风湿清合剂联合甲氨蝶呤治疗活动期类风湿关节炎的效果
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摘要
目的分析风湿清合剂联合甲氨蝶呤治疗活动期类风湿关节炎(ARA)的效果。方法选择广东省深圳市龙华区人民医院风湿科2015年1月~2018年6月收治的60例ARA患者,根据随机数字表法分为对照组(n=30)和观察组(n=30)。对照组采用甲氨蝶呤治疗,观察组采用风湿清合剂联合甲氨蝶呤治疗,3个月后比较两组主要症状疗效、疼痛视觉模拟(VAS)评分、骨密度、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)水平及不良反应发生率。结果观察组治疗前晨僵时间、关节压痛数、关节肿胀数、疼痛VAS评分与对照组比较,差异无统计学意义(P> 0.05);观察组治疗后的晨僵时间、关节压痛数、关节肿胀数、疼痛VAS评分均明显少于对照组,差异有统计学意义(P <0.05)。观察组治疗前骨密度、IL-17、TNF-α与对照组比较,差异无统计学意义(P> 0.05);观察组治疗后骨密度高于对照组,IL-17、TNF-α均低于对照组,差异有统计学意义(P <0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P <0.05)。结论与单纯甲氨蝶呤治疗比较,风湿清合剂联合甲氨蝶呤治疗的效果更加显著,可有效改善患者临床症状,提高骨密度,降低炎性因子水平,且不良反应发生率低。
Objective To analyze the effect of Fengshiqing Mixture combined with Methotrexate on the treatment of active rheumatoid arthritis(ARA). Methods From January 2015 to June 2018, 60 ARA patients admitted to the Department of Rheumatology in Shenzhen Longhua District People′s Hospital of Cuangdong Province were selected. According to the random number table method, the patients were divided into control group(n = 30) and observation group(n =30). The control group was treated with Methotrexate, while the observation group was treated with Fengshiqing Mixture combined with Methotrexate. After 3 months, the efficacy of main symptoms, pain visual analogue scale(VAS) score,bone mineral density, interleukin-17(IL-17), tumor necrosis factor-α(TNF-α) and adverse reaction rate were compared between the two groups. Results The time of morning stiffness, number of joint tenderness, number of joint swelling and VAS pain score in the observation group were not significantly different from those in the control group(P >0.05). The time of morning stiffness, number of joint tenderness, number of joint swelling and VAS pain score in the observation group after treatment were significantly less than those in the control group, with statistically significant differences(P < 0.05). There was no significant difference in bone mineral density, IL-17, TNF-α between the observation group and the control group before treatment(P > 0.05), after treatment, bone mineral density in the observation group was higher than that in the control group, and IL-17 and TNF-α were lower than those in the control group, with statistically significant differences(P < 0.05). The adverse reaction rate in the observation group was lower than that in the control group, and the difference was statistically significant(P < 0.05). Conclusion Compared with single Methotrexate treatment, Fengshiqing Mixture combined with Methotrexate treatment has a more significant effect, which can effectively improve the clinical symptoms of patients,improve bone density, reduce the level of inflammatory factors, and have a low adverse reaction rate.
Objective To analyze the effect of Fengshiqing Mixture combined with Methotrexate on the treatment of active rheumatoid arthritis(ARA). Methods From January 2015 to June 2018, 60 ARA patients admitted to the Department of Rheumatology in Shenzhen Longhua District People′s Hospital of Cuangdong Province were selected. According to the random number table method, the patients were divided into control group(n = 30) and observation group(n =30). The control group was treated with Methotrexate, while the observation group was treated with Fengshiqing Mixture combined with Methotrexate. After 3 months, the efficacy of main symptoms, pain visual analogue scale(VAS) score,bone mineral density, interleukin-17(IL-17), tumor necrosis factor-α(TNF-α) and adverse reaction rate were compared between the two groups. Results The time of morning stiffness, number of joint tenderness, number of joint swelling and VAS pain score in the observation group were not significantly different from those in the control group(P >0.05). The time of morning stiffness, number of joint tenderness, number of joint swelling and VAS pain score in the observation group after treatment were significantly less than those in the control group, with statistically significant differences(P < 0.05). There was no significant difference in bone mineral density, IL-17, TNF-α between the observation group and the control group before treatment(P > 0.05), after treatment, bone mineral density in the observation group was higher than that in the control group, and IL-17 and TNF-α were lower than those in the control group, with statistically significant differences(P < 0.05). The adverse reaction rate in the observation group was lower than that in the control group, and the difference was statistically significant(P < 0.05). Conclusion Compared with single Methotrexate treatment, Fengshiqing Mixture combined with Methotrexate treatment has a more significant effect, which can effectively improve the clinical symptoms of patients,improve bone density, reduce the level of inflammatory factors, and have a low adverse reaction rate.
