目的 观察白芍总苷治疗原发性干燥综合征的疗效及不良反应。 方法 收集2008年1月－2012年1月诊断的原发性干燥综合征患者48例，使其口服白芍总苷0.3～0.6 g，3次/d，疗程6个月，对比治疗前后患者的临床症状及唾液腺功能（唾液腺核素显像定量分析）改善情况、泪液分泌试验（Schirmer试验）、血沉、C反应蛋白、血清γ球蛋白（采用琼脂糖凝胶电泳法）的改善情况，并记录可能的不良反应。 结果 经过6个月的治疗，患者的临床症状、血沉、C反应蛋白、血清γ球蛋白等方面情况有所改善，差异有统计学意义（P＜0.05）。但唾液腺功能、Schirmer试验改善不明显，差异无统计学意义（P＞0.05）。 结论 白芍总苷在改善原发性干燥综合征临床症状及实验室指标疗效好，不良反应少，但在改善唾液腺功能及泪腺功能疗效欠佳。
Objective To discuss the rules of using traditional Chinese medicine (TCM) to treat systemic lupus erythematosus (SLE) and Sjögren syndrome (SS). Methods The TCM prescriptions for patients with SLE or SS treated at the Department of Rheumatology of Longhua Hospital, Shanghai University of Traditional Chinese Medicine between January 2013 and July 2021 were collected. The prescriptions collected were broken down and analyzed for frequencies of the efficacies, properties, flavors and meridian tropisms of drugs in the prescriptions. The correlation and clustering analysis was performed in VOSviewer software. Results The medication information of 3689 cases of inpatients was included, from which 69167 pieces of data of using TCM prescriptions were extracted. The top 20 high-frequency drugs for treating SLE patients were mainly drugs for promoting blood circulation and removing blood stasis, qi-tonifying drugs, and drugs for heat clearing and detoxicating, which were mostly sweet, bitter or acrid in flavor, cold, warm or neutral in properties, and of the spleen, liver or stomach meridian. The drugs could be seperated into 3 clusters, the blue cluster mainly included qi-tonifying drugs, blood-tonifying drugs, and drugs for promoting blood circulation and removing blood stasis; the green cluster mainly included drugs for heat clearing and drugs for promoting blood circulation and removing blood stasis; and the red cluster mainly consisted of drugs for promoting blood circulation and removing blood stasis, drugs for inducing diuresis and alleviating edema, drugs for dispelling wind-heat, and digestant drugs. The top 20 high-frequency drugs for treating SS patients were mainly drugs for promoting blood circulation and removing blood stasis, qi-tonifying drugs, and drugs for inducing diuresis and alleviating edema, which were mostly sweet, bitter or acrid in flavor, slightly cold, cold or warm in properties, and of the spleen, stomach or liver meridian. The drugs could be seperated into 2 clusters, the green cluster mainly consisted of yin-tonifying drugs, drugs for promoting blood circulation and removing blood stasis, and drugs for heat clearing; the red cluster mainly included qi-tonifying drugs, drugs for promoting blood circulation and removing blood stasis, and drugs for inducing diuresis and alleviating edema. Conclusions The medication for SLE is in line with the treatment principle of “supplementing qi and nourishing yin, detoxicating and removing stasis”; the medication for SS, on the other hand, agrees with the basic rule of “nourishing yin and clearing away heat, promoting body fluid to moisten dryness”. Both are based on the approach of strengthening the body resistance, which is in line with the diagnostic and treatment ideas of rheumatology department and may offer the ideas of TCM syndrome differentiation for clinical use of drugs and thereby guiding the current clinical practice.
