CAJ | 학술논문

目的：初步探讨白芍总苷胶囊（TGP）治疗非活动期强直性脊柱炎（AS）的机制。方法选择38例非活动期的 AS 患者，分别采用非甾体抗炎药（NSAID）、NSAID 加 TGP、TGP 治疗，同时纳入15名健康体检者作对照。于基线期、用药24周后检测其 CRP、ESR、ALT、AST、血尿素氮、血清肌酐浓度，记录视觉模拟评分（VAS）、巴氏 AS 病情活动指数（BASDAI）、巴氏 AS 功能指数（BASFI）、AS 疾病活动指数（ASDAS），逆转录 PCR 检测外周血 Toll 样受体-4（TLR-4）、TLR-5、髓样分化因子 MYD88、TNF 受体相关因子6（TRAF6）mRNA 的表达，液相芯片仪检测血清 TNF-α、IL-17α、转化生长因子-β1（TGF-β1）浓度。结果治疗期间3组 AS 患者复发率比较差异无统计学意义，用药24周后3组组间临床评分及炎症指标无明显变化（P 均＞0.05）。治疗前3组 AS 患者 TLR-4、TLR-5 mRNA 表达水平较健康对照组升高（P ＜0.05）。用药24周后合并用药组 TLR-4 mRNA、TLR-5 mRNA 表达降低（P ＜0.05），单用 TGP 组 TLR-5 mRNA 表达降低（P ＜0.05）。3组 AS 患者基线期血清 TNF-α、IL-17α、TGF-β1浓度较健康对照组升高（P ＜0.05），用药24周后，各组 AS 患者血清 TNF-α、IL-17α浓度下降（P ＜0.05）。结论TGP 对非活动期 AS 有治疗前景，其作用机制可能为下调相关炎症因子及调控 TLR-4、TLR-5介导的炎症反应。
목적：초보탐토백작총감효낭（TGP）치료비활동기강직성척주염（AS）적궤제。방법선택38례비활동기적 AS 환자，분별채용비치체항염약（NSAID）、NSAID 가 TGP、TGP 치료，동시납입15명건강체검자작대조。우기선기、용약24주후검측기 CRP、ESR、ALT、AST、혈뇨소담、혈청기항농도，기록시각모의평분（VAS）、파씨 AS 병정활동지수（BASDAI）、파씨 AS 공능지수（BASFI）、AS 질병활동지수（ASDAS），역전록 PCR 검측외주혈 Toll 양수체-4（TLR-4）、TLR-5、수양분화인자 MYD88、TNF 수체상관인자6（TRAF6）mRNA 적표체，액상심편의검측혈청 TNF-α、IL-17α、전화생장인자-β1（TGF-β1）농도。결과치료기간3조 AS 환자복발솔비교차이무통계학의의，용약24주후3조조간림상평분급염증지표무명현변화（P 균＞0.05）。치료전3조 AS 환자 TLR-4、TLR-5 mRNA 표체수평교건강대조조승고（P ＜0.05）。용약24주후합병용약조 TLR-4 mRNA、TLR-5 mRNA 표체강저（P ＜0.05），단용 TGP 조 TLR-5 mRNA 표체강저（P ＜0.05）。3조 AS 환자기선기혈청 TNF-α、IL-17α、TGF-β1농도교건강대조조승고（P ＜0.05），용약24주후，각조 AS 환자혈청 TNF-α、IL-17α농도하강（P ＜0.05）。결론TGP 대비활동기 AS 유치료전경，기작용궤제가능위하조상관염증인자급조공 TLR-4、TLR-5개도적염증반응。
Objective To preliminarily discuss the effect and underlying mechanism of total gluco-sides of paeony (TGP)in treatment of patients with inactive ankylosing spondylitis (AS).Methods Thirty-eight AS patients were enrolled in this clinical trial.They were divided into NSAID,NSAID plus TGP and TGP groups.Fifteen healthy subjects were selected as normal controls.At baseline level and 24 weeks after treat-ment,BASDAI,VAS,BASFI and ASDAS scores were recorded,serum CRP,ESR,ALT,AST,BUN,CRE-AT were measured,the expression of peripheral TLR-4,TLR-5,TRAF6,Myd88mRNA was detected by RT-PCR and the serum TNF-α,IL-1 7αand TGF-β1 were measured by liquid chip assay.Results The recurrence rate among three groups did not significantly differ (BASDAI≥4 as recurrence standard)during the course of treatment.Clinical assessment score and serum CRP,ESR,BUN,ALT,AST and CREAT did not significantly change after 24-week treatment (P >0.05).Patients with AS had significantly higher baseline levels of TLR-4mRNA and TLR-5mRNA compared with healthy counterparts (P <0.05).After 24-week treatment,patients receiving NSAID plus TGP had a significantly decreased level of TLR-4mRNA and TLR-5mRNA (P <0.05).Patients in the TGP group had a declined level of TLR-5mRNA alone (P <0.05).The serum levels of TNF-α, IL-1 7αand TGF-β1 in AS patients were significantly elevated compared with healthy subjects after 24-week therapy (all P <0.05).In all groups,the expression of TNF-αand IL-1 7αwas significantly down-regulated following 24-week treatment (P <0.05).Conclusions TGP is of potential for treating inactive AS,and the underlying mechanism of down-regulating relevant inflammatory factors and blocking TLR-4 /5 signal pathway may be employed.