| Sjogren’s syndrome is considered a chronic autoimmune disease characterized by the inflammation involving the exocrine glands such as the salivary glands and lacrimal gland mainly. And can affect the respiratory system, digestive system and skin, vagina external gland.Also appear interstitial lung,renal interstitial and other systemic damage and vasculitis.In the SS of unknown etiology, no specific and radical method at the present stage, chinese traditional medicine display unique treatment benefits, can improve the mouth and eye dry and other local and systemic symptoms, is expected to carry out the early intervention treatment of SS, control the progress of the disease, so as to improve the life quality of patients with SS.This study explores the pathological changes of the yin deficiency and dryness stasis and treatment principle of Nourishing yin and clearing dryness-heat and removing blood stasis in theory. Clinical observation of nourishing yin and clearing dryness-heat and removing blood stasis therapeutic efficacy in the treatment of Sjogren syndrome and effect on patients with Th17/Treg imbalance. Preliminary discussion on the mechanism of action of Yang Yin Qing Zao Decoction in the treatment of Sjogren syndrome.The first part is the theory research.In a review of integrated traditional Chinese and Western medicine based on advances in the etiology, pathogenesis, diagnosis and treatment of Sjogren syndrome, according to the ancient and modern literature, combined with the clinical features of the disease, clear pathogenesis characteristics for the dry poison, blood stasis with Yin deficiency constitution of Sjogren syndrome, demonstrates to be both nourishing blood producing fluid, obtaining Yin from Yang nourishing yin to moisten dryness adjustment body effect a permanent cure, combined with relieving dryness detoxification clear stasis on theory basis, describes the clinical dialectical points of nourishing yin and clearing dryness-heat and removing blood stasis to treat this disease, "Yang Yin Qing Zao San Yu Decoction" composition principle and the effect of the drugs, both cases were clinically demonstrated.The second part is clinical research.Objective:To observe the effect of nourishing yin and clearing dryness-heat and removing blood stasis clinical intervention of dryness syndrome.Methods:using randomized controlled methods,60 cases of primary Sjogren syndrome patients according to the random number table method were randomly divided into two groups, Yang Yin Qing Zao Decoction group (treatment group) 30 cases, hydroxychloroquine plus total glucosides of paeony group (control group) 30 cases, with TCM syndromes, symptoms score and laboratory indicators of change as the evaluation index.Results:in the control group, fall off in 1 cases. Comparison of the clinical efficacy:The treatment group of 30 cases were effective in 26 cases,4 cases ineffective, the total efficiency of 86.6%,29 cases in control group,20 cases were effective,9 cases ineffective, the total efficiency of 68.9%, the efficacy of the treatment group was better than that of the control group (P<0.05).Evaluation of syndrome effect:TCM syndromes before treatment with higher frequency of occurrence for dry mouth, dry eyes, joint pain, fatigue, dental caries, dry skin, dry stool, weak pulse, pale red tongue. Treatment of the syndrome group showed significant improvement in the performance of the dry mouth, dry eyes, dry stool, joint pain, thready pulse.The symptoms of the treatment group were integral were significantly decreased (P<0.01);The control group in addition to the "dry mouth" no difference before and after the treatment (P>0.05), the other 4 symptom scores were significantly lower (P<0.01);The treatment group "two dry eyes, dry mouth and throat, dry skin" better than the control group (P<0.01 or P<0.05).Inspection index comparison:The two groups before and after treatment of ESR, CRP, IgG have significant difference (P＜0.05), with no significant difference between groups (P>0.05).Conclusion:Yang Yin Qing Zao San Yu Decoction in treating Sjogren syndrome can effectively improve symptoms and laboratory index, compared with hydroxychloroquine plus total glucosides of paeony is safe effective.The third part is the experimental study.Objective:To investigate the nourishing yin and clearing dryness-heat and removing blood stasis intervention mechanism of dryness syndrome.Methods:using randomized controlled methods,60 cases of primary Sjogren syndrome patients according to the random number table method were randomly divided into two groups, Yang Yin Qing Zao San Yu Decoction group (treatment group) 30 cases, hydroxychloroquine plus total glucosides of paeony group (control group) 30 cases, were taken before and after treatment in patients with peripheral blood.Flow cytometry was used to detect Thl7, Treg. Related cytokines IL-6, IL-17 was detected by ELISA method.Results:Comparison of detection index before and after treatment:In two groups before treatment in patients with IL-6, IL-17, Th17 index were higher than those in healthy group, Treg index lower than in the healthy group;After treatment, the treatment group IL-6 and IL-17 decreased, there was significant difference (P<0.01 or P<0.05), Th17 decreased, Treg increased, with significant difference (P<0.01 or P<0.05);Control group IL-6 decreased, there was significant difference (P＜0.05), no significant difference of IL-17, Th17 (P>0.05), Treg increased, with significant difference (P<0.01).The former groups had no significant difference (P>0.05), the treatment group compared with the control group IL-17, Th17, Treg value had significant difference after treatment (P<0.05).Before and after treatment the difference correlation analysis:Treatment there was a significant correlation between the groups of Thl7 and IL-6 value (r=0.40), and there was a statistically significant (P<0.01);There was a significant correlation between the Th17 and the IL-17 value (r=0.54), and there was a statistically significant (P<0.01);There was a significant correlation between the IL-6 and the IL-17 value (r=0.47), and there was a statistically significant (P<0.01).The control groups has large negative correlation to Treg and Th17 (r=-0.7198), and the difference had statistical significance (P<0.01).Conclusion:The presence of Treg/Th17 immune imbalance in patients with Sjogren’s syndrome in peripheral blood, mechanism of nourishing yin and clearing dryness and removing blood stasis may be to regulate the Treg/Th17 immune balance by reducing the secretion of IL-6 and IL-17, to stimulate the proliferation of Treg cells, inhibit the proliferation of Th17 cells.The innovation of this research:The interpretation of Yin deficiency constitution is the connotation of Yin deficiency of Sjogren syndrome, yin deficiency constitution is the easy hair crowd of Sjogren syndrome, dryness toxin, stasis heat and yin deficiency constitution is closely related, has higher academic. Based on the "Jin of homologous blood", "interdependence between yin and Yang" in TCM theory, nourishing Yin regulating body method proposed to be both nourishing blood producing fluid, Yang for Yin, embodies the innovative therapies. The seasonal febrile disease theory applied in modern refractory disease, in treating Sjogren syndrome basic with Wu Youke "Qing Zao Yang Rong Decoction", reflects the inheritance of seasonal febrile disease theory.Tracking focus of immunology research on Sjogren syndrome, and based on new points of Treg/Th17 imbalance related Sjogren syndrome, with Treg,Th17 and related cytokines IL-17,IL-6 as indicators for the study, to explore the mechanism of herbs, reflects the advanced nature of research methods and technology index. |
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