三痹汤加减联合来氟米特片治疗寒湿痹阻型类风湿关节炎的疗效观察
|
摘要
目的观察三痹汤加减联合来氟米特片治疗寒湿痹阻型类风湿关节炎(RA)的临床疗效。方法将74例寒湿痹阻型RA患者按照随机数字表法分为2组。治疗组37例予三痹汤加减联合来氟米特片治疗;对照组37例单纯予来氟米特片治疗。2组均治疗4周后统计疗效,比较2组治疗前后中医症状积分变化情况并评价疗效,包括疼痛、肿胀、压痛、屈伸不利、晨僵、舌象及脉象;根据28个关节的疾病活动度评分(DAS28)改善情况评价2组治疗后病情活动度控制情况;比较2组治疗前后类风湿因子(RF)、红细胞沉降率(ESR)及C-反应蛋白(CRP)水平变化情况;比较2组治疗期间的不良反应情况。结果治疗组总有效率91.89%,病情明显控制率67.57%,对照组总有效率75.67%,病情明显控制率45.94%,治疗组疗效及病情控制均优于对照组(P<0.05);2组治疗后疼痛、肿胀、压痛、屈伸不利、晨僵、舌象及脉象评分与本组治疗前比较均明显降低(P<0.05),且治疗组各中医症状改善均优于对照组(P<0.05);2组治疗后RF、ESR及CRP水平与本组治疗前比较均明显降低(P<0.05),且治疗组改善均优于对照组(P<0.05);治疗组不良反应发生率10.81%,对照组不良反应发生率21.6%,治疗组不良反应发生情况低于对照组(P<0.05)。结论三痹汤加减联合来氟米特治疗寒湿痹阻型RA可明显改善患者中医症状,控制RA病情活动,降低RF、ESR及CRP水平,减少不良反应的发生,提高临床疗效,提高患者生活质量。
Objective To observe the clinical effects of modified Sanbi decoction plus Leflunomide tablets on rheumatoid arthritis(RA) patients of cold-dampness obstruction syndrome.Methods 74 patients with RA of cold-dampness obstruction syndrome were divided into two groups according to the random number table method.37 cases in treatment group were treated by Sanbi decoction plus Leflunomide tablets,37 cases in control group were treated by Leflunomide tablets.After 4 weeks of treatment,the scores of TCM symptoms before and after treatment were compared and clinical efficacy were evaluated,including pain,swelling,pressure pain,bad flexion and extension,morning stiffness,tongue image and pulse image.According to the disease activity score of 28 joints(DAS28),the control of disease activity was evaluated in the 2 groups after treatment.The changes of rheumatoid factor(RF),blood sedimentation rate(ESR),and C-reactive protein(CRP) before and after treatment in the two groups were compared,and adverse reactions during treatment between the two groups were compared.Results The total effective rate of the treatment group was 91.89%,the control rate of the treatment group was 67.57%,the total effective rate of the control group was 75.67%,the control rate of the treatment was 45.94%,the curative effect and the condition control of the treatment group were superior to the control group(P < 0.05).The pain,swelling,pressure pain,bad flexion and extension,morning stiffness,tongue image and pulse image of the two groups after treatment were all significantly lower than those before treatment(P <0.05).After treatment,the improvement of the TCM symptoms improved in treatment group was better than that of control group(P < 0.05).The RF,ESR and CRP levels in two groups after treatment were significantly lower than those before treatment(P < 0.05),and the improvement of RF,ESR and CRP levels in treatment group was better than that in the control group(P < 0.05).The incidence of adverse reactions was 10.81 % in treatment group and21.6% in the control group,the incidence of adverse reactions in treatment group was lower than that in the control group(P < 0.05).Conclusion Sanbi decoction plus Leflunomide tablets can significantly improve TCM symptoms,control RA disease activity,reduce RF,ESR and CRP levels,reduce adverse reactions,improve clinical efficacy,and improve patient's life quality.
