中药联合抗风湿药治疗类风湿性关节炎活动期的临床观察

Clinical Observation of Traditional Chinese Medicine Combined with Antirheumatic Drug Treatment of Rheumatoid Arthritis in Active Stage

摘要:

目的：探讨痛风定胶囊、益肾蠲痹丸联合来氟米特片、甲氨蝶呤片治疗活动期类风湿性关节炎（RA）的临床疗效及抗炎机制。方法：将63例RA患者随机按数字法分为对照组30例和观察组33例。对照组采用甲氨蝶呤片（MTX），口服，10 mg/次，1 次/周；来氟米特片（LEF），口服，20 mg/次，1次/d；塞来昔布胶囊，口服，0.2 g/次，1次/d。观察组在对照组治疗的基础上加用痛风定胶囊，口服，4粒/次，3次/d；益肾蠲痹丸，口服，12 g/次，3次/d。疼痛减轻后停服塞来昔布胶囊，痛风定胶囊改为2粒/次，益肾蠲痹丸改为8 g/次。两组疗程均为24周。记录晨僵时间、压痛指数、肿胀指数、双手握力、20 m步行时间及健康评价问卷评分（HAQ）；检测治疗前后血沉（ESR），c-反应蛋白（CRP）及类风湿因子（RF）；检测治疗前后血清肿瘤坏死因子-α（TNF-α），血清黏附分子（ICAM-1）及白细胞介素1（IL-1）水平。结果：观察组依据美国风湿病学会制定的70%关节（ACR70）有效率为48.48%，优于对照组的16.67%（P<0.01）；第12周观察组晨僵时间、休息痛、压痛指数、肿胀指数的改善均优于对照组（P<0.01）；第24周观察组晨僵时间、休息痛、压痛指数、肿胀指数进一步改善，并优于对照组（P<0.05）；观察组在第12，24周28个关节数的疾病活动度（DAS28）评分均低于对照组（P<0.01）；观察组DAS28评分下降幅度优于对照组（P<0.01）；治疗后24周观察组ESR，CRP，RF水平优于对照组（P<0.01）；治疗后24周观察组TNF-α，ICAM-1及IL-1水平低于对照组（P<0.01）。结论：痛风定胶囊、益肾蠲痹丸与改善病情药联合治疗类风湿性关节炎活动期能快速减轻活动期临床症状，控制炎症反应，临床疗效优于单纯的西医治疗。

Abstract:

Objective: The purpose is to discuss clinical effect the mechanism of anti-inflammatory on Tongfengding capsule and Yishen Juanbi pill combined with leflunomide and methotrexate to treat active stage of rheumatoid arthritis(RA). Method: Sixty-three cases of patients with RA were randomly divided into control group (30 cases) and observation group (35 cases) according to digital method.The patients in control group took methotrexate (MTX),10 mg/time,once a week.taken orally,Leflunomide tablets (LEF),20 mg/time,1 does/day,taken orally;celecoxib capsule,0.2 g/time,1 does/day,taken orally.For patients in observation group,they took Tongfengding capsule on the basis of the control group,4 pieces/time,3 times/day,taken orally,Yishen Juanbi pill,12 g/time,3 does/day,taken orally.After the pain relief,patients stop taking celecoxib capsules.Besides number of taking drugs is changing.Tongfengding capsule took 2 pieces/time and Yishen Juanbi pill took 8 g/time.Treatment courses for two groups are 24 weeks.Record morning stiffness time, tenderness index,swelling index, hands grip strength,20 meters walking time and health assessment questionnaire score (HAQ).Detect erythrocyte sedimentation rate (ESR),c-reactive protein(CRP) and rheumatoid factor (RF) before and after the treatment.Test the level of serum tumor necrosis factor-α (TNF-α),serum adhesion molecule (ICAM-1) and interleukin 1 (IL-1)before and after the treatment. Result: The effective rate of active cavity radiometer 70 of observation group was 48.48% superior to control group (16.67%) (P<0.01), at fourteenth week, the improvement of morning stiffness time,rest pain,tenderness index and swelling index of observation group were superior to control group (P<0.01), at the twenty-fourth week, the further improvement of morning stiffness time,rest pain,tenderness index and swelling index of observation group were superior to control group (P<0.05),a twelve weeks and twenty-four weeks,the grade of disease activity score-28 (DAS28) were both lower than control group(P<0.01), the descend grade range of DAS28 of observation group was superior to control group(P<0.01), after treatment,the level of ESR,CRP and RF of observation group were superior to control group(P<0.01), the level of TNF-α.ICAM-1 and IL-1 were lower than control group(P<0.01). Conclusion: The activities of clinical symptoms that Tongfengding capsule and Yishen Juanbi pill were combined with modifying diseases drugs on rheumatoid arthritis at its active stage and can control the inflammatory response,and its comprehensive clinical effects was superior to simple western medicine treatment.