引文
[1]祁昌杰,柴立民.类风湿关节炎中医药治疗研究进展[J].医学综述,2015,21(9):1652-1653.
[2]霍爱鑫.肿瘤坏死因子拮抗剂联合甲氨蝶呤治疗活动期中重度类风湿关节炎56例对比观察[J].陕西医学杂志,2015,44(9):1209-1211.
[3]林健祥,曾素娥,李永健,等.中西医综合治疗活动期类风湿关节炎(湿热内蕴证)临床观察[J].中国中医急症,2015,24(8):1380-1382.
[4] Aletaha D,Neogi T,Silman AJ et al(2010). 2010 rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Ann Rheum Dis,2010,69(9):1580-1588.
[5]中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270.
[6]吴红萍,王友庆.白芍总苷联合正清风痛宁在治疗类风湿关节炎活动期的疗效观察[J].浙江中医药大学学报,2014(4):422-425.
[7] Lee EB,Fleischmann R,Hall S,et al. Tofacitinib versus methotrexate in rheumatoid arthritis[J]. N Engl J Med,2014,371(12):2377-2386.
[8] Weinblatt ME,Kaplan H,Germain BF,et al. Low-dose methotrexate compared with auranofin in adult rheumatoid arthritis[J]. Arthritis Rheum,2014,33(3):330-338.
[9]吴碧青,吴琛琛,李忆农.老年类风湿关节炎患者甲氨蝶呤错服致严重毒性反应临床分析[J].中国医药,2017,12(1):94-98.
[10]刘婧依,刘岐焕.应用甲氨蝶呤与来氟米特联合手指操缓解活动性类风湿关节炎患者晨僵症状的效果[J].中国医药导报,2017,14(32):108-111.
[11]吕明慧,杨光辉,何奕坤.补肾解毒通络方联合甲氨蝶呤治疗活动期类风湿关节炎的临床研究[J].上海中医药杂志,2014,48(11):55-57.
[12]王友强,兰由玉,何成松.关通舒胶囊联合甲氨蝶呤治疗类风湿关节炎的临床疗效观察[J].检验医学与临床,2014,11(5):616-617.
[13]李斌,唐今扬,周彩云,等.清热解毒活血法外治类风湿关节炎的临床研究[J].世界中医药,2015,10(4):516-519.
[14]罗勇,呼永河,郭明阳,等.五藤二草汤治疗活动期类风湿关节炎临床研究[J].中国中医药信息杂志,2014,21(9):33-35.
[15]农作军.甲氨蝶呤联合来氟米特治疗60例活动期类风湿关节炎的效果观察[J].现代诊断与治疗,2017(12):2188-2189.
[16] Alarcón GS,Schrohenloher RE,Bartolucci AA,et al. Suppression of rheumatoid factor production by methotrexate in patients with rheumatoid arthritis:Evidence for differential influences of therapy and clinical status on IgM and IgA rheumatoid factor expression[J]. Arthritis Rheum,2014,33(8):1156-1161.
[17]陈玉兴,卓俊城,黄雪君,等.痹痛消胶囊对大鼠类风湿性关节炎的作用及其机制[J].中成药,2016,38(6):1211-1215.
[18]李卓伶,程鹏,程青青,等.双乌风湿合剂治疗类风湿关节炎(寒湿痹阻证)的临床研究[J].中国中医急症,2018,27(3):410-413.
[19]陈莉莹,孙华瑜,石桂秀.环孢素A联合甲氨蝶呤治疗对类风湿关节炎患者IL-17表达的影响[J].临床与病理杂志,2015,35(8):1533-1536.
[20]姚瑶,葛卫红.青风藤醇提物与青藤碱治疗胶原诱导关节炎大鼠药效的比较研究[J].药学与临床研究,2014,22(1):25-28.
