甲氨蝶呤片联合痹通方治疗活动期类风湿关节炎的临床观察
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摘要
目的观察痹通方联合甲氨蝶呤片(MTX)治疗活动期类风湿关节炎(RA)患者的效果。方法选取68例就诊于辽宁中医药大学附属医院风湿病科门诊的RA患者,按照入组先后顺序分为治疗组和对照组,每组分别为34例。对照组患者给予甲氨蝶呤片(MTX)治疗,治疗组在此基础上给予痹通方,两组均连续治疗12周。治疗后观察两组患者的中医证候积分、关节肿胀、关节疼痛、晨僵时间、临床疗效,检测血沉(ESR)、C反应蛋白(CRP),记录DAS28、健康评价调查表(HAQ)等指标变化。结果治疗组总有效率91. 17%优于对照组总有效率76. 47%,两组比较差异有统计学意义(P <0. 05)。两组治疗后中医证候积分较治疗前均有改善,差异有统计学意义(P <0. 05);治疗后组间比较,治疗组优于对照组,差异有统计学意义(P <0. 05)。治疗后两组患者的DAS28、HAQ指标均优于治疗前,差异有统计学意义(P <0. 05),且治疗组优于对照组,差异有统计学意义(P <0. 05)。两组患者治疗后ESR、CRP两项指标与治疗前比较差异均有统计学意义(P <0. 05),且治疗组的ESR及CRP水平改善情况均优于对照组(P <0. 05)。治疗过程中未发生严重不良反应。结论痹通方联合MTX能很好地改善RA临床症状、中医证候,控制RA病情活动,提高RA患者生活质量,安全可靠。
Objective To observe the effect on active rheumatoid arthritis( RA) with methotrexate( MTX) tablets and Bitong decoction. Methods Sixty-eight RA patients were selected from the outpatient department of rheumatology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine. They were divided into treatment group and control group according to the order of enrollment,with 34 cases in each group. Patients in the control group were given MTX tablets,and patients in the observation group were given Bitong decocotion and MTX tablets. Both groups were treated continuously for 12 weeks. After treatment,TCM syndrome points,joint swelling,joint pain,morning stiffness time and clinical efficacy of the two groups were observed,ESR and CRP were detected,and the scores of DAS28 and HAQ were recorded.Results The total effective rate of the treatment group was 91. 17% higher than that of the control group( 76. 47%),indicating significant difference( P < 0. 05). Compared with the before treatment,the TCM symptom scores of the two groups improved after treatment,indicating significant difference( P < 0. 05),and the treatment group was better than the control group after treatment. The indexes of DAS28 and HAQ both two groups were better than those after treatment,and the treatment group was superior to the control group after treatment,indicating significant difference( P < 0. 05). There were significant differences in ESR and CRP between the two groups before and after treatment( P < 0. 05),and the improvement of ESR and CRP in the treatment group was better than that in the control group( P < 0. 05). No serious adverse reactions occurred during the treatment. Conclusion Bitong Decoction and MTX can effectively improve the clinical symptoms and TCM syndromes,control the disease activity,improve the quality of life in the treatment of RA,which is safe and reliable.
Objective To observe the effect on active rheumatoid arthritis( RA) with methotrexate( MTX) tablets and Bitong decoction. Methods Sixty-eight RA patients were selected from the outpatient department of rheumatology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine. They were divided into treatment group and control group according to the order of enrollment,with 34 cases in each group. Patients in the control group were given MTX tablets,and patients in the observation group were given Bitong decocotion and MTX tablets. Both groups were treated continuously for 12 weeks. After treatment,TCM syndrome points,joint swelling,joint pain,morning stiffness time and clinical efficacy of the two groups were observed,ESR and CRP were detected,and the scores of DAS28 and HAQ were recorded.Results The total effective rate of the treatment group was 91. 17% higher than that of the control group( 76. 47%),indicating significant difference( P < 0. 05). Compared with the before treatment,the TCM symptom scores of the two groups improved after treatment,indicating significant difference( P < 0. 05),and the treatment group was better than the control group after treatment. The indexes of DAS28 and HAQ both two groups were better than those after treatment,and the treatment group was superior to the control group after treatment,indicating significant difference( P < 0. 05). There were significant differences in ESR and CRP between the two groups before and after treatment( P < 0. 05),and the improvement of ESR and CRP in the treatment group was better than that in the control group( P < 0. 05). No serious adverse reactions occurred during the treatment. Conclusion Bitong Decoction and MTX can effectively improve the clinical symptoms and TCM syndromes,control the disease activity,improve the quality of life in the treatment of RA,which is safe and reliable.
