双枝蠲痹汤联合甲氨蝶呤和艾拉莫德治疗难治性类风湿关节炎患者的效果及对血清细胞因子、骨代谢的影响  

Effect of Shuangzhi Juanbi Decoction combined with Methotrexate and Iguratimod on patients with refractory rheumatoid arthritis and its influence on serum cytokines and bone metabolism

作　　者：郑斐星 叶霖 管向明 ZHENG Feixing;YE Lin;GUAN Xiangming(Department of Traditional Chinese Medicine,Shangrao People's Hospital,Jiangxi Province,Shangrao 334000,China)

机构地区：[1]江西省上饶市人民医院中医科,江西上饶334000

出　　处：《中国当代医药》2024年第35期118-121,125,共5页China Modern Medicine

基　　金：江西省中医药管理局科技计划项目(2020A0085)。

摘　　要：目的探讨双枝蠲痹汤联合甲氨蝶呤和艾拉莫德治疗难治性类风湿关节炎(RRA)患者的效果及对血清细胞因子、骨代谢的影响。方法选取2022年1月至2023年10月上饶市人民医院收治的80例RRA患者作为研究对象,按照随机数字表法分为观察组和对照组,每组各40例。对照组采用甲氨蝶呤和艾拉莫德治疗,观察组在对照组的基础上采用双枝蠲痹汤治疗,比较两组的临床疗效、中医证候积分、基于28关节疾病活动度评分(DAS28)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、骨代谢指标[骨钙素(BGP)、1型胶原氨基端延长肽(P1NP)]和不良反应。结果观察组的总有效率高于对照组,差异有统计学意义(P<0.05);治疗后,观察组的中医证候积分(关节肿胀、关节压痛、晨僵)和DAS28评分均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组的血清ESR、CRP、IL-6、TNF-α水平均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组的血清BGP、P1NP水平均高于对照组,差异有统计学意义(P<0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论双枝蠲痹汤联合西药治疗RRA的效果显著,可有效缓解患者症状体征,降低炎症因子水平,改善骨代谢,且安全性较好。Objective To explore the effect of Shuangzhi Juanbi Decoction combined with Methotrexate and Iguratimod on patients with refractory rheumatoid arthritis(RRA)and its influence on serum cytokines and bone metabolism.Methods A total of 80 patients with RRA admitted to Shangrao People's Hospital from January 2022 to October 2023 were selected as the research objects.According to the random number table method,they were divided into observation group and control group,with 40 cases in each group.The control group was treated with Methotrexate and Iguratimod,while the observation group was treated with Shuangzhi Juanbi Decoction on the basis of control group.The clinical efficacy,traditional Chinese medicine syndrome score,disease activity score in 28 joints(DAS28),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,bone metabolism index(bone glaprotein[BGP],procollagen type 1 N-terminal propeptide[P1NP])and adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).After treatment,the traditional Chinese medicine syndrome score(joint swelling,joint tenderness,morning stiffness)and DAS28 score of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of serum ESR,CRP,IL-6 and TNF-αin the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of serum BGP and P1NP in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Shuangzhi Juanbi Decoction combined with western medicine is effective in the treatment of RRA,which can effecti

关 键 词：难治性类风湿关节炎 双枝蠲痹汤 细胞因子 骨代谢 

分 类 号：R593.22[医药卫生—内科学]