Objective To investigate the current situation of randomized controlled trials (RCTs) on the treatment of Sjogren’s syndrome with Traditional Chinese Medicine (TCM), and to assess whether there is adequate evidence for clinical practice. Methods Such databases as CNKI, VIP, CBM and PubMed were searched from their establishment date to June 2010 to collect the RCTs on the treatment of Sjogren’s syndrome with TCM according to the predefined inclusion criteria. And the quality was assessed by using the Jadad scale, the revised CONSORT statement and other self-defined indexes.Results Among 19 included RCTs, 1 literature scored four points, 4 scored two points, 13 scored one point, and 1 scored zero point according to Jadad scale; no RCT performed the allocation concealment. According to the CONSORT criteria, 19 RCTs accounting for 100% reported the diagnostic criteria, implement of interventions and result, 11 RCTs applied the 2002 international diagnosis and classification criteria of Sjogren’s syndrome, 17 RCTs carried out positive control including one based on the standard treatment, and two RCTs applied only blank control without placebo control. All RCTs took the comprehensive efficacy assessment as the outcome index, but only 6 RCTs (31.6%) assessed both clinical efficacy and TCM syndrome efficacy. Among 6 RCTs (31.6%) describing the random sequence, no RCT reported the detailed methods. Except 1 RCT (5.3%) carried out the double blinding, all the others were non-blind trials. And only 1 RCT adopted analog. Conclusion Currently, the methodology and reporting quality of studies on the treatment of Sjogren’s syndrome with TCM are not good enough to provide reliable evidence for clinical practice.
Objective To detect the expression levels of ERdj5 and XBP1 in the salivary glands of patients with primary Sjögren syndrome (pSS), and analyze the correlation of the expression levels of ERdj5 and XBP1 with salivary gland damage and oral symptoms to explore their significance in the pathogenesis of pSS. Methods A total of 60 pSS patients in the departments of rheumatology and immunology of Xi’an Honghui Hospital and Qinghai Provincial People’s Hospital between January 2020 and June 2021were randomly selected as the case group, and 20 healthy participants in Qinghai Provincial People’s Hospital in the same period were randomly selected as the control group. The mRNA and protein expression levels of ERdj5 and XBP1 in salivary gland tissues were detected by reverse transcription-polymerase chain reaction and Western blot, respectively, and their correlation with histopathology, salivary flow rate, dry mouth degree, and clinical test indicators were analyzed. Results The mRNA and protein expression levels of ERdj5 and XBP1 in the case group were higher than those in the control group (P<0.001). The ERdj5 mRNA expression was positively correlated with the XBP1 mRNA expression in the case group (rs=0.936, P<0.001). The expression levels of ERdj5 mRNA and XBP1 mRNA in the case group were positively correlated with the pathological grade of labial gland (rs=0.344, P<0.001; rs=0.401, P<0.001), dry mouth degree (rs=0.683, P<0.001; rs=0.730, P<0.001), anti-Ro/SSA antibody (rs=0.363, P<0.001; rs=0.350, P<0.001), anti-La/SSB antibody (rs=0.506, P<0.001; rs=0.471, P<0.001), and European League Against Rheumatism Sjogren’s Syndrome Disease Activity Index (rs=0.782, P<0.001; rs=0.865, P<0.001), and were negatively correlated with salivary flow rate (rs=–0.445, P<0.001; rs=–0.526, P<0.001). Conclusion The expression levels of ERdj5 and XBP1 in salivary glands are increased in pSS patients, and they are related to disease activity, anti-Ro/SSA and anti-La/SSB autoantibodies, damage degree of salivary gland and oral symptoms of patients.
目的 探讨原发性干燥综合征周围神经病变的发生与干燥综合征A型/B型抗体（抗SSA/SSB抗体）的关系。 方法 纳入2009年1月－2011年12月期间门诊及住院收治的原发性干燥综合征患者88例。所有患者均接受神经系统检查，采用蛋白质印迹法检测抗SSA抗体和抗SSB抗体，利用全自动化学发光仪检测血清维生素B12水平。 结果 88例原发性干燥综合征患者中有27例（30.7%）存在周围神经病变。有或无周围神经病变的患者在年龄、性别、病程等一般情况方面无明显不同。有周围神经病变和无周围神经病变的原发性干燥综合征患者抗SSA抗体阳性率分别为70.4%（19/27）、70.5%（43/61），差异无统计学意义（χ2=0.000，P=0.991）；抗SSA/SSB抗体双阳性率分别为63.0%（17/27）、14.8%（9/61），差异有统计学意义（χ2=17.416，P=0.000）；血清维生素B12水平分别为（390 ± 55）、（410 ± 86）pg/dL，差异无统计学意义（t=0.908，P=0.370）。 结论 周围神经病变在原发性干燥综合征患者中较常见，且周围神经病变的发生多伴随血清抗SSA/SSB抗体阳性。