滋阴清热药对系统性红斑狼疮患者性激素及临床疗效的影响

目的 探讨滋阴清热中药对系统性红斑狼疮(SLE)患者性激素及临床疗效的影响。方法 将54例伴有阴虚证的活动期SLE患者随机分为2组,治疗组(30例)给予滋阴清热中药知柏地黄丸加大补阴丸结合泼尼松(龙)治疗,对照组(24例)给予泼尼松(龙)治疗,共2个月。比较治疗前后两组患者血清黄体生成素、卵泡刺激素、雌二醇、孕酮、睾酮和泌乳素及临床表现。治疗前同时检测30例伴有非阴虚证的活动期SLE患者及25例正常人血清。结果 治疗前,活动期阴虚证SLE患者血清黄体生成素、卵泡刺激素、雌二醇较非阴虚证患者及正常人显着升高(P<0.05),睾酮显着降低(P<0.05).治疗后,治疗组黄体生成素、卵泡刺激素、雌二醇水平较治疗前明显降低(P<0.05),并低于同期治疗的对照组(P<0.05);睾酮值上升(P<0.05),治疗组高于对照组(P<0.05).治疗组病情SLAM评分的好转优于对照组,阴虚内热的症状明显改善。2个月使用的皮质类固醇总量治疗组少于对照组(P<0.05).结论 采用滋阴清热中药联合西药治疗活动期伴阴虚内热的SLE患者,疗效优于单用西药治疗。其作用机理可能与该类中药具有调节阴虚内热患者垂体、性腺轴的功能,下调雌激素、升高睾酮,从而间接改善患者的免疫功能有关。

Effects of Chinese Drugs for Nourishing Yin and Clearing the Heat on Sex Hormone Regulation and Clinical Efficacy in Systemic Lupus Erythematosus

Objective To investigate the effects of Chinese drugs for nourishing Yin and clearing the heat on regulation of sex hormones and clinical efficacy patients with SLE.Methods Fifty four active SLE patients with Yin deficiency were randomly divided into 2groups.Thirty patients in tr eatment group were treated with Pill of Wind-weed Phellodendron and Rehman nia(Zhibai Dihuang Wan)and Bolus for Replenishing Vital Ess ence(Da Buyin Wan)combined with western medicine for 2months,while 24patients in control group were treated with western medicine alone.Before and a fter treatment,the serum levels of f ollicle-stimulating hormone(FSH),luteinizing hormone,estradiol,pr ogesterone,testosterone,prolactin were measured by ELISA in 54patien ts,respec-tively.Before treatment the serum l evels of FSH,luteinizing hormone,estradiol,progesterone,testosterone,prolactin were measured in 30active SLEpatien ts without Yin deficiency and 25age-matched healthy controls simultaneously.Results The mean levels of FSH,luteinizing h ormone,estradiol were significant ly higher in patients with Yin de-ficiency than those without Yin deficiency and those in heathy controls(P<0.05).The serum level of testosterone was significantly lower in patients with Yin deficiency than that in patients without Yin deficiency and that in normal controls(P<0.05).After treatment,the serum levels o f FSH,luteinizing hormone,estradi ol,prolactin decreased remarkably in treatment group(P<0.05),and the serum levels of FSH,luteini zing hormone,estradiol were lower than those in control group(P<0.05).The level of testosterone increase d in treatment group(P<0.05),which was higher than that in control group(P<0.05).The scores of SLAMdecreased signif icantly in treatment group com-pared with those in control group.The symptoms of internal heat due to Yin deficiency improved remarkably in t he treatment group after treatment (P<0.01),and clinical efficacy in treatment group was superior to that in control group(P<0.05).The dosages of prednisone used in th e treatment group were lower than those in control group.Conclusions Combination of Chinese drugs for nou rishing Yin and clearing the heat with western medicine could enhance the curative effects of active SLE patients with Yin deficiency.Its mechanismmay be due to that this kind of Chinese drugs could regulate pituitary-gonadal-axis in the patients wi th Yin deficiency,and reduce the level of estradiol while elevate the level of testosterone,thus improving the im mune function of SLE indirectly.