Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of <italic style="font-style: italic">Bushen Zhiwang Decoction</italic>（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome

WANG Zihan; LIU Xiaojing; CHEN Yanyu; LAN Tianyi; YANG Huilan; YU Hongwei; TAO Qingwen; XU Yuan

doi:10.13288/j.11-2166/r.2026.05.011

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Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of Bushen Zhiwang Decoction（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome

更新时间：2026-05-19

- Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of Bushen Zhiwang Decoction（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome
- Journal of Traditional Chinese Medicine Vol. 67, Issue 5, Pages: 523-533(2026)
- 作者机构：
  
  1.北京中医药大学，北京市朝阳区北三环东路11号，100029
  2.中日友好医院
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2026.05.011
  CLC：
- Received：18 August 2025，
  
  Revised：2026-01-24，
  
  Published：02 March 2026
- 稿件说明：
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王子涵,刘晓晶,陈艳宇等.补肾治尪汤治疗类风湿关节炎肝肾不足证炎症缓解结局临床预测模型的构建与验证[J].中医杂志,2026,67(05):523-533.

WANG Zihan,LIU Xiaojing,CHEN Yanyu,et al.Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of Bushen Zhiwang Decoction（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome[J].Journal of Traditional Chinese Medicine,2026,67(05):523-533.
王子涵,刘晓晶,陈艳宇等.补肾治尪汤治疗类风湿关节炎肝肾不足证炎症缓解结局临床预测模型的构建与验证[J].中医杂志,2026,67(05):523-533. DOI： 10.13288/j.11-2166/r.2026.05.011.

WANG Zihan,LIU Xiaojing,CHEN Yanyu,et al.Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of Bushen Zhiwang Decoction（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome[J].Journal of Traditional Chinese Medicine,2026,67(05):523-533. DOI： 10.13288/j.11-2166/r.2026.05.011.

摘要

目的

基于代谢组学的炎症缓解程度构建补肾治尪汤治疗类风湿关节炎（RA）肝肾不足证患者炎症缓解结局的临床预测模型，并进行模型验证。

方法

采用前瞻性队列研究，选取60例RA肝肾不足证患者，均给予补肾治尪汤联合常规剂量的传统合成改善病情抗风湿药口服，疗程为12个月。收集临床相关资料，以治疗后28个关节疾病活动度（DAS28）评分较治疗前的变化值（△DAS28评分）作为主要结局指标及分组依据。治疗前采集外周血检测血浆代谢物，使用差异性检验和最小绝对收缩和选择算子（LASSO）回归分析初步筛选差异代谢物，进一步使用机器学习算法筛选核心代谢物组合，根据核心代谢物组合的表达水平计算出新的代谢物指数，即基于标准化代谢物的炎症缓解评分（Met-IRS），并判别其临床适用性。结合临床特征和Met-IRS构建临床预测模型，并评价模型效能。

结果

60例患者中△DAS28评分≥0.27分纳入炎症高缓解组，△DAS28评分＜0.27分纳入炎症低缓解组，每组30例。炎症高缓解组较炎症低缓解组甲氨蝶呤使用频率更高，类风湿因子（RF）阳性率更低（

＜0.05）。共筛选得到7种核心代谢物的最佳组合（包括芒果酸、脂肪酸-羟基脂肪酸酯 40∶6、脂肪酸-羟基脂肪酸酯 18∶0、脂肪酸-羟基脂肪酸酯 36∶1、葡萄糖神经酰胺、溶血磷脂酰胆碱 22∶5、孕烷三醇酮）。计算所得Met-IRS可整体概括差异代谢物特征，具有临床适用性，且炎症高缓解组Met-IRS高于炎症低缓解组，Met-IRS与患者炎症高缓解结局呈正相关关系（