Objective To observe the clinical effects of modified Sanbi decoction plus Leflunomide tablets on rheumatoid arthritis(RA) patients of cold-dampness obstruction syndrome.Methods 74 patients with RA of cold-dampness obstruction syndrome were divided into two groups according to the random number table method.37 cases in treatment group were treated by Sanbi decoction plus Leflunomide tablets,37 cases in control group were treated by Leflunomide tablets.After 4 weeks of treatment,the scores of TCM symptoms before and after treatment were compared and clinical efficacy were evaluated,including pain,swelling,pressure pain,bad flexion and extension,morning stiffness,tongue image and pulse image.According to the disease activity score of 28 joints(DAS28),the control of disease activity was evaluated in the 2 groups after treatment.The changes of rheumatoid factor(RF),blood sedimentation rate(ESR),and C-reactive protein(CRP) before and after treatment in the two groups were compared,and adverse reactions during treatment between the two groups were compared.Results The total effective rate of the treatment group was 91.89%,the control rate of the treatment group was 67.57%,the total effective rate of the control group was 75.67%,the control rate of the treatment was 45.94%,the curative effect and the condition control of the treatment group were superior to the control group(P < 0.05).The pain,swelling,pressure pain,bad flexion and extension,morning stiffness,tongue image and pulse image of the two groups after treatment were all significantly lower than those before treatment(P <0.05).After treatment,the improvement of the TCM symptoms improved in treatment group was better than that of control group(P < 0.05).The RF,ESR and CRP levels in two groups after treatment were significantly lower than those before treatment(P < 0.05),and the improvement of RF,ESR and CRP levels in treatment group was better than that in the control group(P < 0.05).The incidence of adverse reactions was 10.81 % in treatment group and21.6% in the control group,the incidence of adverse reactions in treatment group was lower than that in the control group(P < 0.05).Conclusion Sanbi decoction plus Leflunomide tablets can significantly improve TCM symptoms,control RA disease activity,reduce RF,ESR and CRP levels,reduce adverse reactions,improve clinical efficacy,and improve patient's life quality.
引文
[1]Van der Heijde D,Tanaka Y,Fleischmann R,et al.Tofacitinib(CP-690,550)in patients with rheumatoid arthritis receiving methotrexate:twelve-month data from a twenty-four-month phase III randomized radiographic study[J].Arthritis Rheum,2013,65(3):559-570.
[2]侯勇,赵岩.类风湿关节炎的诊断和治疗进展[J].实用医院临床杂志,2011,8(2):8-10.
[3]穆荣,王素梅,刘传慧,等.小剂量激素治疗类风湿关节炎不良反应的回顾性临床分析[J].中华风湿病学杂志,2005,9(5):303-305.
[4]Vander CB,Van Looy S,Wyns B,et al.DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients:validation of the DAS28 score in patients under infliximab treatment[J].Arthritis Res Ther,2005,7(5):R1063-R1071.
[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]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:115-119.
[7]Vander CB,Van Looy S,Wyns B,et al.DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients:validation of the DAS28 score in patients under infliximab treatment[J].Arthritis Res Ther,2005,7(5):1063-1071.
[8]曾小峰,朱松林,谭爱春,等.我国类风湿关节炎疾病负担和生存质量研究的系统评价[J].中国循证医学杂志,2013,13(3):300-307.
[9]高翌娟.类风湿性关节炎患者生命质量及相关因素分析[J].临床医学,2009,29(9):28-30.
[10]厉彦山,陈慧勇,潘文志,等.红细胞体积分布宽度(RDW)与类风湿关节炎(RA)病情活动的相关性分析[J].复旦学报(医学版),2012,39(2):152-156.
[11]邱霞,徐燕.甲氨蝶呤联合来氟米特对类风湿关节炎患者的ACCP、RF及CRP水平的影响[J].海南医学院学报,2013,19(4):474-477.
[12]刘德芳,晏姣,郭明阳,等.类风湿关节炎湿热痹阻型患者血清和滑膜液IL-17与ESR、CRP的相关性研究[J].中国中西医结合杂志,2014,34(3):272-275.
[13]雷玲,赵铖,米存东.类风湿关节炎病情活动指标与DAS28的相关性研究[J].广西医科大学学报,2008,25(6):893-895.
[14]陈庆平,史雅峰,沈斯瑶,等.类风湿关节炎实验室诊断指标与DAS28评分相关性的研究[J].陕西医学杂志,2012,41(11):1469-1470.
