宣痹消痛汤联合甲氨蝶呤片治疗类风湿关节炎的临床观察

Clinical Observation of Xuanbi Xiaotong Decoction United Methotrexate Tablets in Treating Rheumatoid Arthritis with Damp Heat Stagnation Syndrome

目的：探讨宣痹消痛方联合甲氨蝶呤片治疗类风湿关节炎（湿热痹阻证）的临床疗效及对抗环瓜氨酸肽抗体（抗-CCP）,抗聚角蛋白微丝蛋白抗体（AFA）和肿瘤坏死因子-α（TNF-α）的影响。方法：95例RA患者随机按数字表法分为对照组46例和观察组49例,两组均给予口服甲氨蝶呤片,7.5-20mg/次,1次/周;美洛昔康片,7.5-15mg/次,1次/d;对照组口服白芍总苷胶囊,2粒/次,3次/d;观察组采用宣痹消痛汤内服。两组疗程均为4个月。记录治疗前后关节晨僵时间、休息痛（采用视觉模拟评分法,VAS）,关节压痛数和肿胀指数（包括28个关节）、肿胀关节指数、双手握力及日常生活能力健康评估（HAQ）变化情况;检测治疗前后血沉（ESR）,C-反应蛋白（CRP）,类风湿因子（RF）,抗-CCP,AFA和TNF-α水平。结果：经Ridit分析,观察组临床疗效优于对照组（P〈0.05）;治疗后观察组关节晨僵时间、休息痛、关节压痛数和肿胀指数、肿胀关节指数和HAQ和双手握力的改善优于对照组（P〈0.01）;观察组ESR,CRP和RF水平均低于对照组（P〈0.01）;观察组抗-CCP,AFA和TNF-α水平均低于对照组（P〈0.01）。结论：在甲氨蝶呤片等治疗的基础上加服宣痹消痛汤能减轻临床症状、体征,控制疾病的活动度,减轻RA骨和软骨损坏,临床疗效优于白芍总苷胶囊。

Objective： To discuss the clinical effects of Xuanbi Xiaotong decoction combined with methotrexate tablets in treating rheumatoid arthritis （RA） with damp heat stagnation syndrome, and to observe its influence on anti-cyclic citrullinated peptide antibody （anti-CPP）, antifilaggrin antibody （AFA） and tumor necrosis factor-a （TNF-c-）. Method： Ninety-five patients with RA disease were randomly divided into the control group and the observation group by a digital method. Patients in both groups took 7.5-20 mg methotrexate tablets once weekly, 7.5-15 mg meloxicam once daily. Patients in the control group added 2 pieces of total glucosides of white paeony capsules orally thrice daily. Patients in the observation group added Xuanbi Xiaotong decoction. All patients received 4 months of treatment. The joint time of morning stiffness, rest pain （visual analogue scales） , joint tenderness number, swelling index （including 28 joints） , swollen joint index, hands grip and healthy activity of life quality （HAQ） changes were recorded. Levels of erythrocyte sedimentation rate （ESR） , C reactive protein （CRP）, rheumatoid factor （RF） , anti-CPP, AFA, TNF-c- were detected before and after therapy. Result： The curative effect of the observation group was superior to that of the control group （P 〈 0.05）. After treatment, improvements including joint time of morning stiffness, rest pain, joint tenderness number, swelling index, swollen joint index, HAQ and hands grip in the observation group were better than those in the control group （P 〈 0.01 ）. Levels of ESR, CPR and RF in the observation group were lower than those in the control group （P 〈 0.01 ）. Levels of anti-CCP, AFA and TNF-α in the observation group were inferior to those in the control group （P 〈 0. O1 ）. Conclusion ： On the basis of methotrexate tablets therapy, adding Xuanbi Xiaotong decoction could reduce clinical symptoms and signs, control disease activity, lighten RA bone and cartilage damages. Its clinical effect is superior to using paeony capsules alone.