| 1.Obiective Observation on the Treatment of Systemic Lupus Erythematosus(SLE)with Adrenol-cortico-tropic-hormone(ACTH)and Serum Cortisol(CS),Systemic Lupus Erythematosus Disease in strengthening the spleen and complement the kidney changes in SLE disease activity index(SLE-DAI)scores,quality of life,anxiety,and depression,etc.To investigate the mechanism of strengthening the spleen and complement the kidney on adrenocortical function,hypothalamic-pituitary-adrenal axis,and related factors Sex analysis and study of the relationship between hormone withdrawal in SLE patients.2 Methods2.1 Theoretical Analysis Through a large number of literature studies,the relationship between adrenocortical function impairment and spleen and kidney deficiency in SLE patients was analyzed.The etiology and pathogenesis of TCM patients with adrenocortical function impairment were summarized.The basic theory of SLE patients with adrenocortical function impairment treated from spleen and kidney was analyzed.in accordance with.2.2 Clinical Research2.2.1 Changes in laboratory parameters of the hypothalamus-pituitary-adrenal axis of SLE patients and their correlation studies: The healthy control group consisted of 20 women,all from the Health Examination Center of the First Clinical Medical College of Anhui University of Traditional Chinese Medicine.Radioimmunoassay was used to detect changes in serum ACTH and CS in healthy controls and SLE patients,17-hydroxy-cortico-steroid(17-OHCS),and urinary 17-ketosteroids(17-ketosteroide,17).Changes in-KS)were measured using automated biochemical analyzers for white blood cells,red blood cells,hemoglobin,platelets,ESR,C-reactive protein,complement C3,complement C4,urinary albumin,and 24-hour urinary protein levels in healthy controls and SLE patients.Liver and kidney function,immunoglobulin A, immunoglobulin G,immunoglobulin M and other general laboratory conditions.SPSS22.0 software was used for statistical analysis.2.2.2 The effect of strengthening the spleen and complement the kidney combined with Western medicine on clinical efficacy,related laboratory indicators and quality of life of SLE patients: 60 patients with outpatient and inpatient SLE were selected from the First Clinical Medical College of Anhui University of Traditional Chinese Medicine.Selected from December 2016 to September 2017,60 SLE patients met the revised classification criteria of the American College of Rheumatology(ACR)in 1997 or 2009.Kidney deficiency syndrome in patients with mild to moderate SLE(5 ? SLE-DAI ? 14 points).Using SAS statistical software to obtain a random number table for randomization into Chinese medicine treatment group of 30 cases(The strengthening the spleen and complement the kidney Decoction + prednisone tablets + hydroxychloroquine sulfate)and control group of 30 cases(prednisone tablets + hydroxychloroquine sulfate)There was no statistically significant difference in the general data between the treatment group and the control group before participating in the treatment.(age,sex,duration,condition,etc.)(P>0.05),and they were comparable.A simple health assessment scale(Short Form-36,SF-36),anxiety self-rating scale,self-rating depression scale,TCM symptom grading standard,SLE-DAI score and related laboratory test methods were used to observe the two groups before and after treatment.Quality of life,anxiety and depression,TCM symptom scores,disease activity,serum ACTH and CS changes,17-OHCS,17-KS,urinary albumin,24 h urinary protein quantification,and general laboratory index improvement.3 Results3.1 Theoretical Analysis Results3.1.1 The hypothalamus-pituitary-adrenal axis is closely related to the occurrence of SLE disease;3.1.2 The impairment of adrenocortical function is an important manifestation of the symptoms of TCM syndromes of spleen and kidney deficiency;3.1.3 The medical pathogenesis in SLE is related to the deficiency of spleen and kidney;3.1.4 "The strengthening the spleen and complement the kidney" is one of the effective means of clinical treatment of SLE;3.1.5 The treatment of SLE with strengthening the spleen and complement the kidney method can effectively