马钱子木瓜丸联合西药治疗湿热型类风湿关节炎91例疗效观察  

Treating 91 cases of rheumatoid arthritis of the Shire syndrome with Maqianzi Mugua Wan plus Western medicine

作　　者：张仕玉 镇兰芳 镇东鑫 镇方寿 黄幼玲 彭树刚 石欣 胡红 牛志尊 文晓芳 蒋敏 艾相乾 左新松 镇水清 ZHANG Shiyu

机构地区：[1]咸宁麻塘中医医院,湖北咸宁437000

出　　处：《中医临床研究》2023年第8期120-124,共5页Clinical Journal Of Chinese Medicine

基　　金：湖北省卫健委中医药科研项目(ZY2019M062)。

摘　　要：目的:观察马钱子对湿热型类风湿关节炎的疗效和安全性,探索其作用机制。方法:将190例类风湿关节炎患者按照随机数字表法分为两组,每组各95例。常规西药用药方法:(1)慢作用抗风湿:来氟米特10 mg/次,2次/日,口服;甲氨蝶呤10 mg/次,1次/周,口服;叶酸片10 mg/次,1次/周,口服。(2)抗炎镇痛:洛索洛芬,60 mg/次,2次/日,口服,按需服用。对照组给予上述西药,以及木瓜风湿丸5 g/次,3次/日,饭后服。治疗组所用西药与对照组相同,并给予木瓜风湿丸5 g/次,2次/日,早饭、中饭后服用;晚上睡前服用马钱子木瓜丸5 g。各组每个月复查肝、肾功能,血常规,类风湿因子(Rheumatoid Factor,RF)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、C反应蛋白(C-reactive Protein,CRP)。疗程为12周,治疗结束后评价疗效。结果:治疗结束后,对照组脱落5例,治疗组脱落4例,两组完成疗程的病例各为90、91例,与对照组比较,治疗组ACR20、ACR50均升高(P<0.05)。两组关节肿胀数、关节压痛数、关节疼痛视觉模拟评分法(Visual Analogue Score,VAS)评分、关节功能评分、类风湿关节炎患者病情评价(DAS28)评分、简化的疾病活动指数(Simplified Disease Activity Index,SDAI)评分、炎症指标均较治疗前有显著改善(P<0.01),且治疗组优于对照组(P<0.05)。结论:马钱子木瓜丸联合中西药治疗湿热型类风湿关节炎的疗效优于木瓜风湿丸联合中西药,未见严重不良反应。推测制马钱子有助于减轻患者的关节肿痛,抑制了白细胞介素(Interleukin,IL)-6、肿瘤坏死因子(Tumor Necrosis Factor,TNF)-α的产生,抑制了炎症反应,从而降低了CRP、ESR等炎症因子的水平,这与马钱子碱的药理研究相吻合。这项研究为马钱子的大规模前瞻性研究提供了基础数据,有利于下一步进行前瞻性、随机和对照临床研究。Objective:To observe the efficacy and safety of Maqianzi(Strychni Semen)on rheumatoid arthritis of the Shire syndrome(湿热型)and explore its mechanism.Methods:A total of 190 patients with rheumatoid arthritis were randomly divided into two groups,with 95 cases in each group according to the random number table method.Conventional western medicine medication methods:(1)slow-acting anti-rheumatic medicines such as leflunomide,methotrexate,folic acid tablets were given.(2)Anti-inflammatory and analgesic medicine loxoprofen was given.The control group was given the above western medicine,as well as Mugua Fengshi Wan(木瓜风湿丸).The western medicine applied in the treatment group was the same as that in the control group,and Mugua Fengshi Wan was taken after breakfast and lunch,and Maqianzi Mugua Wan(马钱子木瓜丸)was given at night before going to bed.Each group was reviewed monthly for liver and kidney function,blood routine,rheumatoid factor(RF),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP).The course of treatment was 12 weeks,and the response was evaluated after the treatment.Results:After the end of treatment,5 cases were dropped in the control group and 4 cases in the treatment group,and there were 90 and 91 cases respectively in the two groups,and ACR20 and ACR50 in the treatment group were increased(P<0.05)compared with the control group.The number of joint swelling,joint tenderness,joint pain VAS score,joint function score,DAS28 score,SDAI score and inflammation indexes in the two groups were significantly ameliorated compared with those before treatment(P<0.01),and the treatment group was better than the control group(P<0.05).Conclusion:The efficacy of Maqianzi Mugua Wan plus TCM medicine and western medicines on rheumatoid arthritis of the Shire syndrome was better,with no serious adverse reactions.It is speculated that processed strychnine can help to reduce joint swelling and pain in patients,inhibits the production of interleukin(IL)-6,tumor necrosis factor(TNF)-α,inhibit

关 键 词：制马钱子 马钱子木瓜丸 木瓜风湿丸 类风湿关节炎 

分 类 号：R593.22[医药卫生—内科学]