活血化瘀方联合甲氨蝶呤治疗类风湿关节炎的临床研究  

Clinical study on application of Huoxue Huayu Decoction combined with methotrexate in treatment of rheumatoid arthritis

作　　者：田雨[1] 蒲月红 张翔宇[3] 朱竹菁[1] 周珺[1] 陈晓旭[1] 茅建春[1] 苏励[1] TIAN Yu;PU Yuehong;ZHANG Xiangyu;ZHU Zhujing;ZHOU Jun;CHEN Xiaoxu;MAO Jianchun;SU Li(Department of Rheumatology,Longhua Hospital Affiliated to Shanghai University of Chinese Medicine,Shanghai 200032,China;Department of Emergency,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Critical Care Medicine,Shanghai Tenth People’s Hospital,Shanghai 200072,China)

机构地区：[1]上海中医药大学附属龙华医院风湿科,上海200032 [2]上海中医药大学附属岳阳中西医结合医院急诊科,上海200437 [3]上海市第十人民医院重症医学科,上海200072

出　　处：《上海中医药杂志》2022年第12期68-72,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市科委科技计划项目(18401900900)。

摘　　要：目的观察活血化瘀方联合甲氨蝶呤治疗类风湿关节炎(RA)的临床疗效。方法将80例RA患者随机分为治疗组和对照组,每组40例。两组均给予甲氨蝶呤口服治疗,治疗组加服活血化瘀方,对照组加服活血化瘀方模拟方。两组疗程均为6个月。疗程结束后,比较两组患者的中医证候疗效、中医证候积分、疾病活动度(DAS28)评分、红细胞沉降率(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、纤维蛋白原(Fg)、血管内皮生长因子(VEGF)及关节滑膜血管翳增殖的变化情况。结果(1)最终完成试验者73例,治疗组37例,对照组36例。(2)治疗后,治疗组总有效率为89.19%,对照组总有效率为77.78%;两组中医证候疗效比较,治疗组优于对照组(P<0.05)。(3)治疗前后组内比较,两组DAS28评分、中医证候积分均较治疗前降低(P<0.05);组间治疗后比较,两组DAS28评分差异无统计学意义(P>0.05),治疗组中医证候积分比对照组明显降低(P<0.05)。(4)治疗前后组内比较,两组RF、ESR、CRP、抗CCP抗体水平均较治疗前降低(P<0.05);组间治疗后比较,治疗组RF、CRP水平低于对照组(P<0.05)。(5)治疗前后组内比较,治疗组Fg、VEGF水平均较治疗前降低(P<0.05);组间治疗后比较,治疗组Fg、VEGF水平低于对照组(P<0.05)。(6)治疗前后组内比较,两组关节滑膜血管翳分级均优于治疗前(P<0.05);组间治疗后比较,治疗组关节滑膜血管翳分级优于对照组(P<0.05)。结论活血化瘀方联合甲氨蝶呤治疗RA具有较好的临床疗效,能有效下调CRP、Fg、VEGF水平,具有一定的抑制关节滑膜血管翳增殖的作用。ObjectiveTo observe the clinical effect of application of Huoxue Huayu decoction combined with methotrexate in the treatment of rheumatoid arthritis.Methods80 patients with rheumatoid arthritis were randomly divided into treatment group and control group,40 patients in each group.Both groups were treated with methotrexate.The treatment group was added with Huoxue Huayu Decoction,while the control group was added with Huoxue Huayu Simulated Decoction.The course of treatment in both groups was 6 months.After treatment,the TCM syndrome curative effect,TCM syndromes score,disease activity(DAS28)score,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody,fibrinogen(Fg),vascular endothelial growth factor(VEGF)and proliferation of synovial pannus were observed.Results(1)Finally,73 patients completed the clinical trial,37 patients in the treatment group and 36 patients in the control group.(2)After treatment,the total effective rate of the treatment group was 89.19%,and that of the control group was 77.78%.Comparing the curative effect of TCM syndromes between the two groups,the treatment group was better than the control group(P<0.05).(3)After treatment.,the scores of DAS28 and TCM syndromes of the two groups decreased(P<0.05).After treatment,there was no significant difference in DAS28 score between the two groups(P>0.05),and the TCM syndrome score of the treatment group was significantly lower than that of the control group(P<0.05).(4)After treatment,the levels of RF,ESR,CRP and anti-CCP in both groups were lower than those before treatment(P<0.05).After treatment,the levels of RF and CRP in treatment group were lower than those in control group(P<0.05).(5)After treatment,the levels of Fg and VEGF in the treatment group were lower than those before treatment(P<0.05),and were lower than those in the control group(P<0.05).(6)Comparison between before and after treatment,the synovial pannus grades of both groups were better than those before treat

关 键 词：类风湿关节炎 活血化瘀方 甲氨蝶呤 中医药疗法 临床试验 

分 类 号：R593.22[医药卫生—内科学]