| Ankylosing spondylitis is a chronic progressive autoimmune inflammatory disease.Inflammation can lead to the destruction of joint structure and function,and can be associated with extra-articular manifestations.The rigidity of the lumbosacral pain mostly occurs in the early stage of AS,and spinal rigidity and deformity may occur in the late stage and affect the joint activity,which may have a significant impact on the quality of life of patients.OBJECTIVE:To compare the case-control study of the experimental group including the Feng Bi Formula joint thalidomide,celecoxib,with the control group containing thalidomide combined with celecoxib in the treatment of heat and dampness obstrustion sydrome ankylosing spondylitis.This study will discuss the characteristics and advantages of Feng Bi Formula combined with western medicine in the treatment of ankylosing spondylitis of damp-heat type from the aspects of clinical curative effect,biochemical index,imaging changes and adverse reaction.It will provide reliable evidence-based medicine for the treatment of this disease and investigate the expression of interleukin-17(IL-17)and interleukin-23(IL-23)in peripheral blood of patients with AS and its relationship and its activity with AS disease.This study will provide a theoretical basis for IL-23 and IL-17 as indicators of AS activity.METHODS:Sixty cases of rheumatism clinic and inpatient from Wuhan General Hospital of Guangzhou Military Region were selected and randomly divided into experimental group and control group of 30 cases respectively.The experimental group was treated with Feng Bi Formula combined with thalidomide and celecoxib,while the control group with thalidomide and celecoxib.Before and 3 months after the treatment,the TCM syndrome indexes,vital signs indexes(referring to the distance,pillow distance,Schober test,thoracic activity),Western medical efficacy index(Patient global assessment,BASDAI,BASFI index,VAS scores),laboratory parameters(Erythrocyte sedimentation rate,C-reactive protein,HLA-B27,IL-23,IL-17),sacroiliac joint MRI grading and safety indicators were observed respectively.Comparing the changes of various indexes,and the correlation between IL-23,IL-17 and erythrocyte sedimentation rate and C-reactive protein before and after the treatment.RESULTS:(1)There was no significant difference between the two groups before treatment(P> 0.05).After treatment,both groups were significantly improved(P <0.01),and the improvement in experimental group was better than that in control group(P <0.05).(2)Compared with traditional Chinese medicine,the effective rate of the experimental group(96.67%)was significantly higher than that of the control group(73.33%),the difference was statistically significant(P<0.05).(3)As to western medicine efficacy(PGA,BASDAI,BASFI and nighttime VAS score),there was no significant difference between the two groups before treatment(P> 0.05).Compared with the group before treatment,the indexes after treatment were significantly improved,the difference was statistically significant(P <0.01);The experimental group was better than the control group,the difference was statistically significant(P <0.05).(4)Compared with ASAS20 evaluation in Western medicine,the compliance rate of the experimental group(83.33%)was significantly higher than that of the control group(60%),the difference was statistically significant(P <0.05).(5)Compared with the vital signs(the activity of the thorax,Schober test,the distance between the pillow wall and the ground),there was no significant difference between the two groups before treatment(P> 0.05).Compared with the group before treatment,the thoracic activity of the experimental group and the Schober test in two groups were significantly improved(P <0.01),Whlie the thorax activity of the control group was not significantly improved,the difference was statistically significant(P <0.05).After treatment,the experimental group was better than the control group in improving the indicators,the difference was statistically significant(P <0.05).(6)There was no significant difference in CRP,ESR,IL-17,IL-23 and HLA-B27 between the two groups before and after treatment in the laboratory indicators(CRP,ESR,IL-17,IL-23 and HLA-B27)(P> 0.05).After treatment,CRP,ESR,IL-17 and IL-23 in the two groups decreased compared with those before treatment in the two groups(P<0.01),and the levels of IL-17 and IL-23 decreased lower than the control group(P <0.05).Compared with the group before treatment,there was no significant difference between the two groups after treatment of HLA-B27(P> 0.05).(7)Comparison of imaging indicators.There was no significant difference in MRI grading of sacroiliac joint between the two groups before and after treatment,the difference was not statistically significant(P> 0.05).(8)Compared with the safety index,the incidence of adverse reactions in the control group(40%)was significantly higher than that in the experimental group(13.33%),the difference was statistically significant(P <0.05).(9)Comparing the correlation with disease activity between IL-17 and IL-23 and IL-17 and IL-23 were positively correlated with disease activity factors such as CRP and ESR.The difference was statistically significant(P <0.05).CONCLUSION:(1)Feng Bi Formula combined with Western medicine in the treatment of heat and dampness obstrustion sydrome ankylosing spondylitis can significantly improve TCM syndrome scores,vital signs,laboratory indexes,and the effect is better than simple western medicine group.(2)The incidence of adverse reactions in the experimental group was better than that of the control group,indicating that the safety of Feng Bi Formula combined with western medicine in the treatment of AS was superior to that of western medicine alone.(3)IL-17 and IL-23 in the peripheral blood of patients with ankylosing spondylitis during the active phase showed a high expression status,which was positively correlated with the activity index of ankylosing spondylitis disease.This may provide a theoretical basis for IL-23,IL-17 as an active index of ankylosing spondylitis. |
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