[21] Conway R,Low C,Coughlan RJ,et al. THU0139 Methotrexate Use and Liver Disease in Rheumatoid Arthritis:A MetaAnalysis of Randomised Controlled Trials[J]. Arthritis Rheum,2014,66(4):803-812.
[22]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
[2]霍爱鑫.肿瘤坏死因子拮抗剂联合甲氨蝶呤治疗活动期中重度类风湿关节炎56例对比观察[J].陕西医学杂志,2015,44(9):1209-1211.
[3]林健祥,曾素娥,李永健,等.中西医综合治疗活动期类风湿关节炎(湿热内蕴证)临床观察[J].中国中医急症,2015,24(8):1380-1382.
[4] Aletaha D,Neogi T,Silman AJ et al(2010). 2010 rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Ann Rheum Dis,2010,69(9):1580-1588.
[5]中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270.
[6]吴红萍,王友庆.白芍总苷联合正清风痛宁在治疗类风湿关节炎活动期的疗效观察[J].浙江中医药大学学报,2014(4):422-425.
[7] Lee EB,Fleischmann R,Hall S,et al. Tofacitinib versus methotrexate in rheumatoid arthritis[J]. N Engl J Med,2014,371(12):2377-2386.
[8] Weinblatt ME,Kaplan H,Germain BF,et al. Low-dose methotrexate compared with auranofin in adult rheumatoid arthritis[J]. Arthritis Rheum,2014,33(3):330-338.
[9]吴碧青,吴琛琛,李忆农.老年类风湿关节炎患者甲氨蝶呤错服致严重毒性反应临床分析[J].中国医药,2017,12(1):94-98.
[10]刘婧依,刘岐焕.应用甲氨蝶呤与来氟米特联合手指操缓解活动性类风湿关节炎患者晨僵症状的效果[J].中国医药导报,2017,14(32):108-111.
[11]吕明慧,杨光辉,何奕坤.补肾解毒通络方联合甲氨蝶呤治疗活动期类风湿关节炎的临床研究[J].上海中医药杂志,2014,48(11):55-57.
[12]王友强,兰由玉,何成松.关通舒胶囊联合甲氨蝶呤治疗类风湿关节炎的临床疗效观察[J].检验医学与临床,2014,11(5):616-617.
[13]李斌,唐今扬,周彩云,等.清热解毒活血法外治类风湿关节炎的临床研究[J].世界中医药,2015,10(4):516-519.
[14]罗勇,呼永河,郭明阳,等.五藤二草汤治疗活动期类风湿关节炎临床研究[J].中国中医药信息杂志,2014,21(9):33-35.
[15]农作军.甲氨蝶呤联合来氟米特治疗60例活动期类风湿关节炎的效果观察[J].现代诊断与治疗,2017(12):2188-2189.
[16] Alarcón GS,Schrohenloher RE,Bartolucci AA,et al. Suppression of rheumatoid factor production by methotrexate in patients with rheumatoid arthritis:Evidence for differential influences of therapy and clinical status on IgM and IgA rheumatoid factor expression[J]. Arthritis Rheum,2014,33(8):1156-1161.
[17]陈玉兴,卓俊城,黄雪君,等.痹痛消胶囊对大鼠类风湿性关节炎的作用及其机制[J].中成药,2016,38(6):1211-1215.
[18]李卓伶,程鹏,程青青,等.双乌风湿合剂治疗类风湿关节炎(寒湿痹阻证)的临床研究[J].中国中医急症,2018,27(3):410-413.
[19]陈莉莹,孙华瑜,石桂秀.环孢素A联合甲氨蝶呤治疗对类风湿关节炎患者IL-17表达的影响[J].临床与病理杂志,2015,35(8):1533-1536.
[20]姚瑶,葛卫红.青风藤醇提物与青藤碱治疗胶原诱导关节炎大鼠药效的比较研究[J].药学与临床研究,2014,22(1):25-28.
[21] Conway R,Low C,Coughlan RJ,et al. THU0139 Methotrexate Use and Liver Disease in Rheumatoid Arthritis:A MetaAnalysis of Randomised Controlled Trials[J]. Arthritis Rheum,2014,66(4):803-812.
[22]葛林,石志敏.当归拈痛汤加减联合甲氨蝶呤治疗类风湿关节炎的随机对照研究[J].中医药学报,2017,45(2):84-86.
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