withdraw the dosage of hormone;3.1.6 The treatment of SLE with strengthening the spleen and complement the kidney method has a protective effect on the hypothalamus-pituitary-adrenal axis.3.2 Clinical research results3.2.1 Changes of serum ACTH and CS in patients with SLE and healthy controls The serum levels of ACTH and CS in SLE patients were lower than those in healthy controls,with statistical differences(P<0.01).3.2.2 Change of urine 17-OHCS and urine 17-KS in SLE patients and healthy control group The levels of urinary 17-OHCS and urine 17-KS in the serum of SLE patients were lower than those in the healthy group,with statistical differences(P<0.01).3.2.3 Changes of Serum Complement C3,C4,Anti-C1 q Antibody in SLE Patients and Healthy Control Patients The levels of complement C3 and C4 in serum of SLE patients were lower than those in healthy subjects(P<0.01).The anti-C1 q antibody levels in serum of SLE patients were higher than those in healthy subjects.There was statistical difference between the two groups.Significance(P<0.01).3.2.4 Changes of urinary microalbumin,urinary total protein,urine ?2 microglobulin,24 h urinary protein in patients with SLE and healthy controls The urinary microalbumin,total urinary protein,urinary ?2 microglobulin and24-hour urinary protein levels in patients with SLE were higher than those in the healthy group,and there was statistical difference between the two groups(P<0.01).3.2.5 Changes of Blood Routine Indexes(WBC,RBC,HGB,PLT)in SLE Patients and Healthy Control Groups The serum levels of WBC,RBC,HGB and PLT in the patients with SLE were lower than those in the healthy group,and there was statistical difference between the two groups(P<0.01).3.2.6 Changes of Ig G,Ig A,Ig M,ESR,CRP in SLE patients and healthy controls The related immunological parameters in the blood of SLE patients,ESR,Ig G,Ig A,Ig M,CRP were all higher than those in the healthy group.and there was statistical difference between the two groups(P<0.01).3.2.7 Changes of anxiety and depression in the norm group of SLE patients The scores of anxiety and depression in SLE patients were significantly higher than those in healthy controls,with statistical significance(P<0.01).3.2.8 Correlativity between serum ACTH,CS and various indexes in patients with SLE(1)Correlativity analysis between cortisol function serum ACTH,CS and complement C3,C4,anti-C1 q antibodies in patients with SLE Correlation analysis showed that serum ACTH levels in patients with SLE were positively correlated with complement C3 and C4 levels(P<0.01)and negatively correlated with anti-C1 q antibodies(P<0.01);serum CS levels in SLE patients and complement C3,There was a positive correlation between C4 levels(P<0.01)and no significant correlation with anti-C1 q antibodies.(2)Correlation analysis of cortisol function serum ACTH,CS and urinary microalbumin,urinary total protein,urine ?2 microglobulin,24 h urinary protein quantification in patients with SLE Correlation analysis showed that serum ACTH levels in patients with SLE were negatively correlated with early renal impairment in patients with SLE(P<0.05 or P<0.01).(3)Correlativity analysis between serum ACTH,CS and immunological parameters(Ig G,Ig A,Ig M,ESR,CRP)in patients with SLE By correlation analysis,serum ACTH in SLE patients was negatively correlated with patients' ESR,Ig G,Ig M,and CRP levels(P<0.01);CS in serum of SLE patients was negatively correlated with patients' ESR,Ig G,Ig M,and CRP levels(P<0.05 or P<0.01).3.2.9 Effect of the strengthening the spleen and complement the kidney Prescription Combined with Western Medicine on Clinical Efficacy and Related Laboratory Parameters of SLE The strengthening the spleen and complement the kidney prescription can significantly improve the clinical efficacy,and can significantly reduce the ESR,Ig G,Ig A,Ig M,CRP,urine microalbumin,urinary ?2 microglobulin,anti-C1 q antibody and other indicators,increase WBC,RBC,HGB,PLT,Ig M,C3,C4,serum CS,urine17-OHCS,urine 17-KS,in addition can significantly improve the quality of life of SLE patients,anxiety and depression and TCM symptoms;The strengthening the spleen and complement