青藤碱替代激素治疗类风湿性关节炎疗效分析

Analysis of clinical effect of treating rheumatoid arthritis with sinomenine or glucocorticoid

目的在甲氨蝶呤协同柳氮磺吡啶治疗的基础上,观察联合青藤碱或激素治疗类风湿性关节炎的临床疗效。方法将72例门诊或住院的类风湿性关节炎患者随机分为治疗组(青藤碱+甲氨喋呤+柳氮磺吡啶)36例和对照组(强的松+甲氨喋呤+柳氮磺吡啶)36例。治疗组青藤碱采用静滴+关节腔注射,间隙期口服青藤碱缓释片,对照组采用口服强的松。临床疗效指标为晨僵时间、关节肿胀数、关节压痛数及疼痛VAS评分,实验室检验指标为类风湿因子、血沉、C-反应蛋白。治疗周期为3个月,治疗结束后判定疗效。结果临床疗效两组治疗前、后组内比较4项临床疗效指标均明显改善(均P<0.05),治疗前、后两组组间比较均无明显差异;3项实验室检验指标两组治疗前、后组内比较均明显改善(均P<0.05),两组治疗前组间无明显差异,两组治疗后类风湿因子均下降,但差异无统计学意义,而治疗组血沉和C-反应蛋白的下降明显优于对照组(P<0.05)。结论在甲氨蝶呤协同柳氮磺吡啶治疗的基础上,联合青藤碱治疗类风湿性关节炎的作用等于或略优于强的松。

Objective To observe the clinical effect of treating rheumatoid arthritis with methotrexate and sulfasalazine combined either with sinomenine or with glucocorticoid.Methods 72 outpatients or hospitalized patients with rheumatoid arthritis were randomly divided into two groups.The study group with 36 patients was treated with methotrexate and sulfasalazine plus sinome-nine,and the control group with 36 patients was treated with methotrexate and sulfasalazine plus prednisone.Sinomenirie was given by infusion and intra-articular injection and taken by oral sustained-release tablets in the study group.Prednisone was given by oral in the control group.Clinical observations included the duration of morning stiffness,joint swelling,joint tenderness and pain VAS score.The laboratory tests included rheumatoid factor,erythrocyte sedimentation rate and C-reactive protein.The efficacy of treatment was determined three months by the end of each month.Results It was shown that the four clinical efficacy indicators were significantly(P&lt;0.05) improved in both groups after the treatment compared with those before treatment.There were no significant differences between the two groups after treatment.There was no significant difference between two groups before treatment in all three tests,but there were significant differences(P&lt;0.05) in both groups after treatment.Rheumatoid factor decreased in both groups after treatment,but there was no significant difference.Both erythrocyte sedimentation rate and C-reactive protein were decreased and showed significant differences(P&lt;0.05) after treatment in the study group compared with those of the control group.Conclusion Based on the treatment with methotrexate and sulfasalazine,the clinical effect of sinomenine on rheumatoid arthritis is equal to or slightly better than that of prednisone.