引文
[1]陈磊,汪元,潘惠,等.类风湿关节炎合并心血管疾病的危险因素分析[J].中华中医药杂志,2019,34(1):328-331.
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[10]姚血明,马武开,黄颖,等.类风湿关节炎患者贫血情况及其对疾病影响的研究[J].风湿病与关节炎,2014,3(11):20-22.
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[12]于静,高明利,薛书燕,等.桃红四物汤对AA大鼠整体及病理影响的实验研究[J].实用中医内科杂志,2011,25(5):6-8.
[13]于静,金明秀.痹通对AA细胞凋亡调控基因表达影响的实验研究[J].中华中医药学刊,2003,21(8):1301,1329.
[14]于静.类风湿关节炎“证”的演变规律及养血活血方部分作用机理[D].北京:北京中医药大学,2003.
[15]刘飞.桃红四物汤与“异病同治”[J].实用中医内科杂志,2017,31(7):76-77.
[16]苏伟,李建武.藤龙汤合桃红四物汤治疗痰瘀痹阻型类风湿关节炎30例[J].风湿病与关节炎,2014,5(3):5-9.
[17]秦胜彪.桃红四物汤加减联合丹红注射液对类风湿关节炎患者关节压痛指数及日常生活能力的影响[J].中国药物经济学,2017,8:63-65.
[18]尚娟.桃红四物汤加减治疗类风湿性关节炎[J].中国中医基础医学杂志,2007,13(7):555-557.
[19]王腾腾,赵永见,陈岩.二陈汤加桃红四物汤改善类风湿关节炎的机理研究[J].世界科学技术-中医药现代化,2016,18(11):1874-1878.
[20]蓝肇熙,李红果,张进陶,等.桃红四物汤对大鼠损伤血瘀证的影响[J].华西药学杂志,2008,23(3):286-287.
[2]Arnett FC,Edworthy SM,Bloch DA,et al. The American Rheumatism Assotiation 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum,1988,31(3):315-324.
[3]Aletaha D,Neogi T,Silman AJ,et al. 2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. ArthritisRheum,2010,69(9):2581-2596.
[4]中华中医药学会风湿病分会.类风湿关节炎病证结合诊疗指南[J].中医杂志,2018,59(20):1794-1800.
[5]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:115-119.
[6]Van der Hejde DM,Van't Hof M,Van Riel PL,et al. Development of a disease activity score based on judgment in clinical practice by rheumatologists[J]. The Journal of Rheumatology,1993,20(3):579-581.
[7]Aletaha D,Nell VP,Stamm T,et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis:validation of a clinical activity score[J]. Arthritis Res Ther,2005,7(4):796-806.
[8]王承德,沈丕安,胡荫奇.实用中医风湿病学[M].北京:人民卫生出版社,2009:483-492.
[9]曾苹,侯雷,宁乔怡,等.马武开教授从气虚血瘀论治类风湿关节炎临床经验[J].风湿病与关节炎,2018,7(4):51-53.
[10]姚血明,马武开,黄颖,等.类风湿关节炎患者贫血情况及其对疾病影响的研究[J].风湿病与关节炎,2014,3(11):20-22.
[11]王勇,马玉琛,王志丹.类风湿关节炎患者贫血中医病机与治法浅谈[J].世界中医药,2013,8(9):1121-1123,1127.
[12]于静,高明利,薛书燕,等.桃红四物汤对AA大鼠整体及病理影响的实验研究[J].实用中医内科杂志,2011,25(5):6-8.
[13]于静,金明秀.痹通对AA细胞凋亡调控基因表达影响的实验研究[J].中华中医药学刊,2003,21(8):1301,1329.
[14]于静.类风湿关节炎“证”的演变规律及养血活血方部分作用机理[D].北京:北京中医药大学,2003.
[15]刘飞.桃红四物汤与“异病同治”[J].实用中医内科杂志,2017,31(7):76-77.
[16]苏伟,李建武.藤龙汤合桃红四物汤治疗痰瘀痹阻型类风湿关节炎30例[J].风湿病与关节炎,2014,5(3):5-9.
[17]秦胜彪.桃红四物汤加减联合丹红注射液对类风湿关节炎患者关节压痛指数及日常生活能力的影响[J].中国药物经济学,2017,8:63-65.
[18]尚娟.桃红四物汤加减治疗类风湿性关节炎[J].中国中医基础医学杂志,2007,13(7):555-557.
[19]王腾腾,赵永见,陈岩.二陈汤加桃红四物汤改善类风湿关节炎的机理研究[J].世界科学技术-中医药现代化,2016,18(11):1874-1878.
[20]蓝肇熙,李红果,张进陶,等.桃红四物汤对大鼠损伤血瘀证的影响[J].华西药学杂志,2008,23(3):286-287.