摘要
目的:探讨芪黄健脾滋肾颗粒治疗系统性红斑狼疮(SLE)的临床疗效及对信号转导及转录激活因子3/哺乳动物雷帕霉素靶蛋白(STAT3/m TOR)信号通路的影响,分析其可能作用机制。方法:选取安徽中医药大学第一附属医院2022年5月至2023年5月符合标准的SLE女性患者60例,随机分成对照组和观察组(每组各30例),对照组予以醋酸泼尼松+硫酸羟氯喹口服;观察组在对照组基础上予以芪黄健脾滋肾颗粒口服。连续治疗8周后,评估两组患者治疗前后SLE疾病活动度(SLEDAI)、中医证候积分,比较治疗前后血红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、免疫指标[免疫球蛋白G(Ig G)、C3、C4、CD4^(+)、CD8^(+)]、白细胞介素(IL)-17、IL-23、γ干扰素(IFN-γ)、24 h尿蛋白定量(24 h PRO)、血肌酐(SCr)、STAT3/m TOR通路相关因子[STAT3、磷酸化(p)-STAT3、m TOR蛋白和STAT3、m TOR m RNA]表达变化及不良反应情况。结果:经8周治疗后,观察组临床总有效率为93.33%(28/30),明显高于对照组临床总有效率的70.00%(21/30)(χ^(2)=4.007,P<0.05)。与本组治疗前比较,两组患者SLEDAI、中医证候积分、ESR、hs-CRP、Ig G、CD8^(+)、IL-17、IL-23、IFN-γ、24 h PRO、SCr和STAT3/m TOR通路相关因子表达均显著降低(P<0.01),C3、C4、CD4^(+)显著升高(P<0.01)。与对照组治疗后比较,观察组患者SLEDAI、中医证候积分、ESR、hs-CRP、Ig G、CD8^(+)、IL-17、IL-23、IFN-γ、24 h PRO、SCr和STAT3/m TOR通路相关因子表达均明显降低(P<0.05,P<0.01),C3、C4、CD4^(+)明显升高(P<0.05,P<0.01)。两组治疗前后均未出现严重不良反应。结论:芪黄健脾滋肾颗粒能有效改善SLE机体炎症反应,降低疾病活动度,改善肾损伤,其机制可能与抑制STAT3/m TOR信号通路调节免疫功能有关。
Objective:To investigate the clinical efficacy of Qihuang Jianpi Zishen Granules in the treatment of systemic lupus erythematosus(SLE)and its effect on the signal transducer and activator of tranSCription 3/mammalian target of rapamycin(STAT3/mTOR)signaling pathway,and to decipher the possible mechanism.Method:Sixty female SLE patients who met the criteria in the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2022 to May 2023 were selected and randomized into a control group and an observation group(30 cases in each group).The control group was treated with prednisone acetate+hydroxychloroquine sulfate orally,and the observation group was additionally treated with Qihuang Jianpi Zishen granules.The treatment lasted for 8 weeks.The SLE disease activity(SLEDAI),TCM syndrome score,erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),immune indexes[immunoglobulin G(IgG),C3,C4,CD4^(+),and CD8^(+)],interleukin(IL)-17,IL-23,interferon(IFN)-γ,24 h urinary protein(24 h PRO),serum creatinine(SCr),and expression of proteins[STAT3,phosphorylated(p)-STAT3,mTOR protein and STAT3,mTOR mRNA]in the STAT3/mTOR signaling pathway were determined before and after treatment.In addition,the adverse reactions were recorded.Result:After 8 weeks of treatment,the total response rate in the observation group was 93.33%(28/30),which was higher than that(70.00%,21/30)in the control group(χ^(2)=4.007,P<0.05).After treatment,both groups showed declined SLEDAI,TCM syndrome score,ESR,hs-CRP,IgG,CD8^(+),IL-17,IL-23,IFN-γ,24 h PRO,SCr,and expression of proteins in the STAT3/mTOR pathway(P<0.01)and elevated levels of C3,C4,and CD4^(+)(P<0.01).Moreover,the observation group had lower SLEDAI,TCM syndrome score,ESR,hs-CRP,IgG,CD8^(+),IL-17,IL-23,IFN-γ,24 h PRO,SCr,and expression of proteins in the STAT3/mTOR pathway(P<0.05,P<0.01)and higher levels of C3,C4,and CD4^(+)(P<0.05,P<0.01)than the control group after treatment.Neither group showed serious adverse reactions during the treatment period.Conclusion:Qihuang Jianpi Zishen Granules can ameliorate the inflammatory response,reduce the disease activity,and mitigate the kidney injury in SLE by inhibiting the STAT3/mTOR signaling pathway to regulate the immune function.
作者
汤忠富
黄传兵
程丽丽
陈君洁
尚双双
李明
刘思娣
TANG Zhongfu;HUANG Chuanbing;CHENG Lili;CHEN Junjie;SHANG Shuangshuang;LI Ming;LIU Sidi(The First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第8期118-125,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(82104782)
省级中医优势专科建设项目(皖中医药服务秘[2022]34号)
安徽省临床医学研究转化专项项目(20230429510702014,20230429510702015)
安徽省高校协同创新项目(GXXT-2021-085)。
作者简介
第一作者:汤忠富,在读博士,从事中医药防治风湿病研究,E-mail:2835192721@qq.com;通信作者:黄传兵,博士,博士生导师,主任医师,从事中医药防治风湿病研究,E-mail:chuanbinh@163.com。
