| 1 Objective To observe the changes of the kidney on the bone turnover markers,blood serum25(OH)D3 levels,complement,quality of life,early renal damage index et al in the patients with systemic lupus erythematosus,and the intervention effect of strengthening the spleen and complement the kidney.From the side of bone metabolism to discuss the influence and curative effect of strengthening the spleen and complement the kidney for the patients with SLE.2 Methods2.1 Theoretical research To analysis of the relationship between the damage of bone metabolism in SLE disease and the TCM deficiency of spleen and kidney,summary of TCM etiology and pathogenesis of bone metabolism in patients with SLE by a large number of relevant literature research,in order to explain the theoretical basis of traditional Chinese medicine in treating SLE patients with bone metabolic damage.2.2 Clinical research2.2.1 Changes and correlation of laboratory indexes wit the disease of the bone matabolism in SLE.To selected 20 health people from the First Affiliated Hospital of Anhui University of Chinese medicine.The general data as age,sex were matched with the group of SLE,all of them were healthy,without organic lesion disease.The changes of Serum osteocalcin(OC),Type ? procollagen carboxyl-terminal peptide(PINP),Type I collagen cross-linked telopeptide(CTX)and 25(OH)D3 were detected by Enzyme Linked Immunosorbent Assays(ELISA)in healthy control group and SLE group.General laboratory indexes(routine blood test,erythrocyte sedimentation rate,Ig G,Ig A,Ig M,CRP,C3,C4,anti-C1 q,urine micro albumin,24 h urine protein quantitation,Urine beta 2 micro albumin,et al.)were determined by automatic biochemical analyzer in healthy control group and SLE group.Statistical analysis was performed using SPSS21.0 software.2.2.2 The effect of clinical curative,quality of life and Bone turnover markers form the TCM of strengthening the spleen and complement the kidney grain intervene of the SLE.The 60 cases of SLE patients were divided into control group(hydroxychloroquine sulfate + Prednisone acetate + Calcium carbonate D3)and study group(strengthening the spleen and complement the kidney grain + hydroxychloroquine sulfate + Prednisone acetate + Calcium carbonate D3).30 cases in each group.Observe the effect of Bone formation markers and bone resorption markers,25(OH)D3,the quality of life,TCM symptoms integral,disease activity and related laboratory parameters of improvement as SF-36,SAS,SDS,complement in the two groups before and after treatment.3 Results3.1 The results of theoretical research3.1.1 The bone metabolism damage throughout the whole process of SLE;3.1.2 The bone metabolism damage is an important performance of the TCM symptoms of “Spleen and Kidney Deficiency”;3.1.3 The TCM etiology and pathogenesis of SLE is due to “Spleen and Kidney Deficiency”;3.1.4 The method of strengthening the spleen and complement the kidney is one of the TCM important treatment of SLE.3.2 The results of clinical research3.2.1 The changes of the serum Ca,P and ALP in SLE The SLE patients with Ca,P and ALP were lower than the healthy control group,the difference of two groups was statistically significant(P<0.01).3.2.2 The changes of bone turnover markers OC,PINP and CTX in SLE The SLE group of OC and PINP levels were lower than the control group(P<0.01);the CTX levels of the SLE group was higher than the control group,the difference was statistically significant(P<0.01).3.2.3 The changes of the blood serum 25(OH)D3 levels in SLE The changes of the blood serum 25(OH)D3 levels in SLE was lower than the healthy control group,the difference was statistically significant(P<0.01).3.2.4 The changes of the bone density in SLE The bone density of femoral neck,triangle area,large tuberosity in the SLE group were lower than the control group,the difference was statistically significant(P<0.01).3.2.5 The changes of the serum complement C3,C4 and anti C1 q antibody in SLE The serum complement C3,C4 in SLE patients were lower than those in the healthy control group,the difference was statistically significant(P<0.01);the anti C1 q antibody in SLE patients was higher than the control group,the difference was statistically significant(P<0.01).3.2.6 The changes of urine micro albumin,Urine beta 2 micro albumin,24 h urine protein in SLE The SLE patients with the urine micro albumin,Urine beta 2 micro albumin,24 h urine protein were significantly higher than the healthy control group,the difference was statistically significant(P<0.01).3.2.7 The changes of blood routine index in SLE The blood routine index(WBC,RBC,HGB,PLT)in SLE group was significantly lower than the healthy group,the difference was statistically significant(P<0.01).3.2.8 The changes of blood immunology index in SLE The blood immunology index(ESR,Ig G,Ig A,Ig M,CRP)of SLE patients was higher than the healthy control group,the difference was statistically significant(P<0.01).3.2.9 The changes of anxiety and depression in SLE The anxiety and depression self rating scores with SLE patients were higher than the control group,the difference was statistically significant(P<0.01).3.2.10 The correlation of 25(OH)D3 levels with Complement system,early kidney damage,serum immunology index in SLE Correlation analysis showed that 25(OH)D3 levels of SLE patients and complement C3,C4 levels were positive correlation(P<0.01),the 25(OH)D3 levels and anti C1 q antibody levels was negative correlation(P<0.01);the 25(OH)D3 levels and the urine micro albumin,Urine beta 2 micro albumin,24 h urine protein were negative correlation(P<0.01 or P<0.05);the 25(OH)D3 levels and ESR,Ig G,Ig M,CRP were negative correlation(P<0.05).3.2.11 The effect of clinical curative effect from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE The total effective rate of two groups were no significant difference between the two groups(P>0.05);however,the study group was significantly higher than the control group(P<0.05).3.2.12 The effect of TCM symptom scores from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE After treatment,the scores of TCM symptom scores in the two groups were significantly lower than those before treatment(P<0.01 or P<0.05).Compared with the control group,the study group in improving patient in part of TCM symptom scores were significantly better than the control group(P<0.01 or P<0.05)3.2.13 The effect of SLEDAI score from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE The SLEDAI score of the two groups after treatment was lower than that before treatment(P<0.05).However,compared with the control group,there was no significant difference in SLEDAI score between the two groups(P > 0.05).3.2.14 The effect of the dimensions of quality of life and anxiety and depression scores from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE Compared with before treatment,two groups of patients after treatment of various dimensions of quality of life scores of gold increased,body was statistically significant between the two groups.