基于血清生化指标及DAS28、HAQ评分变化探究桂枝芍药知母汤联合西药在老年类风湿关节炎急性期治疗中的应用效果  

Application effect of Guizhi Shaoyao Zhimu decoction combined with western medicine on elderly patients with acute stage of rheumatoid arthritis based on changes in serum biochemical indicators,DAS28 score and HAQ score

作　　者：刘志宇 朱琳[2] LIU Zhiyu;ZHU Lin(Department of Chinese Medicine and Rheumatology,Taihe Hospital of Traditional Chinese Medicine,Anhui University of Traditional Chinese Medicine,Fuyang 236600,China)

机构地区：[1]安徽中医药大学附属太和中医院中医风湿科,安徽阜阳236600 [2]安徽中医药大学,安徽合肥230031

出　　处：《陕西中医》2024年第5期638-641,共4页Shaanxi Journal of Traditional Chinese Medicine

基　　金：安徽省抗癌协会临床肿瘤协作专业委员会重点研究课题(ACC0-2021-01-01);安徽省阜阳市卫生健康委员会科研项目(FY2021-098);安徽中医药大学临床科研项目(2023LCTH36)。

摘　　要：目的:探究桂枝芍药知母汤联合西药治疗对风寒湿痹型老年类风湿关节炎(RA)急性期患者血清生化指标及DAS28、HAQ评分的影响。方法:选取风寒湿痹型老年RA急性期患者86例为研究对象,采用抽签法随机分为观察组(桂枝芍药知母汤联合来氟米特)及对照组(来氟米特)各43例,比较治疗前及治疗3个月后两组患者中医证候积分、血清生化指标[血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)水平、抗环瓜氨酸肽抗体(CCP)]、免疫功能指标[外周血CD4^(+)T淋巴细胞水平(CD4^(+))、CD8^(+)T淋巴细胞(CD8^(+))水平及其比值(CD4^(+)/CD8^(+))]、关节功能恢复情况[28个关节病情活动指数(DAS28)、健康评价问卷得分(HAQ)],观察并记录两组患者治疗过程中不良反应情况。结果:与治疗前相比,观察组患者治疗3个月后血清生化指标、免疫功能指标(CD4^(+)、CD4^(+)/CD8^(+))、关节功能恢复情况均呈下降趋势,且观察组明显低于同期对照组(P<0.05);观察组CD8^(+)水平明显高于同期对照组(P<0.05);两组患者不良反应发生比较均无统计学差异(P>0.05)。结论:桂枝芍药知母汤联合西药治疗可有效平衡患者免疫功能,降低其机体炎症水平,促进关节功能恢复,具有较好临床疗效。Objective:To explore the influence of Guizhi Shaoyao Zhimu decoction combined with western medicine on serum biochemical indicators,DAS28 score and HAQ score in elderly patients with acute stage of rheumatoid arthritis(RA)of wind-cold-dampness arthralgia.Methods:86 elderly patients with RA of wind-cold-dampness arthralgia were randomly classified into observation group(Guizhi Shaoyao Zhimu decoction combined with leflunomide,43 cases)and control group(leflunomide,43 cases)by means of lottery method.The TCM syndromes scores,serum biochemical indicators[erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),cyclic citrullinated peptide(CCP)],immune function indicators[peripheral blood CD4^(+)T lymphocyte(CD4^(+)),CD8^(+)T lymphocyte(CD8^(+))and CD4^(+)/CD8^(+)]and joint function recovery[Disease Activity Score 28-joint(DAS28),Health Assessment Questionnaire(HAQ)]were compared between both groups of patients before treatment and after 3 months of treatment.The adverse reactions in the two groups during treatment were observed and recorded.Results:Compared with before treatment,serum biochemical indicators,immune function indicators(CD4^(+),CD4^(+)/CD8^(+))and joint function recovery in observation group showed downward trends after 3 months of treatment,and the observation group had significantly lower indicators than those in control group(P<0.05).The level of CD8^(+)in observation group was obviously higher(P<0.05).There were no significant differences in the adverse reactions between groups(P>0.05).Conclusion:The combination of Guizhi Shaoyao Zhimu decoction and western medicine can effectively balance the immune function of patients,reduce the body's inflammation,and promote the recovery of joint function,and it has good clinical efficacy.

关 键 词：类风湿关节炎 急性期 桂枝芍药知母汤 来氟米特 关节功能 免疫功能 老年人 

分 类 号：R593.22[医药卫生—内科学]