Synergistic Effect Of Modified Shaoyao Gancao Decoction On Rheumatoid Arthritis Treated By Western Medicine And Its Correlation With Metabolism Of Paeoniflorin In

Objective① Retrospectively study found,there were no significant correlation between inflamemation indicators,DAS28 scores and TCM syndrome of RA patients. So this study to observe the synergistic effect of Modified Shao Yao Gan Cao Decoction combined with western medicine treatment of RA.② To observe the efficacy mechanism of Modified Shao Yao Gan Cao Decoction in the treatment of RA and inflammatory cytokines of TNF-α,IL-10,IL-17.③ By means of Chinese medicine small molecule monoclonal antibody preparation and detection of traditional Chinese medicine small molecule,to explore the relationship between the traditional Chinese medicine effective component of paeoniflorin metabolism in blood in RA patients and clinical efficacy.④ To study the comparison of paeoniflorin metabolism of saliva and blood,and the correlation of paeoniflorin and curative effect,to enrich the theories of treating RA with traditional Chinese medicine.Methods① Clinical studies cited internationally recognized DAS28 disease activity level to evaluating the curative effect.Using retrospectively analyzed to 241 cases of RA patients,statistical and analysis the levels of basic data of age,gender, course of disease;laboratory test items of RF,ESR,CRP; DAS28 score of six syndrome types of RA patients(phlegm and blood stasis blocked,dampness heat and blood stasis blcoked, cold-damp block,cold dampness and blood stasis blcoked,damp-heat blocked,blood stasis block),to study whether there are differences between RA patients with different TCM syndrome types of the above indexes. Provide the basis for Modified Shao Yao Gan Cao Decoction which is widely using in the treatment of RA.② The DAS28 disease activity score and ACR20/50/70 remission degree as the starting point,to analyze the curative effects of 54 RA patients which conformed Chinese and western medicine diagnostic criteria(randomly divided into control group of 23 cases and treatment group of 31 cases.The control group were given western medicine treatment of system specification,the treatment group were given Modified Shao Yao Gan Cao Decoction based on the western medicine treatment, the course of treatment is 4 weeks).Discuss the effect of Modified Shao Yao Gan Cao Decoction for DAS28 disease activity score and ACR20/50/70 disease remission score,and analyse the relationship between DAS28 score and ACR20 score.③ Using indirect competitive ELISA method, analysed and compared the levels of serum TNF-α,IL-10,IL-17 before and after treatment of the 54 cases RA patients, to observe the effects and efficacy mechanism of Modified Shao Yao Gan Cao Decoction to the inflammatory cytokines of RA.④ By means of Chinese medicine small molecule monoclonal antibody preparation and and detection of traditional Chinese medicine small molecule,analysis of the relationship between Modified Shao Yao Gan Cao Decoction effective component of paeoniflorin in blood and saliva of RA patients (There were totally 22 cases of RA patients which conformed Chinese and western medicine diagnostic criteria,given Bai Shao particles(16.7g/kg) and put it in the 0 capsules to take,period was 14 days.Collected saliva during 45 minutes after given drugs of 0-14 days and collected venous blood of before and after treatment)with DAS28 score, ACR50,ESR, CRP; detected the relationship between the content of paeoniflorin in saliva and in blood,to explore the feasibility of traditional Chinese medicine small moecule detection in saliva.Results①Retrospectively case analysis shows that the syndrome among patients with RA constituent ratio of different ages, duration, RF levels before and after treatment, ESR levels, CRP levels and DAS28 scores were not statistically significant difference (p> 0.05).②Clinical observations show that the two groups of patients with RA after treatment ESR levels, CRP levels and DAS28 scores were significantly improved compared with before treatment (p<0.05);Overall Evaluation treated group of RA patients DAS28 score improved significantly better than the control group of RA patients (p<0.05) Treated group of RA patientsACR20/50 response rate was significantly better than the control group of RA patients (p<0.05);But Modified Shaoyao Gancao Decoction in the treated group patients with RA aspects to improve the ESR and CRP levels than control group in RA patients with no significant statistical difference;Two groups of patients with the disease activity scores and DAS28 ACR20 alleviate disease score can objectively reflect the condition of patients with RA, There is no obvious statistical difference between two kinds of evaluation methods have no (p> 0.05).③ The two groups after treatment of serum TNF-α,IL-10,IL-17 was significantly lower than before treamtent(P<0.01), but comparison of the two groups after treatment showed that cytokines had no significant difference(P>0.05).④ Experimental study showed,with the increasing of DAS28 score,paeoniflorin in saliva and blood were gradually rising trend. At the same time,according to the ACR50 score, With the remission of RA patients,There was a decreasing trend of paeoniflorin content in blood and saliva. Paeoniflorin content in saliva and blood had no significant correlation with CRP. Paeoniflorin content in the blood of normal ESR group of patients was significantly higher than the elevated ESR group of patients(P<0.05).The levels of paeoniflorin content in saliva was significantly lower than in blood(P<0.05),the levels of paeoniflorin content in blood about six times than in saliva.Conclusion① There is no significant statistical difference between TCM syndrome classification and RA patients with RF, ESR and CRP levels as well as the improvement of DAS28.② Modified Shao Yao Gan Cao Decoction can significant improve the symptoms of joint swelling degree and the joint tenderness of RA patients. It can significantly improve RA patients’DAS28 ACR20/50 score, which curative effect is superior to western medicine control group, meanwhile DAS28 and ACR20 existence consistency in the evaluation of patients with RA disease mitigation; But Modified Shao Yao Gan Cao Decoction for improve the ESR and CRP in patients with RA effect is not obvious.③ Modified Shao Yao Gan Cao Decoction collaborative medicine can improve disease activity in RA patients, but its mechanism of RA patientsis not achievedby reducing serum levels of TNF-α, IL-10 and IL-17 levels levels, the mechanism needs to be further explored.④ There is a certain linkage effects between Paeoniflorin levels in saliva and blood of DAS28, ACR50 score, high levels of paeoniflorin may lead to lower ESR levels, may be one of the mechanisms Paeoniflorin treatment of RA. Paeoniflorin in RA patients were significantly higher than the blood of its content in saliva, is about six times. Paeoniflorin in saliva can reflect which levels in the blood, which can be detected in the human body as an active ingredient of traditional Chinese medicine a new approach.