(P < 0.01),two groups of patients after treatment of anxiety and depression were significantly decreased,and there was a significant difference between the two groups(P < 0.01);compared with the control group the study group,in improving the quality of life of each dimension score and anxiety integral was significantly better than the control group(P < 0.01).3.2.15 The effect of Complement system from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE After treatment,two groups of patients with serum C3 and C4 levels were significantly higher than before treatment,anti C1 q antibody significantly decreased,the difference between the two groups were statistically significant(P < 0.01);compared with the control group,anti C1 q antibody group in improving patients complement C3,C4 and significantly better than the control group(P < 0.01 or P < 0.05).3.2.16 The effect of blood and serum immunology index from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE After treatment,two groups of patients with WBC,RBC,HGB and PLT levels were significantly increased,and the difference was statistically significant(P < 0.01);compared with the control group,the study group in WBC,HGB and PLT were improved significantly better than the control group(P < 0.01).After treatment,two groups of serum immunological indexes in patients with ESR,Ig G,Ig A,Ig M,CRP were significantly decreased,the difference was statistically significant(P < 0.05);compared with the control group,the study group in ESR,Ig G,Ig M patients and CRP were better than the control group(P < 0.01 or P < 0.05).3.2.17 The effect of early renal damage index from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE After the treatment the urine micro albumin,Urine beta 2 micro albumin,24 h urine protein of two groups decreased significantly(P < 0.01);compared with the control group,the study group in improving patients with urine micro albumin,Urine beta 2 micro albumin,24 h urine protein were better than the control group,the difference was statistically significant(P < 0.05 or P < 0.01).3.2.18 The effect of bone turnover markers and 25(OH)D3 from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE Compared with before treatment,patients in the study group after treatment serum Ca,P,ALP and 25(OH)D3 levels increased significantly(P < 0.05 or P < 0.01),patients in the control group after treatment serum P,25(OH)D3 levels were increased significantly after treatment(P < 0.01);compared with the control group,the study group patients with Ca,P,ALP and 25(OH)D3 level is significantly better than the control group(P < 0.01 or P < 0.05).Two groups of patients after treatment levels in the OC and PINP was higher than before treatment(P < 0.01),the two groups after treatment CTX levels were significantly lower(P < 0.01);compared with the control group,the study group in improving with bone turnover markers OC,PINP and CTX were significantly better than the treatment group,the difference was statistically significant(P < 0.05 or P < 0.01).3.2.19 The effect of bone mineral density from the TCM of strengthening the spleen and complement the kidney combined with western medicine intervene the SLE After treatment,the two groups of patients with bone mineral density compared with before treatment,there was no significant change,the difference was no statistically significant(P > 0.05).4 Conclusion4.1 The bone metabolism damage throughout the whole process of SLE;4.2 The TCM etiology and pathogenesis of SLE and its bone metabolism damage is due to “Spleen and Kidney Deficiency”;The method of strengthening the spleen and complement the kidney is one of the TCM important treatment of SLE.4.3 The main causes of bone damage in patients with SLE were caused by inflammatory factors,immune factors,metabolic factors,drug factors and hormone levels,the granules of strengthening the spleen and complement the kidney can regulate bone metabolism by regulating immunity,inhibiting inflammation,inhibiting the formation and differentiation of osteoclasts and promoting the synthesis of osteoblasts.4.4 Correlation analysis showed that 25(OH)D3 levels of SLE patients and complement C3,C4 levels were positive correlation,the 25(OH)D3 levels and anti C1 q antibody levels was negative correlation;the 25(OH)D3 levels and ESR,Ig G,Ig M,CRP were negative correlation;the 25(OH)D3 levels and the early renal damage indexes were negative correlation.It is suggested that the level of 25(OH)D3 may be related to disease activity and early renal damage,and can be used as one of the indexes of clinical disease activity and early renal damage.4.5 The granules of strengthening the spleen and complement the kidney with western medicine can significantly increase bone metabolism index(Ca,P,ALP,25(OH)D3,OC,PINP)levels,reduce the levels of CTX in the patients with SLE;it can reduce the anti C1 q antibody levels,increased the levels of complement C3 and C4,lower indicators of early renal damage of urine micro albumin,24 h urine protein and the levels of serum immune indexes of ESR,Ig G,Ig A,Ig M,CRP,elevated indicators of blood levels of WBC,RBC,HGB,PLT,which curative effect is better than that of simple western medicine group.4.6 The health survey of each dimension points was down and the scores of SAS and SDS were higher in SLE,it show that the quality of life significantly decreased in SLE.4.7 The clinical efficacy can be significantly improved by the granules of strengthening the spleen and complement the kidney with western medicine in SLE,and also can reduced the TCM symptoms integral value in fatigued spirit and lack of strength,lusterless complexion,palpitation and shortness of breath,soreness and weakness of waist and knees,aversion to cold,which curative effect is better than that of simple western medicine group.4.8 It can significantly improve the quality of life of SLE patients by the granules of strengthening the spleen and complement the kidney with western medicine,it can improve the quality of life,anxiety and depression scores in SLE,which curative effect is better than that of simple western medicine group. |
PDF Full Text Request