| ObjectiveThrough the retrospective case study method,the distribution regularity of TCM syndrome types in rheumatoid arthritis of elderly patients was analyzed,and the correlation between each syndrome type and laboratory indicators and disease activity was studied;at the same time,through the establishment of CIA model,research was conducted.Peripheral blood inflammatory cytokines and histopathological features of elderly CIA were further explored,and the differences between them and young CIA were further explored as well as the intervention effect of Modified Shaogan Fuzi Decoction.Clinical researchMethods:A total of 107 cases of EORA patients admitted to the Department of Rheumatology,Eastern Hospital,Beijing University of Chinese Medicine between January 2011 and March 2018 were included.Patients were screened according to inclusion and exclusion criteria.Baseline data,clinical symptoms,laboratory indicators,and disease activity were recorded.Results:This study included a total of 107 cases of EORA patients,including 8 cases of rheumatism phlegm syndrome,accounting for 7.5%;29 cases of cold dampness stasis syndrome,accounting for 27.1%;11 cases of damp heat stasis syndrome,accounting for 10.3%;16 cases,accounting for 15%;10 cases of qi and blood deficiency,accounting for 9.3%;33 cases of liver and kidney deficiency syndrome,accounting for 30.8%.It can be seen that the common syndromes of EORA in clinic are cold dampness phlegm syndrome and liver and kidney deficiency syndrome.In terms of the proportion of males and females,the prevalence rates of rheumatoid arthritis,dampness and heat stasis syndrome,and liver and kidney deficiency syndromes were 1.7:1,1.2:1,and 2.3:1,respectively.Most of the cases were male,and the remaining syndromes were female patients.The ratio of males to females is 1:2.In the course of disease and BMI,there was a statistically significant difference between multiple syndromes(P<0.05);the liver and kidney deficiency syndrome was statistically different in the course of disease and the remaining 5 syndromes(P<0.05),and the duration of liver and kidney deficiency syndrome was significant.It was longer than the rest of the syndromes;in terms of BMI,there was a statistically significant difference between rheumatoid arthritis syndrome,dampness and heat stasis syndrome,and blood and blood deficiency syndrome(P<0.05).In WBC and PLT,there was no statistical difference between the syndromes(P>0.05).In RBC,there was a statistically significant difference between liver and kidney deficiency syndrome and rheumatoid arthritis syndrome and dampness and heat stasis syndrome(P<0.05).For HGB,there was a statistically significant difference between dampness and heat stasis syndrome and deficiency of blood and blood,liver and kidney deficiency syndrome(P<0.05);In ESR and CRP,there was no statistical difference between each syndrome(P>0.05);in RF,there were statistical differences among multiple syndromes(P<0.05);,Cold and dampness block resistance is the second,the lowest blood and blood deficiency.In the aspect of anti-CCP,there was a statistically significant difference between the dampness and sputum resistance syndrome and the sputum blockage syndrome,rheumatoid arthritis syndrome,qi and blood deficiency syndrome,and liver and kidney deficiency syndrome(P<0.05);The highest CCP value of the card is the resistance,followed by the phlegm resistance card,and the lowest in the blood and blood deficiency.In terms of IgG,in addition to phlegm-restriction syndrome,there was a statistically significant difference between the damp-heat phlegm syndrome and the other 4 syndromes(P<0.05).In terms of DAS28,there were statistical differences between blood and blood deficiency syndromes,cold and dampness stasis syndromes,sputum blockage syndromes,and liver and kidney deficiency syndromes(P<0.05);cold dampness stasis syndrome and damp heat stasis syndrome had statistics Difference(P<0.05);Among them,the DAS28 score was the highest in the cold dampness stasis syndrome,and the lowest in the blood and blood deficiency syndrome;in the VAS score,the deficiency of blood and blood was associated with cold and dampness stasis syndrome,stasis syndrome,and liver and kidney The deficiencies were statistically significant(P<0.05).Among them,the VAS score was the highest in the cold dampness phlegm syndrome,followed by the liver and kidney deficiency syndrome,and the lowest in the qi and blood deficiency syndrome.There were 31 patients with pulmonary interstitial fibrosis,accounting for 29%of the total.Among them,liver-kidney deficiency syndrome and cold-water sputum syndrome often combined pulmonary interstitial fibrosis,accounting for 32.3%and 25.8%,respectively.Experimental StudyExperiment 1:Twenty-four SPF female Wistar aged and young rats were divided into two groups.One group was normal and the other group replicated a rat model of collagen-induced arthritis(CIA).Two groups of behavioral behaviors were recorded and the body weight and toe swelling volume of the two groups were measured and the joint inflammation scores of the model group were recorded.result:1 General statusDuring the modeling period,the young and old rats began to develop foot and toe joint swelling and AI index after 7 days of model building.The joints were swollen and peaked after 14d-21d,and the joints were swollen and deformed after 28 days of modeling.The activities were seriously affected.limit.The compositional modulus of the elderly is 92%(11/12),and the youth composition modulus is 100%(12/12).During the modeling period,the body weights of the old and young model groups showed a decreasing trend,and there was no statistical difference between the groups(P>0.05).2 Inflammatory Signs Evaluation-Toe Swelling and AI ScoreDuring the modeling period,the drainage volume of the right foot of the aged and youth groups were higher than that of the normal group