the kidney prescription combined with Western medicine in clinical efficacy,improve adrenal cortex Functional,quality of life,some symptoms of traditional Chinese medicine,anxiety and depression,and some laboratory indicators,reducing the scores of SLE disease activity scores are better than Western medicine alone;The strengthening the spleen and complement the kidney prescription combined with western medicine is superior to Western medicine in the reduction of glucocorticoids;There was no adverse drug reaction between the strengthening the spleen and complement the kidney prescription and Western medicine treatment of SLE,suggesting that the comprehensive effect of the strengthening the spleen and complement the kidney Granules combined with Western medicine in the treatment of SLE is superior to western medicine.indicating that for the treatment of SLE patients,the use of spleen tonic kidney combined with Western medicine treatment is better.4 Conclusion4.1 Progress of SLE is closely related to adrenocortical hormone levels;4.2 The etiology and pathogenesis of SLE and its adrenocortical function abnormalities are closely related to the deficiency of spleen and kidney deficiency in traditional Chinese medicine,and Jianpizishen method is its main treatment principle.4.3 Adrenal cortical hormones ACTH,CS,urine 17-OHCS,urine 17-KS levels and blood routine indicators of WBC,RBC,HGB,PLT,complement system damage index C3,C4,C1 q antibodies,serum immunological parameters ESR,SLE patients Ig G,Ig M,CRP,and 24 h urinary protein quantification,urinary microalbumin,urinary total protein, and urinary ?2 microglobulin are closely related to early renal damage index,suggesting that hypothalamic-pituitary-adrenocortical axis activity may be imbalanced in SLE patients.The use of corticosteroids can affect hypothalamic-pituitary-adrenal cortical function,and iatrogenic adrenocortical insufficiency occurs.4.4 The strengthening the spleen and complement the kidney prescription combined with Western medicine treatment can significantly increase the serum CS level in SLE patients with SLE;there is no significant increase in serum ACTH,but after treatment was significantly better than the control group;reduce anti-C1 q antibody,increase complement C3,C4 Level,reduce the level of early kidney damage indicators(urine microprotein,24 h urinary protein,etc.),and reduce the serum immunological parameters(ESR,Ig G,Ig A,Ig M,CRP),increase WBC,RBC,HGB,PLT and other blood Academic indicators,and the efficacy is better than simple Western medicine group;4.5 ACTH,CS in serum of patients with SLE were positively correlated with complement C3,C4,anti-C1 q antibody,serum immunological parameters ESR,Ig G,Ig M,CRP,early renal damage index 24 h urinary protein quantification,urinary total protein,urinary microalbumin And urinary ?2 microglobulin was negatively correlated,suggesting abnormal HPAA function in SLE patients,The strengthening the spleen and complement the kidney method in the treatment of SLE at the same time on the hypothalamic-pituitary-adrenal axis protection,can stimulate and increase endogenous corticosteroids At the same time,it can effectively remove hormones.4.6 The scores of each dimension of the SLE patient health questionnaire(SF-36)were significantly lower than those of the normal module,SAS,SDS The scores were significantly higher than the normal ones,suggesting that there was a decline in the quality of life in SLE patients.4.7 The strengthening the spleen and complement the kidney prescription combined with Western medicine treatment of SLE is effective in improving the clinical efficacy of patients,effectively reducing the score of TCM symptoms,and the curative effect is better than that of western medicine group.4.8 The strengthening the spleen and complement the kidney prescription combined with Western medicine treatment of SLE improve the quality of life of patients with significant effect,improve the SF-36 scores in each dimension,reduce the SAS,SDS score,and the effect was significantly better than the Western medicine treatment group. |
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