早期类风湿性关节炎患者影像学改变与乌头汤加减线性关系的临床研究
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摘要
目的:探讨早期类风湿性关节炎(RA)患者影像学改变与乌头汤加减线性关系。方法:选取本院收治的早期RA患者134例,按随机数字表法分组,对照组67例予以甲氨蝶呤联合来氟米特治疗,研究组67例在对照组基础上予以乌头汤加减治疗。比较两组间临床疗效、临床症状指标、核磁共振成像(MRI)检查指标、血液指标以及不良反应发生率。结果:对照组总有效率(73. 14%)低于研究组总有效率(91. 04%),具有统计学意义(P <0. 05)。与对照组比较,研究组治疗后28个关节的疾病活动(DAS28)评分、关节压痛数、肿胀评分、晨僵时间较低,治疗后血沉(ESR)及血清C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽(抗CCP)抗体水平较低,差异有统计学意义(P <0. 05)。与对照组比较,研究组治疗1个月、治疗2个月及治疗后滑膜炎评分、骨侵蚀评分及骨髓水肿评分较低,差异有统计学意义(P <0. 05)。研究组患者滑膜炎评分、骨侵蚀评分及骨髓水肿评分均与治疗时间呈负相关关系(r=-0. 921,P=0. 000; r=-0. 903,P=0. 000; r=-0. 864,P=0. 000)。两组患者发生的不良反应主要为恶心呕吐、皮疹、腹泻、肝功能异常,对照组不良反应发生率(16. 43%)与研究组(10. 47%)比较,差异无统计学差异(P> 0. 05)。结论:乌头汤加减治疗早期RA患者的临床疗效及安全性较好,且患者滑膜炎评分、骨侵蚀评分及骨髓水肿评分等MRI检查指标与乌头汤加减作用时间负相关,对乌头汤加减治疗RA的疗效有监测和评价价值。
Objective: To investigate the relationship between the imaging changes of early rheumatoid arthritis and the Modified Wutou Decoction. Methods: A total of 134 patients with early rheumatoid arthritis( RA) from our hospital were selected,and grouped by random number table. Sixty-seven cases in the control group received methotrexate combined with leflunomide and those in the experiment group received Modified Wutou Decoction on the basis of the control group. The clinical efficacy,clinical symptom indexes,nuclear magnetic resonance imaging( MRI) examination indexes and blood indexes and incidence of adverse reactions were compared after treatment. Results: The total effective rate in the control group( 73. 14%) was lower than that of the experiment group( 91. 04%) with significant difference( P < 0. 05). Compared with the control group,28 joints disease activity score( DAS28),the number of joint tenderness,swelling score and the time of morning stiffness were lower after treatment in the experiment group. The erythrocyte sedimentation rate( ESR) and serum C reactive protein( CRP),rheumatoid factor( RF),anti cyclic citrullinated peptide( anti CCP) antibody levels were lower after treatment and the differences were statistically significant( P < 0. 05). Compared with the control group,the synovitis score,bone erosion score and bone marrow edema score in the experiment group were lower after 1 and 2 months treatment and the differences were statistically significant( P < 0. 05). The synovitis score,bone erosion score and bone marrow edema score in the experiment group were negatively correlated with the treatment time( r =-0. 921,P = 0. 000; r =-0. 903,P = 0. 000; r =-0. 864,P = 0. 000). The adverse reactions in two groups were mainly nausea and vomiting,rash,diarrhoea and abnormal liver function. The incidence of adverse reactions in the control group( 16.43%) was not statistically significant compared with that of the experiment group( 10. 47%)( P > 0. 05). Conclusion: The clinical efficacy and safety of Modified Wutou Decoction in treatment of patients with RA are good,and the synovitis score,bone erosion score and bone marrow edema score and other MRI examination indicators were negatively correlated with the time of Modified Wutou Decoction,which has the monitoring and evaluation value for the treatment of RA with Modified Wutou Decoction.
Objective: To investigate the relationship between the imaging changes of early rheumatoid arthritis and the Modified Wutou Decoction. Methods: A total of 134 patients with early rheumatoid arthritis( RA) from our hospital were selected,and grouped by random number table. Sixty-seven cases in the control group received methotrexate combined with leflunomide and those in the experiment group received Modified Wutou Decoction on the basis of the control group. The clinical efficacy,clinical symptom indexes,nuclear magnetic resonance imaging( MRI) examination indexes and blood indexes and incidence of adverse reactions were compared after treatment. Results: The total effective rate in the control group( 73. 14%) was lower than that of the experiment group( 91. 04%) with significant difference( P < 0. 05). Compared with the control group,28 joints disease activity score( DAS28),the number of joint tenderness,swelling score and the time of morning stiffness were lower after treatment in the experiment group. The erythrocyte sedimentation rate( ESR) and serum C reactive protein( CRP),rheumatoid factor( RF),anti cyclic citrullinated peptide( anti CCP) antibody levels were lower after treatment and the differences were statistically significant( P < 0. 05). Compared with the control group,the synovitis score,bone erosion score and bone marrow edema score in the experiment group were lower after 1 and 2 months treatment and the differences were statistically significant( P < 0. 05). The synovitis score,bone erosion score and bone marrow edema score in the experiment group were negatively correlated with the treatment time( r =-0. 921,P = 0. 000; r =-0. 903,P = 0. 000; r =-0. 864,P = 0. 000). The adverse reactions in two groups were mainly nausea and vomiting,rash,diarrhoea and abnormal liver function. The incidence of adverse reactions in the control group( 16.43%) was not statistically significant compared with that of the experiment group( 10. 47%)( P > 0. 05). Conclusion: The clinical efficacy and safety of Modified Wutou Decoction in treatment of patients with RA are good,and the synovitis score,bone erosion score and bone marrow edema score and other MRI examination indicators were negatively correlated with the time of Modified Wutou Decoction,which has the monitoring and evaluation value for the treatment of RA with Modified Wutou Decoction.
