| 1.Objective To explore the relationship between the pathogenesis of p SS and the deficiency of Spleen Yin in traditional Chinese medicine.Through the observation of clinical laboratory indexes and the study of clinical indexes,to explore the clinical effect and mechanism of invigorating spleen and nourishing Yin on p SS patients.It provides a reliable theoretical basis for Chinese medicine in the treatment of p SS patients.2 Method2.1 Theoretical analysis According to clinical practice and referring to Chinese and English literature,this paper analyzes the relationship between spleen yin deficiency and pathogenesis of p SS patients,analyzes the close relationship between TCM etiology and pathogenesis of p SS patients and spleen yin deficiency,as well as the correlation with cytokines IL-6,TNF-α,IL-10,IL-4,as the theoretical basis for proposing "spleen nourishing yin method" and studying its mechanism of action and clinical efficacy evaluation.2.2 Clinical research2.2.1 The changes and correlation of IL-6,TNF-α,IL-10,IL-4 and other laboratory indexes in patients with p SS From the rheumatology department and physical examination center of our hospital,60 patients with PSS and 20 normal people were selected respectively.The whole blood was collected from the two groups of people,including Ig G,Ig A,Ig M,ESR,hs CRP,C3 and C4 of the complement,which was tested by biochemical instrument of the test center.The serum IL-6,TNF-α,IL-10 and IL-4 were measured The change of the target was detected by ELISA.2.2.2 Compare the changes of clinical indexes of Jianpi Yangyin formula group and control group before and after treatment 60 patients with pSS were selected from the outpatient and inpatient department of Rheumatology and Immunology Department of the First Affiliated Hospital of Anhui University of traditional Chinese medicine.60 patients were randomly divided into two groups.The treatment group was treated with traditional Chinese medicine granule Jianpi Yangyin formula,and the control group was treated with prednisone acetate tablets + hydroxychloroquine sulfate tablets.The changes of IL-6,TNF-α,IL-10,IL-4,TCM symptom score,SF-36,HAMA / HAMD,dryness,ESSDAI,ESSPRI and other related laboratory indexes were compared before and after treatment.3 Results3.1 Theoretical analysis results3.1.1 IL-6,TNF-α,IL-10 and IL-4 are closely related to the activity of p SS;3.1.2 "deficiency of Spleen Yin" is closely related to the pathogenesis of p SS,and "deficiency of Spleen Yin" runs through the whole disease;3.1.3 "invigorating the spleen and nourishing yin method" can reduce the disease activity of p SS and relieve the patients’ clinical symptoms;3.1.4 Based on the fact that deficiency of Spleen Yin is the basic pathogenesis of the disease,it is concluded that one of the important treatment methods of traditional Chinese medicine for p SS is "strengthening the spleen and nourishing Yin".3.2 Clinical research results3.2.1 Comparison of serum IL-6,IL-4,IL-10 and TNF-α between p SS group and healthy control group Compared with the control group,the serum levels of IL-10 and IL-4 in p SS group were significantly lower,while the levels of IL-6 and TNF-αwere significantly higher(P <0.01).3.2.2 Comparison of Ig G,Ig A,Ig M,CRP,ESR,C3,C4 in serum between p SS group and healthy control group Compared with the healthy control group,the serum Ig A,Ig M,CRP and C4 levels of the patients in the p SS group had no significant difference(P > 0.05),indicating that the expression of Ig A,Ig M,CRP and C4 in the serum of the patients with p SS was normal or of no clinical significance,and the levels of ESR,RF and Ig G were significantly higher(P < 0.01),while the level of C3 was significantly lower(P < 0.01).3.2.3 Correlation between serum levels of IL-6,TNF-α,IL-10,IL-4 and laboratory indexes in patients with p SS The results showed that IL-6 and TNF-α were positively correlated with the levels of RF,ESR and Ig G(P < 0.05),and negatively correlated with the levels of C3(P <0.01);IL-4 was negatively correlated with the levels of RF and ESR(P< 0.01),but not with the levels of C3(P > 0.05);IL-10 was negatively correlated with the levels of RF,ESR and Ig G(P < 0.05),and positively correlated with C3(P < 0.05).3.2.4 Correlation between IL-6,TNF-α,IL-4,IL-10 and dryness in patients with p SS The results showed that TNF-αand IL-6 were negatively correlated with static salivary flow rate and tear film rupture time(P < 0.05),positively correlated with corneal fluorescence