问荆合剂治疗湿热痹阻证类风湿性关节炎的临床研究  

Clinical Trial on Rheumatoid Arthritis of Syndrome Blockage Due to Damp-Heat with Decoction Wen-jing He-ji

作　　者：李可大[1] 

机构地区：[1]广州中医药大学第一附属医院,广东广州510405

出　　处：《中华中医药学刊》2007年第5期958-962,共5页Chinese Archives of Traditional Chinese Medicine

摘　　要：目的:以类风湿性关节炎(rheumatoid arthritis,RA)自身免疫炎症为切入点,探讨中药复方-问荆合剂对湿热痹阻证RA的临床疗效及其作用机制。方法:临床研究采用随机对照研究的方法,将60例RA患者随机分为实验组(问荆合剂、甲氨碟呤和双氯灭痛)和对照组(甲氨碟呤和双氯灭痛),观察其治疗前后生物化学、肿瘤坏死因子(TNF-α)、白细胞介素10(IL-10)、症状体征、中医证候学等多种指标的变化,系统评价问荆合剂对RA的临床疗效。结果:在临床研究中,实验组的总有效率为80%,对照组的总有效率为16.67%,两组疗效经统计学处理,差异有显著性(P<0.01);两组血清TNF-α(P<0.05)和IL-10(P<0.05)的治疗前后差值比较,有显著性差异;CRP组内治疗前后各自比较(P<0.01)有显著性差异,组间治疗前后差值比较(P>0.05),没有显著性差异;ESR、RF的组内治疗前后比较有显著差异性(P<0.01),组间治疗前后比较有显著差异性(P<0.05);晨僵时间、关节疼痛数、手握力、肿胀关节数及关节功能评分治疗前后组内各自比较均有显著性差异(P<0.01);关节功能评分组间差值比较无显著性差异(P>0.05),余组间治疗前后差值比较均有显著性差异(P<0.01);中医证候指标在组内治疗前后各自比较有显著差异性(P<0.01),组间治疗前后差值比较均亦有显著性差异(P<0.01)。结论:问荆合剂对湿热痹阻RA具有显著疗效,临床应用安全可靠。对与RA相关细胞因子TNF-α有明显下调作用即下调了前炎性因子TNF-α水平,上调了抑炎因子IL-10的水平。由此认为问荆合剂对TNF-α和IL-10的调控作用是其治疗RA的作用机制之一。Objective ：To investigare the therapeutic mechanism of Decoction Wenjing Heji on rheumatoid arthritis, RA （blockage due to damp - heat） from the breakthrough point of autoimmune and inflammatory responses. Methods ： We divided 60 patients into 2 groups randomly： experimental group （ Decoction Wenjing Heji ＋ methotrexate MTX ＋ dedofenae）, control group （methotrexate MTX ＋ deelofenae ）. To evaluate the therapeutic effects systemielly we observed such indices as TNF -α ,IL -10,signs , biochemistry ,symptoms,syndrome of TCM. We divided 50 rats into 5 groups randomly,10 rats for each group （normal control,model control ,MTX, Decoction Wenjing Heji , Decoction Wenjing Heji ＋ MTX groups）. Results ：The total effective rate in experimental group was 80% and 16.67% in control group in clinical study,the difference between the two groups was significant statistically（ P 〈0. 01 ） ;The variations of serum TNF - α and IL - 10 levels of the experimental group were significantly higher than that of the control group （ P 〈 0. 01 ,P 〈 0.05 ） ; the variations of CRP was significant within groups（ P 〈 0.01 ）but not significant between groups（ P 〉 0.05 ） ;the variations of ESR and RF were significantly different（ P 〈0.01 ）between and within groups;the grip strength,joint swelling count,joint pain/tenderness score and morning stiffness were significantly different between and within groups （ P 〈 0.01 ）, the functional class within groups was different significantly（ P 〈 0.01 ）, but not between groups（ P 〉 0.05 ） ;the TCM symptoms were also different significantly between and within groups（ P 〈 0.01 ）. Conclusion： Decotion Wenjing Heft has a promising therapeutic effect on RA（ blockage due to damp - heat） and is of good tolerance and safty. It can regulate the serum levels of TNF -α （down -regulate） and IL- 10 （up -regulate） ,which maybe one of the therapeutic mechanisms of RA.

关 键 词：类风温性关节炎 肿瘤坏死因子-Α 白细胞介素-10 湿热痹阻 问荆合剂 

分 类 号：R593.22[医药卫生—内科学] R255.6[医药卫生—临床医学]