| Objective:To treat patients with active rheumatoid arthritis by applying heat-clearing,de humidification,removing blood stasis and detoxification method.To detect changes in rel ated cytokines before and after treatment,and indirectly speculate on the regulation of i mmune balance in patients.It provides a reference treatment for clinical diagnosis and tre atment of rheumatoid arthritis,and provides a basis for further research on its specific m echanism.Methods:A total of 57 patients with active rheumatoid arthritis were enrolled,and basic data,four diagnostic information,and laboratory tests were collected.Through clinical ra ndomized controlled trials,the clinical efficacy of this prescription in the treatment of rh eumatoid arthritis was observed,including the number of joint swolling,the number of j oint tenderness,DAS28 score,VAS score,TCM syndrome score,ESR,CRP and RF,bef ore and after treatment.The overall clinical efficacy was evaluated according to the TC M syndrome evaluation criteria and the ACR20/50/70 criteria.At the same time,the cha nges of this serum-related cytokine levels in the treatment group and the observation gro up were observed by ELISA,including IL-4,IL-6,IFN-?,IL-10,IL-17.TNF-?,the ratio s of IFN-y/IL-4 and IL-17/IL-10 before and after treat:ment were further compared.Finall y,the results of two parts of the study were combined to analyze the clinical effects an d the effects on cytokines of this method on the active phase of RA.Results:The study included 54 patients with active RA,including 12 male patients and 42 female patients.The age of onset was mainly in the range of 21-73 years,and the d uration of disease ranged from 1-240 months.The baseline was no statistical difference b etween the two groups before the treatment,including general data,clinical indicators an d cytokine(P>0.05),and it's comparable.1.After 12 weeks of treatment,the number of joint pain in the treatment group co mb:ined with heat-clearing,dehumidification,removing blood stasis and detoxification met hod was(3.26±1.43),the number of joint swolling was(0.851±0.82),and the VAS score was(20.56±6.41).Compared with the conventional western medicine group,the number of joint pain(4.52±2.14),joint swelling(1.78±1.25)and VAS score(22.78±6.98).And th e difference in joint pain and joint swolling was statistically significant(P<0.05).In parti cular,there was a significant difference in the number of joint swolling(P<0.01),but the re was no statistical difference between the two groups in the VAS score(P>0.05).2.After 12 weeks of treatment,the HAQ score of the treatment group combined wi th heat-clearing,dehumidification,removing blood stasis and detoxification method was(4.44±1.12).and the DAS28 score was(3,40±0.68).Compared with the conventional Wes tern medicine group,the HAQ score(5.52±2.33)and DAS28 scores(3.91±0.80).and the differences were statistically significant(P<0.05).3.In terms of TCM syndrome scores,the total score of the treatment group after tr eatment was(4.11±2.03),which was significantly lower than that of the control group(6.37±2.15).The difference was statistically significant(P<0 05).Further analysis Single-poin t scores showed statistically significant differences in joint pain,joint swolling,flexion an d extension,and morning stiffness,respectively(P<0.05),especially in joint pain and joi nt swolling scores,the difference was statistically significant(P<0.01).In the four points:joint tenderness,local joint fever,weak waist and knee and dark red tongue,the differe nce between the two groups after treatment did not reach statistical significance(P>0.05).4.In terms of ESR,CRP and RF,after treatment for 12 weeks,the ESR of the tre atment group was(17.11±7.76),CRP was(4.88(2.53,7-63)),and RF was(58.0(21.5,120.0)),were lower than the control group ESR(23.93±14.27),CRP(7.37(4.81,11.30))a nd RF(98.0(28.0,144.0)).And the difference of ESR and CRP was statistically signific ant(P<0.05).There was no significant difference between the two groups in RF(P>0.05).5.In terms of cytokines,combined with traditional Chinese medicine treatment grou p,IL-6(0.28(0.23,0.33)),IL-17(0.92(0.78,1.11)),IFN-?(4.93(3.37,6.03))and TNF-a(18.63(17.54,20.46))was lower than the control group IL-6(0.36(0.28,0.47)),IL-17(1.29(0.98,1.75)),IFN-?(5.87(4.42,7.13)).and TNF-a(21.06(19.16,26.56))levels.IL-10(33.68(31.52,39.49))was higher in the treatment group than in the control group(29.30(25.09,34.44)).There were significant differences in IL-6,IL-10,IL-17,IFN-y a nd TNF-a between the two groups(P<0 05),especially the difference of IL-17 was signi ficant(P<0.01),but there was no statistical difference between the two groups in IL-4(P>0.05).6.In terms of immune balance,IFN-y/IL-4(0.157±0.063)and IL-17/IL-10(0.028±0.010)were lower in the combined Chinese medicine treatment group than in the control group IFN-y/IL-4(0.200±0.095),IL-17/IL-10(0.047±0.020),there was a statistically signif icant difference between the two groups in the difference of IL-17/IL-10(P<0.01),while in IFN-y/IL-4,there was no significant difference between the two groups(P>0.05).7.In terms of overall efficacy,the total effective rate of TCM syndromes in the tre atment group combined with Chinese medicine was 92.6%,and the total effective rate in the control group was 74.1%.The difference between the two groups was statistically si gnificant(P<0.01).After treatment,the remission rates of ACR20,ACR50,and ACR70 i n the treatment group were 85,2%,44.4%,and 3.7%,respectively.The remission rates of ACR20,ACR50,and ACR70 in the treatment group were 70.4%,22.2%,and 0.0%,res pectively.The differences in the three groups of remission rates did not reach statistical significance(P>0.05).8.In terms of safety observation,there were 3 cases of gastrointestinal discomfort i n the treatment group,2 cases of gastrointestinal discomfort,and 2 cases of liver enzym es increased slightly,and improved after symptomatic treatment in the control group.No serious adverse reactions were observed in either group.Conclusion:The key to the pathogenesis of active RA is the damp heat and toxin stasis.The clinical efficacy of the treatment of RA during the active period of heat-clearing,d ehumidification,removing blood stasis and detoxification method is more obvious,can imp rove clinical remission rate,can better reduce the level of related pro-inflammatory factor s,increase the level of anti-inflammatory factors,and may regulate immune balance.It is worth for further clinical researching. |
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