雷公藤制剂合中药辨证治疗激素依赖性类风湿关节炎临床研究

Clinical Study on Hormone Dependent Rheumatoid Arthritis Treated by Tripterygium Preparation and Syndrome Differentiation of TCM

目的:观察雷公藤制剂结合中药辨证施治对激素依赖性类风湿关节炎的临床疗效。方法:45例激素依赖性类风湿关节炎患者予雷公藤制剂合中药辨证治疗,雷公藤制剂为全根制剂,剂型为酒剂和片剂,中药辨证分型①阴虚内热型、②湿热痹阻型、③寒热错杂型、④瘀血痹阻型⑤气阴两伤型、⑥肝肾不足型,分别采用青蒿鳖甲汤合知柏地黄汤加减、四妙散加味、桂枝芍药知母汤加减、桃红四物汤加味、左归饮或右归饮加减治疗。观察时间最短5个月,最长2年,平均10.2月。结果:显效29例,64.44%;进步10例,22.22%;有效5例,11.11%;无效1例,2.22%,总有效率97.78%。对关节疼痛、压痛、肿胀、功能障碍等指数治疗前后均值具有非常显著的意义(P<0.001),并且血沉、C-反应蛋白、类风湿因子值均下降,柯兴氏综合征有明显改善或消失。结论:雷公藤制剂合中药辨证对激素依赖性类风湿关节炎临床疗效显著,改善症状体征明显,副作用少,是一个值得推广的方案。

Objective ：To observe the clinical effect on treating hormone dependent rheumatoid arthritis with Tripterygium preparation by syndrome differentiation of traditional chinese medicine. Methods ：45 patients with hormone-dependent rheumatoid arthritis were divided into six types by TCM differentiation： ① yin-deficiency and interior-heat type; ② hot-humid and blockage type; ③ cold-heat complex type; ④ stagnant blood and blockage type; ⑤qi-yin injury type; ⑥ liver-kidney deficiency type. Differentially and flexibly treated patients in each type using the Tripterygium preparations together with the Qinghao Biejia Decotion and Zhibai Dihunag Decotion, Simiaosan, Guizhi Shaoyao Zhimu Decotion, Taohong Siwu Decotion, Zuoguiyin or Youguiyin. The shortest observation time was 5 months, the longest 2 years, with an average of 10.2 months. Results：29 cases with marked efficiency （64.44%） ; 10 cases improved （22.22%） ; 5 cases with efficiency only （ 11.11% ） ; 1 ineffective （2.22%）. The total effective rate was 97.78%. There was very significant for the index of joint pain, tenderness, swelling and dysfunction before and after the treatment （P 〈 0.001 ） ; The erythrocyte sedimentation rate, the C-reactive protein and the rheumatoid factor value decreased and the Cushingt syndrome significantly improved or disappeared. Conclusion ： The effect of differential treatment of hormone-dependent rheumatoid arthritis with Tripterygium preparation was significant with few side effects and worth spreading.