白芍总苷治疗非活动期强直性脊柱炎机制研究

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。

Study of mechanism of glucosides of paeony in treating inactive ankylosing spondylitis patients

Objective To preliminarily discuss the effect and underlying mechanism of total glucosides of paeony（ TGP） in treatment of patients with inactive ankylosing spondylitis（ AS）. Methods Thirtyeight 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 treatment,BASDAI,VAS,BASFI and ASDAS scores were recorded,serum CRP,ESR,ALT,AST,BUN,CREAT were measured,the expression of peripheral TLR-4,TLR-5,TRAF6,Myd88 mRNA was detected by RTPCR and the serum TNF-α,IL-17α and TGF-β1were 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-17α and 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-α and IL-17α was 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.