清热解毒法治疗类风湿关节炎热毒证临床研究  

Clinical Study on Rheumatoid Arthritis with Heat Toxicity Syndrome Treated by Clearing Heat and Detoxifying Method

作　　者：晏姣 刘德芳 刘涛 李莞 罗婷 赵雯雯 黄湘玉 郭明阳 YAN Jiao;LIU Defang;LIU Tao;LI Guan;LUO Ting;ZHAO Wenwen;HUANG Xiangyu;GUO Mingyang(Department of Traditional Chinese Medicine,General Hospital of Western Military Zone,Chinese People’s Liberation Army,Chengdu 610083,China)

机构地区：[1]中国人民解放军西部战区总医院中医科,四川成都610083

出　　处：《山东中医杂志》2024年第11期1230-1234,共5页Shandong Journal of Traditional Chinese Medicine

基　　金：四川省中医药管理局课题(编号:2021MS436)。

摘　　要：目的:观察清热解毒法治疗类风湿关节炎(RA)热毒证的临床疗效。方法:选择RA患者120例,按随机数字表法分为治疗组和对照组各60例。对照组接受常规西药治疗,治疗组在对照组基础上,在清热解毒思路下分别采用速效热痹饮、五藤二草汤、三黄一龙汤辨证治疗。两组均治疗36周。在治疗前和治疗12周、24周、36周后采用视觉模拟评分法(VAS)、疾病活动性评分(DAS28)分别评估两组患者的疼痛程度和疾病活动程度,并在治疗前后检测C反应蛋白(CRP)、红细胞沉降率(ESR)、抗酒石酸酸性磷酸酶-5b(TRACP5b)、骨特异碱性磷酸酶(BAP)的水平;同时行双手X线检查,获取Sharp评分。最后参照美国风湿病学会(ACR)制定疗效判定标准ACR70观察疗效。结果:治疗组在治疗12周、治疗24周、治疗36周的VAS和DAS28评分均低于对照组(P<0.05)。治疗36周后,治疗组CRP、ESR、TRACP5b、BAP水平以及X线Sharp评分均低于对照组(P<0.05)。治疗组总有效率为98.18%,对照组73.58%,差异有统计学意义(χ2=13.654,P=0.0002)。结论:清热解毒法治疗类风湿关节炎热毒证,可以缓解RA患者的疼痛,抑制疾病活动性,减轻炎症反应,改善骨破坏。Objective:To observe the clinical efficacy of clearing heat and detoxifying method in treating rheumatoid arthritis(RA)of heat toxic syndrome.Methods:Totally 120 patients with RA were divided into a treatment group and a control group using the random number table method.The control group received conventional western medicine treatment,while the treatment group further received differential treatment using Suxiao Rebi Decoction(速效热痹饮),Wuteng Ercao Decoction(五藤二草汤),and Sanhuang Yilong Decoction(三黄一龙汤).Both groups were treated for 36 weeks.Two groups were evaluated for pain and disease activity using Visual Analogue Scale(VAS)and Disease Activity Scale(DAS28)before treatment,as well as 12 weeks,24 weeks,and 36 weeks after treatment.The levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),tartaric acid phosphatase-5b(TRACP5b),and bone specific alkaline phosphatase(BAP)were measured before and after treatment;besides,X-ray examination was conducted on both hands to obtain Sharp score.Finally,the efficacy evaluation criteria such as ACR70 by American College of Rheumatology(ACR)to observe the efficacy.Results:The VAS and DAS28 scores of the treatment group were lower than those of the control group after 12 weeks,24 weeks,and 36 weeks of treatment(P<0.05).After 36 weeks of treatment,the treatment group had lower CRP,ESR,TRACP5b,BAP,and X-ray Sharp scores than the control group(P<0.05).The total effective rate in the treatment group was 98.18%,while the total effective rate of the control group was 73.58%,with a statistical difference(χ2=13.654,P=0.0002).Conclusion:The method of clearing heat and detoxification is used to treat RA with heat toxicity syndrome,which can alleviate the pain of RA patients,inhibit disease activity,reduce inflammatory reactions,and improve bone destruction.

关 键 词：清热解毒法 类风湿关节炎 热毒证 速效热痹饮 五藤二草汤 三黄一龙汤 

分 类 号：R255.6[医药卫生—中医内科学]