Effect Of Xinfeng Capsule On Expression Of ICAM-1 And VCAM-1 In Peripheral Blood Of RA Patients

1 ObjectiveThe purpose of this study is to explore the effect of Xinfeng Capsule(XFC)on rheumatoid arthritis(RA)disease activity.The therapeutic effect is determined through the monitoring of experimental indicators and clinical symptoms,and through the detection of adhesion molecules(ICAM)before and after treatment.The levels of VCAM-1 and cytokines(TNF-α,IL-1β),to explore the possible mechanism of XFC in the treatment of RA from the perspective of adhesion molecules.2 Methods2.1 Theoretical AnalysisSearch the relevant literature in Chinese and English databases,and read related books to find the connection between ICAM-1,VCAM-1 and RA,as well as their relationship with spleen deficiency,and find the theoretical basis for the treatment of the spleen.2.2 Clinical research2.2.1 Research on the changes and correlation of related indicators between RA patients and healthy people: Twenty healthy people were selected from our hospital as controls.All of them came from the physical examination center.There was no significant difference in general data(P>0.05).Two groups of ICAM-1,VCAM-1,TNF-α,IL-1β were detected.2.2.2 The clinical efficacy study of XFC in the treatment of RA: We selected 60 RA patients who met the RA classification and diagnostic criteria jointly launched by ACR/EULAR in 2010,from August 2019 to December 2020.The control group was treated with leflunomide orally,and the study group was treated with Xinfeng Capsule.Observe the changes of ICAM-1,VCAM-1,RF,CCP,ESR,CRP,DAS-28,TCM syndrome score and quality of life score before and after treatment in the two groups.3 Results3.1 Theoretical research results(1)ICAM-1 and VCAM-1 are closely related to RA;(2)TNF-α and IL-1 β are closely related to RA;(3)Peripheral blood ICAM-1 and VCAM-1 of RA patients are closely related to the syndrome of "spleen deficiency" in traditional Chinese medicine;(4)Treating from the spleen is one of the key treatments for RA.3.2 Clinical research results3.2.1 Comparison of serum ICAM-1,VCAM-1,TNF-α,IL-1β and immune laboratory indexes between RA group and healthy control group:ICAM-1,VCAM-1,TNF-α,IL-1β levels in RA patients are all higher than healthy people(P<0.01);immune indexes RF,CCP,IgG,CRP,ESR are also higher in RA group;but C3,C4,There was little difference in IgM and IgA levels between the two groups(P>0.05).3.2.2 Correlation study of peripheral blood ICAM-1,VCAM-1 levels and other related indexes in RA group(1)The correlation study of peripheral blood ICAM-1 and VCAM-1 levels with TNF-α and IL-1β in RA group: P<0.01,ICAM-1 and VCAM-1 were positively correlated with TNF-α and IL-1β.(2)Study on the correlation between peripheral blood ICAM-1 and VCAM-1 levels and serum immune blood indicators and DAS-28 in RA group: ICAM-1 and VCAM-1 were positively correlated with RF,DAS-28,CRP,and ESR(P< 0.05 or P<0.01),no correlation with IgG,IgA,IgM,C3,C4 levels(P>0.05);ICAM-1 is positively correlated with CCP(P<0.05),VCAM-1 has no correlation with CCP(P >0.05).(3)The correlation study of serum TNF-α and IL-1β levels with immunological laboratory indexes and DAS-28 in RA group: TNF-α,IL-1β and RF,DAS-28,ESR are all positively correlated(P<0.05 or P <0.01),no correlation with CCP,IgG,IgA,IgM,C3,C4(P>0.05);TNF-α is positively correlated with CRP(P<0.05),VCAM-1 is not correlated with CRP(P>0.05)).(4)Study on the correlation between the levels of ICAM-1 and VCAM-1 in peripheral blood and TCM syndrome scores in the RA group: ICAM-1 was positively correlated with loose stools and joint swelling(P<0.05),and was negatively correlated with post-eating abdominal distension(P<0.05),VCAM-1 level is positively correlated with joint swelling,joint pain,loose stools(P<0.05);both of them are related to morning stiffness,joint tenderness,joint heaviness,loss of appetite,fatigue and lack of breath There was no correlation between speech and abdominal distension after eating(P>0.05).3.2.3 XFC clinical efficacy and changes in related indicatorsAfter 12 W treatment,the total effective rate of the two groups was 83.3% after LEF treatment and 86.7% after XFC treatment.Although the total effective rate of XFC was slightly higher than that of LEF,the difference was not significant(P>0.05).(1)Effect of Xinfeng Capsule on ICAM-1 and VCAM-1 Levels in Peripheral Blood of RA PatientsAfter treatment,ICAM-1 and VCAM-1 decreased in both groups(P<0.01).Compared with the two groups,P<0.01,the decrease in the study group was more obvious.(2)Effect of Xinfeng Capsule on the levels of TNF-α and IL-1β in RA patientsAfter treatment,the levels of TNF-α and IL-1β in the two groups decreased(P<0.01).Compared between the groups,P<0.01,and the decrease in the study group was more obvious.(3)Effect of Xinfeng Capsule on Serum Immunological Index and DAS-28 Score of RA PatientsAfter treatment,RF,CCP,ESR,CRP,IgG,IgM,and DAS-28 decreased in the two groups(P<0.01),and ESR,CRP,IgG,DAS-28 in the study group decreased more significantly(P<0.05).(4)Influence of Xinfeng Capsule on TCM Syndrome Score of RA Patients.After treatment,in the two groups,morning stiffness and joint tenderness were not significantly improved compared to before treatment(P>0.05),and the other TCM scores were reduced(P<0.05 or P<0.01),and the decrease in the study group was more significant(P<0.05 or P<0.01).(5)Influence of Xinfeng Capsule on the Quality of Life of RA Patients.After treatment,the quality of life scores of the two groups improved(P<0.01).Except for the mental function scores and health self-recognition ability,the study group improved significantly compared with the control group(P<0.01).4 Conclusion(1)The onset of RA is related to the expression levels of ICAM-1 and VCAM-1 in peripheral blood;(2)The incidence of RA is related to the levels of serum TNF-α and IL-1β;(3)Peripheral blood ICAM-1,VCAM-1,TNF-α,IL-1β levels in RA patients are closely related to the "spleen deficiency" in traditional Chinese medicine;(4)"Strengthening the spleen,dissipating dampness and dredging collaterals" is one of the key treatments for RA;(5)Xinfeng Capsule treats rheumatoid arthritis from the spleen,and its clinical efficacy is equivalent to that of leflunomide;(6)Xinfeng Capsule can reduce the expression levels of ICAM-1 and VCAM-1 in peripheral blood of patients,and the curative effect is better than leflunomide;(7)Xinfeng Capsule can reduce the levels of serum TNF-α,IL-1β,serum immunological indicators(RF,CCP,ESR,CRP,IgG)and DAS-28,indicating that XFC can alleviate the disease activity of RA patients and delay disease progression;(8)Xinfeng Capsule can effectively improve the TCM syndrome score of RA patients,indicating that XFC treats the spleen and can effectively improve the clinical symptoms of RA;(9)Xinfeng Capsule can improve the quality of life scores of RA patients,suggesting that XFC can improve the quality of life of RA patients and improve their survival status;(10)Xinfeng Capsule may inhibit the expression of ICAM-1 and VCAM-1 in RA patients,inhibit cell recruitment,down-regulate the levels of TNF-α and IL-1β,and inhibit inflammation,thereby improving the clinical symptoms and inflammatory indicators of RA patients.