和痹方治疗类风湿关节炎疗效观察  

Treatment of Rheumatoid Arthritis by Hebi Recipe:an Efficacy Observation

作　　者：姜萍[1] 张琳英[1,2] 戴玲玲 蒋雪梅[4] 

机构地区：[1]山东中医药大学第一临床医学院,济南250011 [2]淄博市中医医院内二科,山东255300 [3]山东省烟台市中医医院肿瘤二科,山东264001 [4]山东中医药大学附属医院超声科,济南250011

出　　处：《中国中西医结合杂志》2016年第1期24-28,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：山东省高等学校科技计划项目(No.J12LK09)

摘　　要：目的观察和痹方辅助治疗早期类风湿关节炎(rheumatoid arthritis,RA)的临床疗效及安全性。方法将63例早期RA肝脾失调型患者随机分为治疗组(32例,和痹方加甲氨蝶呤治疗,和痹方每日1剂,分2次口服,连续治疗24周)和对照组(31例,甲氨蝶呤治疗),两组甲氨蝶呤从7.5mg逐渐加至12.5mg,每周1次,疗程24周。观察两组中医证候疗效、ACR20改善率、28个关节数疾病活动度评分(disease activity score in 28joints,DAS28)、ESR、类风湿因子(rheumatoid factor,RF)、C反应蛋白(Creactive protein,CRP)、抗环瓜氨酸肽(anti-cyclic citrullinated peptide,CCP)抗体和相关超声检查项目(滑膜厚度、关节腔积液、滑膜血流分级)及不良反应。结果治疗组治疗后总有效率[83.9%(26/31)]、ACR20改善率[74.2%(23/31)]高于对照组[分别为60.7%(17/28)、46.4%(13/28),P<0.05]。与本组治疗前比较,两组治疗后DAS28评分、ESR、RF、CRP、CCP抗体、滑膜厚度、关节腔积液、滑膜血流分级均降低(P<0.01,P<0.05)。与对照组同期比较,治疗组干预后ACR20改善率升高,DAS28评分、ESR、RF、CRP、滑膜厚度、关节腔积液、滑膜血流分级降低,差异均有统计学意义(P<0.01,P<0.05)。治疗组1例出现肝功能异常;对照组1例白细胞减低,2例出现肝功能异常。结论和痹方可有效改善早期RA肝脾失调型患者的关节及全身症状。Objective To observe the auxiliary efficacy and safety of Hebi Recipe（HR）in treating early rheumatoid arthritis（RA）.Methods Totally 63 early RA patients with Gan-Pi disharmony were randomly assigned to the treatment group[32 cases,treated by HR（one dose per day,taken in two portions for 24 successive weeks）plus Methotrexate（MTX）]and the control group（31 cases,treated by MTX alone）.The dosage of MTX was increased from7.5 mg to 12.5 mg,once per week,24 weeks as one course of treatment.Efficacy for Chinese medical syndromes,American College of Rheumatology 20（ACR20）improvement rate,disease activity score in 28 joints（DAS28）,laboratory related indices[ESR,rheumatoid factor（RF）,C-reactive protein（CRP）,anti-cyclic citrullinated peptide（CCP）],and related ultrasonic inspection items（synovium thickness,synovium blood flow classification,effusion of joint）,and adverse reactions were observed.Results The total effective rate（83.9%,26/31 cases）and ACR20 improvement rate（74.2%,23/31 cases）were higher in the treatment group than in the control group[60.7%（17/28 cases）,46.4%（13/28 cases）;P〈0.05].Compared with before treatment in the same group,DAS28 score,ESR,RF,CRP,CCP,synovium thickness,synovium blood flow classification,effusion of joint all decreased in the two groups after treatment（P〈0.01,P〈0.05）.Compared with the control group after treatment,ACR20 improvement rate,DAS28 score,ESR,RF,CRP,CCP,synovium thickness,synovium blood flow classification,effusion of joint all decreased in the treatment group（P〈0.01,P〈0.05）.Liver dysfunction occurred in 1 case of the treatment group.One leucopenia and2 liver dysfunction occurred in the control group.Conclusion HR could effectively improve joints and systemic symptoms of early RA patients with Gan-Pi disharmony.

关 键 词：类风湿关节炎 和痹方 甲氨蝶呤 

分 类 号：R259[医药卫生—中西医结合]