[15]Saudan M,Saudan P,Perneger T,et al.Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement:a prospective randomised trial[J].J Bone Joint Surg Br,2007,89(2):155-159.
[16]李梦涛,姚中强,于孟学,等.重新评价糖皮质激素对类风湿关节炎的治疗作用及不良反应[J].北京医学,2005,27(12):748-751.
[17]黄建林,巫世瑶,罗敏琪,等.来氟米特治疗类风湿关节炎的上市后安全性再观察[J].广东医学,2010,31(14):1870-1872.
[18]孙禹.类风湿关节炎中医病因病机研究进展[J].亚太传统医药,2014,10(11):54-55.
[19]纪德凤,张春芳.三痹汤治疗类风湿关节炎的Meta分析[J].亚太传统医药,2016,12(14):80-83.
[20]张春芳,纪德凤,祁永校,等.三痹汤对佐剂性关节炎大鼠膝关节滑膜病理改变的影响及其机制研究[J].江苏中医药,2016,48(9):75-78.
[2]侯勇,赵岩.类风湿关节炎的诊断和治疗进展[J].实用医院临床杂志,2011,8(2):8-10.
[3]穆荣,王素梅,刘传慧,等.小剂量激素治疗类风湿关节炎不良反应的回顾性临床分析[J].中华风湿病学杂志,2005,9(5):303-305.
[4]Vander CB,Van Looy S,Wyns B,et al.DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients:validation of the DAS28 score in patients under infliximab treatment[J].Arthritis Res Ther,2005,7(5):R1063-R1071.
[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]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:115-119.
[7]Vander CB,Van Looy S,Wyns B,et al.DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients:validation of the DAS28 score in patients under infliximab treatment[J].Arthritis Res Ther,2005,7(5):1063-1071.
[8]曾小峰,朱松林,谭爱春,等.我国类风湿关节炎疾病负担和生存质量研究的系统评价[J].中国循证医学杂志,2013,13(3):300-307.
[9]高翌娟.类风湿性关节炎患者生命质量及相关因素分析[J].临床医学,2009,29(9):28-30.
[10]厉彦山,陈慧勇,潘文志,等.红细胞体积分布宽度(RDW)与类风湿关节炎(RA)病情活动的相关性分析[J].复旦学报(医学版),2012,39(2):152-156.
[11]邱霞,徐燕.甲氨蝶呤联合来氟米特对类风湿关节炎患者的ACCP、RF及CRP水平的影响[J].海南医学院学报,2013,19(4):474-477.
[12]刘德芳,晏姣,郭明阳,等.类风湿关节炎湿热痹阻型患者血清和滑膜液IL-17与ESR、CRP的相关性研究[J].中国中西医结合杂志,2014,34(3):272-275.
[13]雷玲,赵铖,米存东.类风湿关节炎病情活动指标与DAS28的相关性研究[J].广西医科大学学报,2008,25(6):893-895.
[14]陈庆平,史雅峰,沈斯瑶,等.类风湿关节炎实验室诊断指标与DAS28评分相关性的研究[J].陕西医学杂志,2012,41(11):1469-1470.
[15]Saudan M,Saudan P,Perneger T,et al.Celecoxib versus ibuprofen in the prevention of heterotopic ossification following total hip replacement:a prospective randomised trial[J].J Bone Joint Surg Br,2007,89(2):155-159.
[16]李梦涛,姚中强,于孟学,等.重新评价糖皮质激素对类风湿关节炎的治疗作用及不良反应[J].北京医学,2005,27(12):748-751.
[17]黄建林,巫世瑶,罗敏琪,等.来氟米特治疗类风湿关节炎的上市后安全性再观察[J].广东医学,2010,31(14):1870-1872.
[18]孙禹.类风湿关节炎中医病因病机研究进展[J].亚太传统医药,2014,10(11):54-55.
[19]纪德凤,张春芳.三痹汤治疗类风湿关节炎的Meta分析[J].亚太传统医药,2016,12(14):80-83.
[20]张春芳,纪德凤,祁永校,等.三痹汤对佐剂性关节炎大鼠膝关节滑膜病理改变的影响及其机制研究[J].江苏中医药,2016,48(9):75-78.