staining(P< 0.01),positively correlated with static salivary flow rate and tear film rupture time(P< 0.05)and negatively correlated with corneal fluorescence staining(P< 0.05).3.2.5 Correlation of IL-6,IL-4,IL-10,TNF-α with ESSPRI,ESSDAI,anxiety and depression in patients with p SS The results showed that IL-6 and TNF-α were positively correlated with ESSPRI,Iscore,ESSDAI score and Anxiety Depression Scale score(P < 0.05),IL-4 and IL-10 were negatively correlated with ESSPRI score,ESSDAI score and Anxiety Depression Scale score(P< 0.01).3.2.6 Clinical effect of spleen strengthening and Yin nourishing therapy on patients with p SS and its influence on relevant indexes(1)The levels of ESR,RF and Ig G in the serum of patients with p SS were higher than those of normal people,and the level of C3 was lower.After treatment,the levels of ESR,RF and Ig G in the treatment group and the control group were lower,and the level of C3 was higher;(2)Compared with before treatment,the levels of IL-4 and IL-10 in the two groups were significantly higher,and the levels of IL-6 and TNF-αwere significantly lower.Compared with the control group,the level of IL-4 and IL-10 in the treatment group increased more significantly,and the level of IL-6 and TNF-α decreased more significantly.The results showed that the Jianpi Yangyin recipe was better than the control group;(3)The treatment group and the control group can significantly reduce the ESSDAI and ESSPRI scores of p SS patients,and the treatment group has more advantages than the control group;(4)After treatment,the static salivary flow rate and tear film rupture time of the patients in the two groups were increased,the corneal fluorescence staining score was decreased,but the improvement of the indicators in the treatment group was more significant;(5)In the treatment group and the control group,the TCM symptom score,anxiety and Depression Scale score of p SS patients were significantly reduced,also can Improve quality of life scores,but the therapeutic effect of the treatment group was significantly better than that of the control group;(6)The total effective rate of Jianpi Yangyin formula group is higher than that of the control group,from which we can see that the control group is slightly weaker than the treatment group in improving the clinical symptoms and the overall treatment effect.4 Conclusion(1)"Deficiency of Spleen Yin" is closely related to the pathogenesis of p SS,and "deficiency of Spleen Yin" runs through the whole course of the disease.Deficiency of Spleen Yin affects the normal operation of the viscera function of the body,and causes diseases due to the insufficient production of Qi,blood and body fluid.Based on the basic pathogenesis of this disease,this paper summarizes that one of the important treatment methods of Chinese medicine for p SS is "strengthening the spleen and nourishing Yin".(2)The activity and progress of the disease in patients with p SS are closely related to the serum IL-6,TNF-α,IL-10,IL-4 and other related laboratory indexes.Jianpi Yangyin recipe can indirectly adjust the immune balance disorder of patients by promoting the production of anti-inflammatory factors IL-10,IL-4 and inhibiting the production of pro-inflammatory factors TNF-α,IL-6,and can inhibit the immune inflammation of glands to alleviate clinical symptoms.It provides an important basis for observing the changes of clinical diseases and adjusting the treatment plan.(3)Jianpi Yangyin formula can significantly improve the serum complement C3 and other indicators of p SS patients,reduce the serum ESR,RF,Ig G levels of p SS patients,which shows that "Jianpi Yangyin method" can inhibit the immune inflammatory response,so as to alleviate the symptoms of joint pain caused by the clinical inflammatory response of p SS patients,and reduce the disease activity of patients.(4)The score of essdai and esspri of the patients with p SS was significantly lower than that of the western medicine group.(5)p SS patients often suffer from local discomfort of mouth,eye and joint caused by diseases,which affects the quality of life and has anxiety and depression.Both treatment methods can effectively improve the symptom score of traditional Chinese medicine,local symptoms of mouth and eye,improve the quality of life of patients and reduce anxiety and depression,but the total effective rate of "Jianpi Yangyin method" is better than that of the control group. |
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