Study On The Clinical Effect Of The TCM Strengthening The Spleen And Complement The Kidney On SLE And The Mechanism Of Hoemone Reduction Withdrawal

1.Objective To observe the laboratory indexes of Adrenocorticotropic hormone(ACTH),Cortisol(CS),Macrophage migration inhibitory factor(MIF),and interleukin-17(Il-17)inpatients with SLE,there are also changes in the activity index of Systemic Lupus Erythematosus(SLE-DAI),TCM symptom score,clinical efficacy,anxiety and depression score and quality of life,to probe into the influence of strengthening spleen and complement kidney method on the clinical efficacy of SLE and its correlation analysis,and to study the mechanism of hormone reduction withdrawal in the treatment of SLE.2 Methods 2.1 Theoretical Analysis Combined with clinical research through a large number of relevant literature,exploring ACTH,CS,MIF,IL-17 in SLE patients Based on the theory of traditional Chinese medicine(TCM),this paper analyzes the relationship between the etiologyand pathogenesis of SLE and the spleen and kidney,discusses the relationship between the deficiency of spleen and kidney and glucocorticoid therapy,and expounds the theoretical basis of treating SLE patients from the spleen and kidney.2.2 Clinical Research 2.2.1 Comparison and correlation analysis of serum ACTH,CS,MIF,IL-17 and other related indexes in SLE patients: Twenty healthy women were selected as the healthy control group from the physical examination personnel of the physical examination center of Anhui Hospital of traditional Chinese medicine.Compared with SLE group,there was no significant difference in age,course of disease and other general information between the two groups(P<0.01).The serum ACTH,CS,MIF,IL-17 and other indicators were detected by enzyme-linked immunosorbent assay(ELISA).The blood routine(WBC,RBC,HGB,PLT)and inflammatory immunology index(ESR,CRP,Ig A,Ig G,Ig M),urine protein(Urine MA,?2-MG,24 h Pro),complement C3,C4,anti-C1 q antibody and other indicators were detected by automatic biochemical instrument.SPSS21.0 was used as the software of data statistical analysis.2.2.2 The effect of invigorating the spleen and nourishing the kidney therapy on the clinical efficacy and hormone reduction withdrawal of SLE patients: SLE patients were selected from the out-patients and in-patients of Anhui Traditional Chinese Medicine Hospital,all the 60 cases were in accordance with the classification standard of SLE established by American College of Rheumatology(ACR)in 1997 or the classification standard of SLE revised by SLCC in 2009,and the SLE-DAI score was in the range of 0?14 points.The Syndrome type of TCM was deficiency of both spleen and kidney.Sixty SLE patients were randomly divided into two group.The Control Group was only treated with Western medicine(hormone and hydroxychloroquine),while the treatment group was treated with Jianpi Zishen formula orally on the basis of Western medicine,the general data of the two groups were comparable before Treatment(P>0.05).The changes of ACTH,CS,MIF and IL-17,disease activity,SF-36 scores,anxiety and depression scores and TCM symptom scores were observed and compared between two groups after treatment.3 Results 3.1 Theoretical Analysis 3.1.1 ACTH,CS and MIF,IL-17 are closely related to the occurrence and development of SLE,disease activity and hormone reduction withdrawal;3.1.2 Deficiency of spleen and kidney in traditional Chinese medicine is the key etiological factor and pathogenesis of SLE;3.1.3 Deficiency of spleen and kidney is closely related to the treatment of SLE with Glucocorticoid;3.1.4 Invigorating the spleen and nourishing the kidney is one of the major methods in the treatment of SLE;3.1.5 Invigorating the spleen and nourishing the kidney can improve the clinical curative effect and the quality of life of SLE patients,it's good for hormone reduction withdrawal.3.2 Clinical efficacy 3.2.1 Comparison of serum ACTH,CS,MIF,Il-17 between SLE group and healthy control group Compared with the healthy control group,the serum ACTH and CS levels of SLE patients were significantly lower(P<0.01),and the levels of MIF and IL-17 increased significantly(P<0.01).3.2.2 Comparison of blood routine indexes(WBC,RBC,HGB,PLT)between SLE group and healthy control group Compared with the healthy control group,the blood routine indexes WBC,RBC,HGB,PLT of SLE patients group were significantly lower(P<0.01).3.2.3 Comparison of anti-C1 q antibodies and complement C3,C4 between SLE group and healthy control group Comparison between the two groups,the levels of complement C3 and C4 in SLE group were significantly lower than that in the healthy control group(P<0.01).The level of anti-C1 q antibody was significantly higher than that of the healthy control group(P< 0.01).3.2.4 Comparison of 24 h Pro,urinary MA and urinary ?2-MG between SLE group and healthy control group Comparison between the two groups,the urinary MA,?2-MG and 24 h Pro in SLE group were significantly higher than that in the healthy control group(P<0.01).3.2.5 Comparison of inflammatory and immunological indicators(ESR?CRP?Ig G?Ig A?Ig