| Rheumatoid Arthritis (RA) is an autoimmune disease characterized by synovial hyperplasia and joint deformity. Angiogenesis plays an important role in the process of RA. RA pathology, in the process of angiogenesis plays an important role, and it appears early, even in the presence of specific clinical and histological signs of inflammation, has happened before, resulting in synovitis, pannus growth, bone and cartilage destruction, and osteophyte formation. Block for the characteristics of disease is that Luo Bing."Luo Bing" theory means that the disease are closely associated with vascular lesions. From clinical syndrome differentiation treatment of commonly used WenTong collaterals, activating blood know luo for commonly used therapeutic principle. Mentor professor Zhu Yuelan treatment of rheumatoid arthritis patients in the clinical work, application of peony liquorice monkshood soup taste for improving the clinical symptoms of patients with RA and associated inflammatory indexes, blood rheology have certain effect, to improve the compound Chinese medicine for rheumatoid arthritis may affect synovial hyperplasia of vascular abnormalities related.REVIEWFirst, we discuss the etiology, pathogenesis, clinical character-ristics and treatment of Chinese medicine of treating Bi Zheng using Tong Luo.Then,we discuss the correlation of VEGF with RA.CLINICAL RESEARCHOBJECTIVE:To study the clinical effect of Shaoyao-Gancao-Fuzi soup of RA patients and the effect on vascular endothelial growth factor (VEGF) of the patients serum.METHODS:Using randomized controlled methods,60RA cases which of ShenQi XuHan syndrome were divided into treatment group and control group.30cases of treatment group which treated by Shaoyao-Gancao-Fuzi soap and30cases of control group which treated by Tripterygium Glycosides. To evaluate curative effect by using TCM syndrome judgment standard and DAS28curative effect evaluation standard, the ACR reaction, and the laboratory indicators including VEGF associated with rheumatism were statistically analyzed.RESULTS:72patients in3cases due to poor adherence exit the experiment,1 case in the treatment group,2cases in the control group.The two groups’baseline have no deviation before treatment(P>0.05).Patients of the two groups both have no significant curative effect evaluated by TCM symptoms observation and integral comparison before and after the treatment.Effective rate of treatment group is71.43%, this rate in the control is67.65%.No significant difference in total effective rate was found between the two groups(P>0.05).Accord to standard of DAS28,there is no obvious change compared with baseline in the two groups after4weeks treatment (P>0.05),Same as8weeks treatment compared with4weeks,12weeks treatment compared with8weeks. After8weeks treatment,treatment group has significantly decreased (P<0.05), and has declined significantly after12weeks treatment(P<0.01). Control group also has significantly decreased compared to a baseline after8weeks treatment (P<0.05),and has declined significantly after12weeks treatment(P <0.01). No significant difference was found between the two groups at the same point.(P>0.05). After the treatment, the total effective rate of treatment group is68.57%, this rate in the control is64.71%. The Ridit analysis show that R1=0.492(treatment group), R2=0.508(control group), u=-0.237,P>0.05.There is no significant difference between two groups. There is no statistically significant difference between two groups according to ACR20standard at the same time point(P>0.05).After treatments, number of cases reaching ACR20is26which accounting for74.29%of the total number in this group.The number in control group is24which accounting for70.59%of the total number of the group. The number of cases reaching ACR50has no statistically significant difference in8weeks and12weeks after treatment at the same time point (P>0.05).There is no cases reaching ACR70after the treatment of8weeks and12weeks.Laboratory results showed ESR, CRP and VEGF reduced significantly than baseline data in both groups(P<0.01). There is no statistically significant difference between two groups at the same point in time(P>0.05). Safety index test results showed that there is no obvious abnormal in the blood, urine and stool.There is1case which appeared high ALT,and soon returned to normal after2weeks treatment.The rest has no obvious anomalies. Overall control did not see obvious difference before and after.CONCLUSION:ShaoYao-GanCao-FuZi soap has good clinical curative effect in the RA patient of ShenQiXuHan type. Laboratory observation results show that RA patients serum VEGF is higher before treatment, and is droped after treatment.EXPERIMENTAL RESEARCH OBJECTIVE:To study expression of VEGF and its receptor VEGFR-2in the CIA rats serum and synovial tissue, and the effect of ShaoYao-GanCao-FuZi soap on their expressioins.METHODS:SPF level Wistar rats were randomly divided into normal group、 model group、treatment group (treated by ShaoYao-GanCao-FuZi soup) and control group (treated by Tripterygium Glycosides). Arthritis index and X-ray abnormalities were evaluated by two independent observers blinded to the groups of the animals. The level of VEGF and sVEGFR-2/VEGFR-2in serum and synovium were studied by ELISA、immunohistochemical staining and realtime PCR respectively.RESULTS:①The CIA model rats showed varying degrees of joint inflammation, swelling of the toes and joint, slow growth of the weight compared with the normal group. Degrees of inflammation droped apparently after treatment (P <0.05),but there was no significant difference between two groups (P>0.05).Rats joint pathology score show that normal histological structure in the normal bilateral ankle group.Inflammatory cell infiltration, edema, granulation tissue formation and even more apparent destruction of articular cartilage showed in the synovial of Model group.All about it would decreased after treatmend. X-ray of rats showed changes in the knee joint, ankle and toe joints. Cortical thinning of bone, osteoporosis,Marginal bone erosion, bone proliferative reaction, joint bone destruction can be seen. Even bone hyperplasia, bulky, joint space narrowing or widening disappear.②Using the ELISA method to detect VEGF and VEGFR-2of the serum, the model group was obviously higher than normal group (P<0.05).After the treatment, control group and treatment group significantly decreased (P<0.05). Expression of VEGF in the control group is slightly lower than the treatment group, and there was no statistically significant difference between them (P>0.05).VEGF and VEGFR-2are located in the cytoplasm and cytoplasmic staining for a tan for positive cells by the immune histochemical.Synovial cell cytoplasm of normal group rats is visible on a small amount of evenly distributed brownish-yellow granules.Synovial cell cytoplasm brownish-yellow granules is significantly more dense on model group which is obvious differences compare with the normal group (P<0.05).The number of positive cells decreased in the both Control group and treatment group which are significant difference compared with the model group (P<0.05).③By statistics analysis,the expression of VEGF and VEGFR-2on the model group is significantly higher than the normal group (P<0.05).The expression of VEGF and VEGFR-2on the treatment group and control group is decreased significantly compared with the model group (P <0.05), but there is no significant difference between two groups (P>0.05).CONCLUSION:ShaoYao-GanCao-FuZi soup can obviously reduce the CIA rat’ articular inflammation index, reduce its swelling degree、pathological grading、levels of VEGF and its receptor on serum and expression of VEGF and VEGFR-2on synovial tissue. The role of the specific mechanism remains to be further research. |
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