respectively(P<0.05);the drainage volume of the old and young blank model group was higher than that of the young in the 3rd week and the aged group.Group(P<0.05),there was no statistical difference in other periods.In terms of AI scores,both the elderly and the young model groups had statistical significance during the 2w-4w(P<0.05).The AI scores of the old age group were higher than the youth group.Experiment 2:Sixty-four female SPF grade Wistar aged and young rats were divided into 8 groups.In addition to the normal group,a rat model of collagen-induced arthritis(CIA)was established.During the period,scores of joint inflammation were recorded for each group,behavioral records were recorded,and the inflammatory cytokine levels were measured in the peripheral blood serum after one-month intragastric intervention,and histopathological features of the joints and lungs were observed.result:1 General statusIn the young and old group rats,the swelling of the paws and metatarsophalangeal joints began to appear 7 days after the model was established,and the AI index increased.The swelling of the joints reached the peak after 14d-21d.The rats’ hair was dull,disorderly,and the flexibility was reduced.Model 28d Joint swelling and malformation occurred,and the activity was severely limited.The age-forming modulus was 87.5%(21/24),and the youth composition modulus was 84.6%(22/26).During the dosing period,the body weight of the old Chinese medicine group showed an upward trend,with no statistical difference between the groups(P>0.05);the body weight of the young group showed an overall increase,and the body weight increased from 0 to 4 w,the control group and the traditional Chinese medicine Compared with the blank model group,the group had statistical significance(P<0.05).2 Inflammatory Signs Evaluation-Toe Swelling and AI ScoreDuring the administration,the drainage volume of the right foot of the old Chinese medicine group and the control group was lower than that of the blank model group during the 1 week of administration(P<0.05);the right foot drainage volume of the control group and the Chinese medicine group was lower than that of the 3w and 4w administration groups.In the blank model group,there was no statistical difference among the groups(P>0.05).In the youth group rats,the drainage volume of the right foot of the control group and the Chinese medicine group was lower than that of the blank model group during the period from 1w to 4w,with statistical difference(P<0.05).During the dosing period,the AI scores of old and young rats in each group were decreased.After 3 w and 4 w administration,the old control group and the Chinese medicine group were significantly different from the blank model group(P<0.05).The Chinese medicine group had a lower AI score than the control group.Group(P<0.05);Administration of 1w and 2w,the young control group and Chinese medicine group had statistically significant differences(P<0.05)compared with the blank model group,3 W and 4w administration,control group and Chinese medicine group AI score All were lower than the blank model group(P<0.05),and the AI scores of the Chinese medicine group were lower than those of the control group(P<0.05).3 Organ Index and PathologyAfter administration for 4 weeks,the index of thymus in each group was lower than that in young groups(P<0.05).The spleen index,lung index,and thymus index were significantly lower in the elderly blank model group than in the young blank model group.The difference was statistically significant(P<0.01);the liver index of the elderly control group was lower than that of the young control group,with statistical significance(P<0.05).The inflammation of lung tissue in the elderly CIA model was more severe than that of the young group.However,the inflammation of the whole ankle joint and synovial tissue of the elderly group was lighter than that of the young CIA model.There was no cartilage destruction and the prognosis was good.4 Inflammatory cytokines and safety indicatorsAt 4 weeks after administration,IL-6 and IFN-y levels of inflammatory cytokines were not statistically significant between the old group and the young group(P>0.05);in the IL-17A,the old Chinese medicine group was low.In the elderly blank model group and the control group,there was a statistically significant difference(P<0.05);IL-17A in the young Chinese medicine group had statistically significant differences compared with the control group and the model group(P<0.05);the elderly group and the young group In comparison,the levels of inflammatory cytokines in peripheral blood of each group were not statistically different(P>0.05).There was no statistical difference in the safety index among the old group rats(P>0.05);there was a statistically significant difference in the ALT between the young control group and the model group and the Chinese medicine group(P<0.05);in the CREA,the control group Compared with the normal group,the model group and the TCM group,there were significant differences(P<0.05).The ALT and CREA values in the control group were higher than those in the model group and the TCM group,and there was no statistical difference in the other indicators.The ratio was statistically significant(P<0.01),and there was no statistical difference in other indicators.conclusion1.Rheumatoid arthritis in elderly patients is characterized by cold dampness phlegm syndrome and liver and kidney deficiency syndrome,and there is a correlation between different TCM syndrome types and disease activity and common laboratory indicators.2.In terms of peripheral serological features and histopathology,there is a difference between the elderly CIA model and the young CIA model.The inflammatory cytokines are involved in the pathogenesis of elderly CIA.Modified Shaogan Fuzi Decoction has an interventional role and is highly safe. |
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