| 1.ObjectiveTo research changes of XFC on rheumatoid arthritis patients,the factors on serum markers of bone metabolism,OPG/RANKL/RANK,inflammatory/suppression of inflammatory cytokines and related laboratory parameters.To study the effect of XFC on serum markers of bone metabolism in patients of RA.Clarify the correlation between OPG/RANKL/RANL system and RA.Investigate the mechanism of XFC in the treatment of RA with abnormality of bone metabolism.2.Methods2.1 Theoretical researchThrough a large number of literature research,elaborate the relationship between spleen and kidney deficiency and osteoporosis treatment research progress from the spleen.The medical etiology and pathogenesis were summarized,and the theoretical study of RA patients combined with the treatment of the spleen on the treatment of osteoporosis was discussed.2.Clinical StudiesSelected 60 patients with rheumatoid arthritis in the First Affiliated Hospital of Anhui University of traditional Chinese medicine in the Department of Rheumatology.Then divide them into 2 groups by random number table.There were 30 patients in the treatment group and 30 in the control group,and selected 20 volunteers from the First Affiliated Hospital of Anhui University of traditional Chinese medicine health examination center as normal group.Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of PINP,BGP,CTX,OPG,RANKL,IL-1?,IL-17,IL-4,IL-6 and anti cyclic citrullinated peptide(CCP)antibody in serum of patients with RA.Measurement of bone mineral density of the femoral neck and lumbar vertebrae of RA patients by dual energy X-ray.Erythrocyte sedimentation rate(ESR)was detected using Westergren method.C-reactive protein and rheumatoid factor(RF)were detected using Hitachi 7060 automatic biochemical analyzer and liver and kidneyfunction were measured by automatic biochemical analyzer.DAS28 score in RA patients.The questionnaire was used to investigate the quality of life.To observe the effect of XFC on RA patients,serum bone metabolism index,OPG/RANKL/RANL system,disease activity index and quality of life,anxiety and depression.3.Results3.1 Theoretical Results3.1.1 OPG/RANKL/RANK system is an important pathway and link between the immune system and the regulation of bone.3.1.2 The role of inflammatory factors in RA-induced osteoporosis is a regulatory network,which is linked to the OPG/RANK/RANKL system.3.1.3 Always run through the spleen and kidney deficiency symptoms of osteoporosis in patients with RA disease.3.1.4 The treatment from the spleen is an important way to treat osteoporosis in RA patient.3.2 Clinical studies3.2.1 Study on the changes and correlation of serum indexes in RA patientsCompared with healthy control group,serum OPG and OPG/RANKL in group RA were significantly lower than those in healthy control group in RA group(P<0.01),and the levels of RANKL were higher than those of healthy controls(P<0.01).Compared with the healthy group,the levels of bone resorption markers CTX in RA patients were significantly higher than those in healthy controls,and the levels of PINP and BGP were lower than those of healthy controls(P<0.01).Compared with the healthy control group,the serum levels of IL-1??IL-17 and IL-6 in the RA group were higher than those in the healthy control group(P<0.01),and the levels of IL-4 were lower than those of healthy controls(P<0.01).The incidence of OP in RA patients was significantly higher than that in the healthy group,which was about 2.33 times that of the normal control group.The bone mineral density of the femoral neck and lumbar vertebrae in the RA group were significantlylower than that in the healthy group,and the incidence of bone density reduction was higher in the lumbar spine.The levels of age,course of disease,IL-1?,IL-17,IL-6,OPG,RANKL and OPG/RANKL were generally higher in the OP group of RA patients than in the non OP group(P<0.05 or P<0.01).The levels of ESR,CRP,RF,CCP,CTX,PINP and BGP in the group OP were higher than those in the non OP group,but the difference was not statistically significant(P>0.05).Correlation analysis showed that RANKL in serum of patients with RA were positively correlated with the course of disease(P<0.05).The CTX and OPG was negatively correlated with the course of disease(P<0.05).Correlation analysis showed that CTX,IL-6 and IL-17 was positively correlated with ESR,CRP,DAS28(P<0.05),and IL-1? and RANKL was positively correlated with ESR,CRP(P<0.05).Further analysis,The IL-1 ?,IL-6 and IL-17 was positively correlated with RANKL(P<0.05),and negatively correlated with OPG(P<0.05).The IL-4 was positively correlated with OPG(P<0.05),and negatively correlated with RANKL(P<0.05).Correlation analysis showed that the joint pain was positively correlated with CTX and RANKL(P<0.05);joint tenderness was positively correlated with CTX,RANKL and OPG(P<0.05);morning stiffness was positively correlated with CTX and RANKL(P<0.05).Correlation analysis showed that anorexia was negatively correlated with OPG(P<0.05),and RANKL was positively correlated(P<0.05);the joint weight was positively correlated with CTX and RANKL(P<0.05),and was negatively correlated with OPG in the study group(P<0.05).3.2.2 The effects of Xinfeng Capsule on the level of OPG?RANKL?OPG/RANKL in patients with RAThere was no significant difference in serum OPG?RANKL?OPG/RANKL levels between the two groups of patients with RA before treatment(P>0.05).Thelevels of serum OPG were significantly increased after treatment(P<0.01),and the level of RANKL was significantly decreased(P<0.01).Compared with the control group,the improvement of OPG in the treatment group was significantly better than that of the control group(P <0.05).After treatment,the reduction of RANKL in the treatment group was significantly better than that in the control group(P <0.05).3.2.3 The effects of Xinfeng Capsule on the level of inflammatory factors in patients