雷公藤多苷、白芍总苷联合柳氮磺胺吡啶诱导缓解并维持性治疗强直性脊柱炎的临床观察  

Induction,Remission,and Maintenance of Ankylosing Spondylitis by Tripterygium Glycosides,Total Glucosides of Paeony Capsule Combined Sulfasalazine

作　　者：郑红霞[1] 章伟明[2] 王圳 汪卫[1] 于健宁[1] 张雯[1] ZHENG Hong-xia;ZHANG Wei- ming;WANG Zhen;WANG Wei;YU Jian-ning;ZHANG Wen(Department of Rheumatology, Hangzhou Red Cross Hospital, Hangzhou 310003;Department of Pharmacy, Hangzhou First People＇s Hospital, Hangzhou 310009)

机构地区：[1]浙江省杭州市红十字会医院风湿科,杭州310003 [2]浙江省杭州市第一人民医院药剂科,杭州310009

出　　处：《中国中西医结合杂志》2018年第6期651-654,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：2015年杭州市医学重点专科专病项目(No.20150733Q43)

摘　　要：目的观察雷公藤多苷、白芍总苷胶囊联合柳氮磺胺吡啶诱导缓解并维持性治疗强直性脊柱炎(ankylosing spondylitis,AS)的临床疗效。方法将100例AS患者随机分为4组,4组开始均用西乐葆胶囊(每粒0.2 g),每次0.2 g,每日2次口服,6周后改为西乐葆胶囊,每次0.2 g,每日1次口服,12周后停药。同时各组开始均给予改善病情抗风湿药(disease-modifying anti-rheumatic drugs,DMARDs),组1(G1)给予雷公藤多苷片(每片10 mg),每次20 mg,每日3次;白芍总苷胶囊(每粒0.3 g),每次0.6 g,每日3次;联合柳氮磺胺吡啶片(每片0.25 g),每次1 g,每日2次口服;组2(G2)给予雷公藤多苷片,每次20 mg,每日3次;联合柳氮磺胺吡啶片,每次1 g,每日2次口服;组3(G3)给予白芍总苷胶囊,每次0.6 g,每日3次;联合柳氮磺胺吡啶片,每次1 g,每日2次口服;组4(G4)给予柳氮磺胺吡啶片,每次1 g,每日2次口服。分别在开始治疗前及治疗6、12、24周判断疗效,疗程24周。使用疾病活动性得分(ankylosing spondylitis disease activity score,ASDAS)-CRP(基于CRP计算)判断病情活动情况,并记录用药期间不良反应。结果 4组在治疗6周时ASDAS-CRP评分均较治疗前降低(P<0.01),但4组间比较,差异无统计学意义(P>0.05)。治疗12、24周时ASDAS-CRP评分G1、G2组均较G3、G4组低(P<0.05),G1较G2组低(P<0.05);G3组较G4组低(P<0.05)。与治疗6周比较,G1、G2组治疗24周ASDAS-CRP评分减低(P<0.05)。结论雷公藤多苷、白芍总苷胶囊联合柳氮磺胺吡啶片三药联合治疗AS,尤其雷公藤多苷在疾病活动期可以帮助非甾体抗炎药(NSAIDs)加强诱导缓解,在维持性治疗阶段三药联合可以保证NSAIDS药物停用后疾病处于低活动状态。Objective To observe the clinical efficacy of tripterygium glycosides（ TG）,Total Glucosides of Paeony（ TGP） combined with sulfasalazine（ SSZ） in induction,remission,as well as maintenance treatment of ankylosing spondylitis（ AS）. Methods Totally 100 AS patients were randomly assigned to 4 groups. All patients started to take Cele Brex Capsule（ 0. 2 g/pill）,0. 2 g each time,twice per day for 6 weeks. They changed to take 0. 2 g Cele Brex Capsule,0. 2 g each time,once per day from week 6 to 12,and then discontinued taking. At the same time all patients started to take diseasemodifying anti-rheumatic drugs（ DMARDs）. Those in Group 1 took TG（ 10 mg/tablet,20 mg each time,three times per day） ＋ TGP（ 0. 3 g/pill,0. 6 g each time,three times per day） ＋ SSZ（ 0. 25 g/tablet,1 g each time,twice per day）.Those in Group 2 took TG Tablet（ 20 mg each time,three times per day） ＋ SSZ（ 1 g each time,twice per day）. Those in Group 3 took TGP（ 0. 6 g each time,three times per day） ＋ SSZ（ 1 g each time,twice per day）. The curative effects were judged before treatment,at week 6,12,and 24 after treatment. The course of treatment was 24 weeks. The activity of AS was judged by ankylosing spondylitis disease activity score（ ASDAS）-CRP score. Adverse events during medication were recorded as well. Results The ASDAS-CRP scores were lower at treatment week 6 than before treatment in the four groups（P〈 0. 01）. But there were no significant differences in ASDAS-CRP score among the 4 groups（P 〉 0. 05）. At treatment week 12 and 24 the ASDAS-CRP scores were lower in Group 1 and 2 than in Group 3 and 4（P 〈 0. 05）. The ASDAS-CRP score was lower in Group 1 than in Group 2（P 〈 0. 05）. The ASDAS-CRP score was lower in Group 3 than in Group 4（P〈 0. 05）. The score of ASDAS-CRP in Group 1 and Group 2 was significantly lower at treatment week 24 than at treatment week 6（P 〈 0. 05）. Conclusions In treatment of AS by TG,TGP,combined with SSZ,especially in ac

关 键 词：强直性脊柱炎 雷公藤多苷 白芍总苷胶囊 柳氮磺胺吡啶 疾病活动性得分 

分 类 号：R593.23[医药卫生—内科学]