引文
[1]曾小威.类风湿性关节炎治疗及免疫分子机制研究进展[J].中华实用诊断与治疗杂志,2015,29(11):1044-1046.
[2]庄媛媛,马培,林明宝,等. JAK激酶抑制剂在类风湿性关节炎治疗中的研究进展[J].实用中西医结合临床,2016,16(1):85-90.
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[7] Singh J A,Saag K G,Jr B S,et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis[J]. Arthritis Care Res,2016,68(1):1-25.
[8]国家中医药管理局.中华人民共和国中医药行业标准-中医病证诊断疗效标准(ZY/T001. 1-94)[S].北京:中国医药科技出版社,2012:47.
[9]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:62-64.
[10] Ejbjerg B,Mcqueen F,Lassere M,et al. The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas:the wrist joint[J].Ann Rheum Dis,2005,64 Suppl 1(1):i23.
[11]莫永生.抗类风湿性关节炎药物不良反应及临床研究进展[J].临床合理用药杂志,2016,9(9):172-173.
[12]刘清平,李楠,林昌松,等.从伏毒论治类风湿关节炎[J].中华中医药杂志,2016,31(4):1168-1170.
[13]梅阳阳,付长龙,庞书勤,等.乌头汤药理药效研究及其干预骨关节炎的机制探讨[J].风湿病与关节炎,2016,5(6):47-50.
[14]陈达,陈后煌,邵翔,等.乌头汤抑制骨关节炎炎症反应的作用机制探讨[J].风湿病与关节炎,2016,5(8):62-66.
[15]李乃谦.探讨白芍的药理作用及现代研究进展[J].中医临床研究,2017,9(20):137-138.
[16]杨芳,郭春霞. ESR、RF、抗CCP和AKA联合检测对类风湿性关节炎的诊断价值[J].中国医学创新,2015,12(2):1-3.
[17]魏志刚,全冠民,袁涛.早期类风湿性关节炎腕关节病变MRI研究进展[J].国际医学放射学杂志,2013,36(2):131-135.
[18]雷毅,柯雯昙.类风湿关节炎的早期诊断及应用价值[J].中华临床医师杂志:电子版,2016,10(7):85.
[2]庄媛媛,马培,林明宝,等. JAK激酶抑制剂在类风湿性关节炎治疗中的研究进展[J].实用中西医结合临床,2016,16(1):85-90.
[3]梁燕,邹豪.类风湿性关节炎药物治疗研究进展[J].海军医学杂志,2014,31(4):332-333.
[4]马华,刁永红.中药对类风湿关节炎滑膜细胞增殖与凋亡的研究[J].中国实用医药,2017,12(34):189-190.
[5]刘莹,路洪剑,黄艳娟.早期类风湿关节炎核磁共振改变分析[J].医学信息,2016,29(z1):21-22.
[6]池里群,周彬,高文远,等.治疗类风湿性关节炎常用药物的研究进展[J].中国中药杂志,2014,39(15):2851-2858.
[7] Singh J A,Saag K G,Jr B S,et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis[J]. Arthritis Care Res,2016,68(1):1-25.
[8]国家中医药管理局.中华人民共和国中医药行业标准-中医病证诊断疗效标准(ZY/T001. 1-94)[S].北京:中国医药科技出版社,2012:47.
[9]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:62-64.
[10] Ejbjerg B,Mcqueen F,Lassere M,et al. The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas:the wrist joint[J].Ann Rheum Dis,2005,64 Suppl 1(1):i23.
[11]莫永生.抗类风湿性关节炎药物不良反应及临床研究进展[J].临床合理用药杂志,2016,9(9):172-173.
[12]刘清平,李楠,林昌松,等.从伏毒论治类风湿关节炎[J].中华中医药杂志,2016,31(4):1168-1170.
[13]梅阳阳,付长龙,庞书勤,等.乌头汤药理药效研究及其干预骨关节炎的机制探讨[J].风湿病与关节炎,2016,5(6):47-50.
[14]陈达,陈后煌,邵翔,等.乌头汤抑制骨关节炎炎症反应的作用机制探讨[J].风湿病与关节炎,2016,5(8):62-66.
[15]李乃谦.探讨白芍的药理作用及现代研究进展[J].中医临床研究,2017,9(20):137-138.
[16]杨芳,郭春霞. ESR、RF、抗CCP和AKA联合检测对类风湿性关节炎的诊断价值[J].中国医学创新,2015,12(2):1-3.
[17]魏志刚,全冠民,袁涛.早期类风湿性关节炎腕关节病变MRI研究进展[J].国际医学放射学杂志,2013,36(2):131-135.
[18]雷毅,柯雯昙.类风湿关节炎的早期诊断及应用价值[J].中华临床医师杂志:电子版,2016,10(7):85.