摘要
目的:观察青附蠲痹汤治疗寒湿痹阻型类风湿关节炎(RA)临床疗效及安全性,探讨其疗效机制。方法:寒湿痹阻型RA患者120例,按随机数字表法分为治疗组(青附蠲痹汤联合甲氨喋呤片)60例和对照组(甲氨喋呤片)60例,连续治疗8周后,评价RA患者DAS28评分及证候疗效。于治疗前和治疗后采集RA患者静脉血,分别检测血沉(ESR)、类风湿因子(RF)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、基质金属蛋白酶-3(MMP-3)及基质金属蛋白酶抑制剂-1(TIMP-1)含量。记录治疗过程中出现的所有不良反应。结果:经8周治疗,治疗组和对照组总有效率分别为96.67%和83.33%,治疗组显著优于对照组(P<0.05)。治疗后,治疗组较对照组同期显著改善关节疼痛、关节肿胀、屈伸不利、晨僵及肢体冷痛等症状评分(P<0.01)。治疗组DAS28评分、ESR、RF及CRP均较对照组同期显著降低(P<0.01)。治疗组TNF-α、IL-1β及MMP-3较对照组同期降低,TIMP-1较对照组同期上调(P<0.01,P<0.05)。两组不良反应率差异无统计学意义。结论:青附蠲痹汤治疗寒湿痹阻型RA疗效显著,显著改善临床症状,降低CRP、ESR、CRP水平,其疗效机制可能与抑制促炎性细胞因子TNF-α、IL-1β表达,降低MMP-3水平、上调TIMP-1表达有关。
Objective: To investigate the efficacy, safety and mechanisms of Qingfu Juanbi Decoction in treating rheumatoid arthritis(RA) with syndrome of cold-dampness arthralgia. Methods: A total of 120 RA Patients with syndrome of cold-dampness arthralgia were randomly divided into the treatment group(60 cases) and the control group(60 cases). Patients of the treatment group were treated with Qingfu Juanbi Decoction and methotrexate, and patients of the control group were treated with methotrexate, both of them for 8 weeks. The DAS28 score and efficacy of syndrome of TCM were assessed. Collected blood from patients with RA before and after treatment to detect the content of CRP, ESR, TNF-α, IL-1β, MMP-3, and TIMP-1 in serum. Adverse events were recorded during therapy. Results: After 8 weeks of therapy, the total efficacy rates of treatment group and the control group were 96.67% and 83.33%. The treatment group was significantly better than the control group(P<0.05). The symptom scores of joint pain, joint swelling, unfluent flexion and extension, morning stiffness and limb crymodynia had significant improvement in treatment group(P<0.01). DAS28 scores and levels of ESR, RF and CRP in treatment group were significantly lower than the control group(P<0.01). Compared with control group, TNF-α, IL-1β and MMP-3 were reduced and TIMP-1 was increased(P<0.01, P<0.05). There was no significant difference in the adverse frequency between two groups. Conclusion: Qingfu Juanbi Decoction was an effective drug in treating RA with syndrome of cold-dampness arthralgia to significantly improve clinical symptoms and reduce CRP, ESR, CRP levels. Its therapeutic mechanism may be related to inhibiting the expression of pro-inflammatory cytokines TNF-α, IL-1β, decreasing MMP-3 levels and up-regulating TIMP-1 expression.
引文
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