目的 运用1H-NMR技术，分析补肾强督法（益督丸）治疗强直性脊柱炎（Ankylosing spondylitis，AS）的代谢通路，寻找中药作用靶点。方法 招募符合虚督寒型强直性脊柱炎患者25例，给予口服中药汤剂治疗3个月，治疗前后抽取血清进行代谢组学检测，利用多元统计方法分析代谢物变化情况，并确定差异代谢通路。同时结合治疗前后中医证候积分、血沉、CRP、脊柱活动量表等变化，分析中药作用机制。结果 我们发现益督丸能有效改善患者腰膝酸软、晨僵、怕冷及睡眠等症状，提高脊柱疾病活动度，治疗后患者羟丁酸盐、前列腺素D2、丙氨酸、精氨酸、甜菜碱、脯氨酸、谷氨酰胺及酪氨酸水平上升，而谷氨酸盐、α-酮戊二酸、甘氨酸、马尿酸盐、葡萄糖、胆碱及瓜氨酸水平下降。结论 我们发现益督丸能有效改善人体的三羧循环障碍、氨基酸与脂类代谢紊乱，参与调节胃肠道菌群及免疫水平，从而起到延缓强直性脊柱炎病情发展。

Objective To analyze the mechanism of Yidu pill on treating ankylosing spondylitis of kidney deficiency and cold type by means of metabonomics.Methods A total of 25 cases were treated with Yidu pill for 3 months. NMR technique was used to detect the serum before and after treatment and the multivariate statistical method was used to analyze the changes of metabolites in plasma. The differential metabolic pathways were determined and blood sedimentation rate, CRP, TCM syndrome score, BASFI and BASDA were analyzed.Results Yidu pill could improve patients" symptoms, such as lumbar and knee pain and weakness, morning stiffness, cold phobia, etc. The motion of the patient"s spine was improved. The administration of Yidu pill increased the levels of hydroxybutyrate, prostaglandin D2, alanine, arginine, betaine, proline, threonine, glutamine, and tyrosine in patients, and the levels of n-acetylglycoprotein, glutamate, n-ketoglutaric acid, glycine, taurine, hippurate, glucose, choline and citrulline decreased.Conclusion Through the changes of metabolites mentioned above, we found that the mechanism of action may be related to energy metabolism, amino acid metabolism, lipid metabolism, gastrointestinal flora, immune disorders, and other metabolic abnormalities.

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