levels were not correlated; granulocyte fill body regulating protein CD55,CD59 and cytokines TNF-? and IFN-? levels were not correlated. 3.2.9 The effect of clinical curative effect and related laboratory indexes from the TCM of strengthening the spleen and complement the kidney combine with western medicine intervene the SLE.strengthening the spleen and complement the kidney combined with western medicine can significantly reduce Ig G, Ig A, ESR, CRP, anti C1 q antibodies, urinary micro albumin, urine beta 2 micro albumin, elevated WBC, RBC, PLT, Ig M, C3, C4 indicators,serum cytokine TNF-? and IFN-?; At the same time, it can significantly increase the peripheral blood complement regulatory protein CD55, CD59 and it can also improve SLE patients' quality of life score, TCM symptom score, anxiety and depression scale integration,also significantly reduced disease activity(SLEDAI) score in patients with SLE; There was no significant difference between the effect of strengthening the spleen and complement the kidney combine with western medicine and simple western medicine on the improvement of some laboratory indexes, but it was superior to the simple western medicine group in improving TCM symptom score, life quality score and complement system and so on. And there was no obvious adverse drug reaction of strengthening the spleen and complement the kidney combine with western medicine, it suggested that the comprehensive function of strengthening the spleen and complement the kidney combine with western medicine is better than western medicine alone. 4 Conclusion 4.1 The incidence of SLE is closely related to the complement system. 4.2 The SLE peripheral blood complement regulating proteins CD55, CD59 level were closely related with blood analysis indexes of RBC, WBC, HGB, PLT, complement system damage indicators complement C3, C4 and anti-C1 q antibody,early renal damage index of urinary albumin, urine beta 2 microglobulin were and 24 h urinary protein, serum immune learning index, ESR, CRP, Ig G, Ig A, Ig M, serum cytokines TNF-? and IFN-?, it suggested that complement system is involved in the pathogenesis of systemic lupus erythematosus and aggravate the symptoms and signs of the patients. 4.3 The strengthening the spleen and complement the kidney combine with western medicine can significantly increase the complement C3, C4 and complement regulatory protein CD55, CD59 in patients with SLE, reducing the level of complement system such as anti C1 q antibody, lower indicators of early renal damage of urinary albumin, urinary beta 2 micro albumin and the levels of serum immune indexes of CRP, ESR, Ig G, Ig M, reducing the content of cytokine IFN-?, elevated indicators of blood levels of HGB, PLT, which curative effect is better than that of simple western medicine group. 4.4 The health survey of each dimension points were down and accompanied by anxiety and depression in SLE,it show that the quality of life significantly decreased in SLE. 4.5 The clinical efficacy can be significantly improved by the strengthening the spleen and complement the kidney combine with western medicine in SLE, and also can reduce the TCM symptoms integral value in Shenpi tired body, lusterless complexion, palpitation and shortness of breath, less gas lazy words, Yaoxisuanruan, dizziness, tinnitus, aversion to cold, anorexia and abnormal stools, which curative effect is better than that of simple western medicine group. 4.6 It can reduce the anxiety and depression scores in SLE patients by the strengthening the spleen and complement the kidney combine with western medicine, it can improve the quality of life, anxiety and depression scores in SLE, which curative effect is better than that of simple western medicine group. 4.7 The pathogenesis of SLE is related to the disorder of the complement system, at the same time, it also was related to the expression of complement regulatory protein CD55,CD59, the effective mechanism of the the strengthening the spleen and complement the kidney combine with western medicine in the treatment of SLE includes immune anti-inflammatory effect, regulating the content of complement, complement regulatory protein and cytokine, improving the body metabolism, enhancing immune function, relieving clinical symptoms, improving the level of quality of life, reducing anxiety and depression. |
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