with RAThere was no significant difference in serum IL-1?,IL-17,IL-6 and IL-4 levels between the two groups of patients with RA before treatment(P>0.05).The levels of serum IL-4 were significantly increased after treatment(P<0.01),and the level of IL-1?,IL-17 and IL-6 was significantly decreased(P<0.01).Compared with the control group,the level of IL-4 in the treatment group was significantly better than that of the control group(P < 0.05).The treatment group was significantly better than the control group in reducing IL-1?,IL-17 and IL-6 after treatment(P<0.05).3.2.4 The effects of Xinfeng Capsule on serum bone metabolic markers in patients with RAThere was no significant difference in serum PINP,CTX and BGP levels between the two groups of patients with RA before treatment(P>0.05).The levels of serum PINP and BGP were significantly increased after treatment(P<0.01),and the level of CTX was significantly decreased(P<0.01).Compared with the control group,the treatment group was obviously better than the control group in improving the level of PINP and BGP after treatment(P<0.05).The treatment group was obviously better than the control group in reducing CTX after treatment(P<0.05).3.2.5 The effects of Xinfeng Capsule on BMD in patients with RAThere was no significant difference in bone mineral density before and after treatment in the two groups of patients with RA.3.2.6 The effects of Xinfeng Capsule on the disease activity of rheumatoid arthritis patientsThere was no significant difference in CCP,CRP,ESR,RF and DAS28 between the two groups before treatment(P>0.05),the disease activity related indicators of RA patients were significantly reduced after treatment(P<0.05 or P<0.01).There was no significant difference in the reduction of CCP,CRP,ESR,RF and DAS28 levels between the treatment group and the control group(P>0.05).3.2.7 Clinical effect of Xinfeng Capsule on traditional Chinese medicine and its effect on bone metabolism in patients with rheumatoid arthritisCompared with the two groups,the total effective rate of the treatment group was86.3%,the total effective rate of the control group was 83.4%,there was no significant difference between the two groups(P>0.05),but the treatment group was significantly higher than the LEF group(P<0.01).3.2.8 The effects of Xinfeng Capsule on quality of life in patients with rheumatoid arthritisThere was no significant difference in quality of life and anxiety and depression scores before treatment(P>0.05).The scores of the two groups were both increased after treatment and the effect of the treatment group was significantly better than that of the control group(P<0.05).3.2.9 The effects of Xinfeng Capsule on traditional Chinese medicine syndrome in patients with rheumatoid arthritisTwo groups of patients with RA joint swelling,joint pain,joint pain,morning stiffness were significantly better after treatment(P<0.05),and there was no significant difference between the two groups(P>0.05).After treatment,the symptoms of spleen deficiency were significantly improved in the treatment group(P<0.05),While the control group patients with less gas lazy,anorexia symptoms did not improve significantly(P>0.05).The treatment group has obvious effect on improving the patients appetite loss,fatigue,less gas lazy words,loose stool symptoms(P<0.05).4.Conclusion4.1 Analysis of changes in OPG/RANKL/RANK system index,inflammatory factors and their correlation in RA patientsCompared with healthy control group,serum OPG and OPG/RANKL in group RA were significantly lower than those in healthy control group in RA group and the levels of RANKL were higher than those of healthy controls.Compared with the healthy group,the levels of bone resorption markers CTX in RA patients were significantly higher than those in healthy controls,and the levels of PINP and BGP were lower than those of healthy controls.Compared with the healthy control group,the serum levels of IL-1??IL-17 and IL-6 in the RA group were higher than those in the healthy control group and the levels of IL-4 were lower than those of healthy controls.The incidence of OP in RA patients was significantly higher than that in the healthy group,which was about 2.33 times that of the normal control group.The bone mineral density of the femoral neck and lumbar vertebrae in the RA group were significantly lower than that in the healthy group,and the incidence of bone density reduction was higher in the lumbar spine.Correlation analysis showed that RANKL in serum of patients with RA were positively correlated with the course of disease.The CTX and OPG was negatively correlated with the course of disease.The CTX is closely related to the degree of disease activity.The IL-1 ?,IL-6 and IL-17 was positively correlated with OPG/RANK/RANKL.4.2 Effect of XFC on the clinical efficacy and various indexes of RA patientsXFC has significant effect in treating RA,reducing disease activity and controlling the disease condition,improving joint symptoms,quality of life score,spleen deficiency symptoms,anxiety and depression of RA patients.Improve joint function,improve life treatment,and mental health status.XFC can reduce serum CTX,increase PINP and BGP,decrease IL-1 beta,IL-17 and 1L-6 levels,increase IL-4 level,increase OPG level and reduce RANKL level in RA patients.4.3 The possible mechanism of XFC in the treatment of RA patients with osteoporosisXFC may improve the osteoporosis of RA patients by regulating the balance of the network level of cytokines.XFC can regulate the level of inflammatory factors and reduce the bone resorption and bone destruction in RA patients by inhibiting the development of inflammation.XFC can increase the level of OPG,increase the activity of osteoblasts,reduce the level of RANKL,inhibit the activity of osteoclasts,increase bone formation and reduce bone loss. |
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