M)between SLE group and healthy control group Comparison between the two groups,the ESR,CRP,Ig G,Ig A and Ig M were significantly higher in SLE group than in healthy control group(P<0.05 or P<0.01).3.2.6 Comparison of SF-36 scores,SAS and SDS scores between SLE group and healthy control group Compared with the healthy control group,the scores of seven dimensions of SF-36 questionnaire in SLE patients were significantly lower,and the scores of SAS and SDS in SLE patients were significantly higher,the difference was statisticall y significant(P<0.01).3.2.7 Correlation between serum levels of ACTH,CS,MIF and Il-17 in SLE patients and various indexes of complement,urine protein and inflammatory immunology(1)The levels of ACTH and CS in SLE patients were positively correlated with the levels of C3 and C4(P<0.01),while ACTH was negatively correlated with anti-C1 q antibody(P<0.05).In addition,the levels of MIF and IL-17 in SLE patients were negatively correlated with the levels of C3 and C4(P<0.01 or P<0.05),and IL-17 was positively correlated with anti-C1 q antibody(P<0.05).(2)The levels of ACTH and CS in SLE patients were negatively correlated with 24 h Pro and urinary MA(P<0.01 or P<0.05).In addition,the level of IL-17 was positively correlated with 24 h Pro and urinary MA(P<0.01),and the level of MIF was positively correlated with urinary ?2-MG(P<0.05).(3)There was a negative correlation between the levels of ACTH,CS and ESR,CRP,Ig G and Ig M(P<0.05 or P <0.01),but no significant correlation between ACTH,CS and Ig A.The serum levels of MIF and IL-17 were positively correlated with ESR,CRP,Ig G and Ig M(P<0.05 or P<0.01),but not with Ig A.3.2.8 The effect of spleen-tonifying and kidney-tonifying therapy on the clinical efficacy of SLE patients and other relevant indicators as well as hormone reduction withdrawal In the treatment group of Jianpi Zishen recipe combined with western medicine,the clinical effect of the patients was significantly improved,and the indexes of CS,WBC,RBC,HGB,PLT,C3,C4 and SF-36,as well as the indexes of MIF,IL-17,ESR,CRP,Ig G,Ig A,Ig M,anti-C1 q antibody,urine MA,?2-MG,24 h Pro,SLE-DAI score,TCM symptom score,anxiety and depression score were significantly improved;Moreover,compared with single in the pure western medicine control group,the treatment group has obvious advantages in reducing MIF,IL-17,ESR,CRP,Ig G,Ig M,anti-C1 q antibody,urine MA,?2-MG,24 h Pro and other indicators,improving ACTH,CS,WBC,HGB,PLT,complement C3,C4 and other indicators,and in improving clinical efficacy,the vast majority of TCM symptoms,anxiety and depression,quality of life and other aspects,which is significantly conducive to hormone withdrawal to improve the long-term prognosis.The results showed that the method of invigorating the spleen and nourishing the kidney combined with western medicine was more effective in the treatment of SLE,and was more conducive to the reduction of hormone in the long run.4 Conclusion 4.1 The etiology and pathogenesis of lupus and the related symptoms after hormone withdrawal can be explained by "deficiency of spleen and kidney",which provides theoretical basis for invigorating the spleen and nourishing the kidney as the key treatment;4.2 The serum ACTH,CS,MIF and IL-17 in lupus patients are closely related to the pathogenesis,disease activity,HPA axis function and GC resistance of SLE.The withdrawal of SLE hormone is related to the levels of ACTH,CS,MIF and IL-17;4.3 The clinical effect of strengthening the spleen and nourishing the kidney method combined with western medicine on SLE is obviously better than that of western medicine control group;4.4 The spleen and nourishing the kidney method combined with Western medicine can significantly increase CS levels in SLE patients and significantly reduce MIF,IL-17 and other indicators,and increase WBC,HGB,PLT,C3,C4 and reduce ESR,Ig G,Ig M,The degree of CRP,anti-C1 q,urinary MA,?2-MG and 24 h Pro is better than that of the western medicine group alone,indicating that the method of strengthening the spleen and nourishing the kidney is beneficial to the improvement of the adrenal cortical function of SLE patients,and the improvement of GC resistance caused by the increase of MIF and IL-17.Conditions,can help reduce hormones;4.5 Invigorating the spleen and nourishing the kidney combined with western medicine can alleviate the adverse effects of long-term use of hormones,and reduce the possible occurrence of hormone reducion withdrawal(deep fatigue,palpitations,shortness of breath,less breathlessness,soft waist and knees,cold chills,etc.)Symptom points such as Qi deficiency and Yin deficiency are better than those of the western medicine group alone,which is conducive to hormone withdrawal;4.6 Strengthening the spleen and complement the kidney method combined with western medicine can significantly reduce the SLE-DAI score,TCM symptom score and anxiety and depression score,improve the patient's SF-36 scores in various dimensions,help to improve patients' quality of life and clinical efficacy,control disease development,and benefit hormones Reduction.