＜0.05）。基于变量Met-IRS、是否使用甲氨蝶呤、是否使用来氟米特、是否RF阳性构建“RA治疗炎症缓解（Cj-RTRM）”临床预测模型，经模型效能验证其具有临床预测能力，且受试者工作特征曲线下面积（AUC）为0.880、灵敏度0.967、特异度0.700、约登指数0.667。

结论

基于Met-IRS构建的临床预测模型Cj-RTRM可有效预测补肾治尪汤治疗RA患者的临床炎症缓解结局，并精准识别补肾治尪汤治疗的优势人群，可为炎症动态监测、靶向管理及中医药优势人群的识别提供指导性证据。

Abstract

Objective

To construct and validate a clinical prediction model for inflammatory remission outcomes in rheumatoid arthritis （RA） patients with liver and kidney deficiency syndrome treated with

Bushen Zhiwang Decoction

（补肾治尪汤， BZD） based on metabolomics.

Methods

A prospective cohort study was conducted， enrol-ling 60 RA patients with liver and kidney deficiency syndrome. All patients were treated with BZD and conventional-dose oral conventional synthetic disease-modifying antirheumatic drugs （csDMARDs） for 12 months. Clinical data were collected， and the change in disease activity score in 28 joints （DAS28） after treatment compared with baseline （△DAS28） was used as the primary outcome and grouping criterion. Peripheral blood samples were collected before treatment to analyze plasma metabolites. Differential analysis and least absolute shrinkage and selection operator （LASSO） regression were used to preliminarily screen differential metabolites， followed by machine learning algorithms to further identify a core metabolite combination. Based on the expression levels of the core metabolite combination， a novel metabolite index， namely the metabolomics-based inflammatory remission score （Met-IRS）， was calculated using standar-dized metabolite values， and its clinical applicability was evaluated. A clinical prediction model was constructed by integrating clinical characteristics and Met-IRS， and the model performance was assessed.

Results

Among the 60 patients， those with △DAS28 ≥ 0.27 were assigned to the high inflammatory remission group， while those with △DAS28 ＜ 0.27 were assigned to the low inflammatory remission group， with 30 cases in each group. Compared to the low inflammatory remission group， the high inflammatory remission group showed a higher frequency of methotrexate use and a lower positive rate of rheumatoid factor （RF）（

＜0.05）. Seven core metabolites were identified as the optimal combination， including mangiferic acid， fatty acid-hydroxy fatty acid ester 40∶6， fatty acid-hydroxy fatty acid ester 18∶0， fatty acid-hydroxy fatty acid ester 36∶1， glucosylceramide， lysophosphatidylcholine 22∶5， and pregnanetriol ketone. The calculated Met-IRS comprehensively reflected the characteristics of differential metabolites and demonstrated clinical applicability. Met-IRS was significantly higher in the high inflammatory remission group than in the low inflammatory remission group， and was positively correlated with high inflammatory remission outcomes （

＜0.05）. Based on the variables Met-IRS， methotrexate use， leflunomide use， and RF positivity， a clinical prediction model for inflammatory remission in RA treatment （Cj-RTRM） was constructed. Model performance evaluation demonstrated that the model had good clinical predictive ability， with an area under the receiver operating characteristic curve （AUC） of 0.880， sensitivity 0.967， specificity 0.700 and Youden's index 0.667.

Conclusion

The clinical prediction model Cj-RTRM constructed based on the metabolomics-based inflammatory remission score Met-IRS can effectively predict clinical inflammatory remission outcomes in RA patients treated with BZD and accurately identify the advantageous population for this treatment. This model provides guiding evidence for dynamic inflammation monitoring， targeted management， and identification of populations with advantages in traditional Chinese medicine.

关键词

Keywords

references

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Construction and Validation of a Clinical Prediction Model for Inflammatory Remission Outcome of Bushen Zhiwang Decoction（补肾治尪汤）in the Treatment of Rheumatoid Arthritis with Liver and Kidney Deficiency Syndrome

DOI：10.13288/j.11-2166/r.2026.05.011

摘要

Abstract

关键词

Keywords

references