中西医结合疗法治疗寒热错杂型类风湿关节炎效果观察

Effect of integrative Chinese and western medicine therapy on cold and hot miscellaneous rheumatoid arthritis

目的类风湿关节炎对患者身心健康造成严重影响,常规西医治疗效果并不理想,且不良反应明显。本研究旨在观察寒热错杂型类风湿关节炎患者应用中西医结合疗法的治疗效果。方法选取2017-01-01-2018-06-01濮阳风湿病医院收治的91例寒热错杂型类风湿关节炎患者为研究对象,采用性别、年龄和病程等因素组间匹配的原则分为对照组和观察组。对照组45例给予甲氨蝶呤口服,观察组46例增加祛风通脉汤煎服。观察两组治疗后症状体征、炎性因子〔肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C-反应蛋白(C-reactive protein,CRP)和血清炎症因子白细胞介素-1β(interleukin-1beta,IL-1β)〕和类风湿因子〔血红细胞沉降率(erythrocyte sedimentation rate,ESR)和类风湿因子(rheumatoid factor,RF)〕水平变化,并对比临床疗效及不良反应发生率。结果治疗后观察组肿胀评分为(0.96±0.12)分,低于对照组的(2.13±0.36)分,t=20.890,P<0.001;关节疼痛评分为(0.85±0.09)分,低于对照组的(2.23±0.41)分,t=22.289,P<0.001;晨僵评分为(0.76±0.10)分,低于对照组的(2.18±0.31)分,t=29.539,P<0.001;TNF-α水平为(0.88±0.07)ng/mL,低于对照组的(1.53±0.11)ng/mL,t=33.548,P<0.001;CRP水平为(19.85±2.03)mg/L,低于对照组的(26.96±5.02)mg/L,t=8.822,P<0.001;IL-1β水平为(1.08±0.07)pg/mL,低于对照组的(2.13±0.31)pg/mL,t=22.175,P<0.001;ESR为(17.11±2.53)mm/h,低于对照组的(25.02±5.11)mm/h,t=9.389,P<0.001;RF为(21.13±7.02)U/mL,低于对照组的(30.01±8.11)U/mL,t=5.570,P<0.001。观察组总有效率为93.48%,高于对照组的77.78%,χ^2=4.579,P=0.032;不良反应发生率为6.52%,低于对照组的24.44%,χ^2=5.613,P=0.018。结论中西医结合疗法能够有效消除寒热错杂型类风湿关节炎患者症状体征,抑制炎症反应,不良反应低。

OBJECTIVE Rheumatoid arthritis has a serious impact on the physical and mental health of patients.The treatment effect of conventional western medicine is not ideal,and the adverse reactions are obvious.The purpose of this study was to observe the therapeutic effect of integrated traditional Chinese and Western medicine on rheumatoid arthritis patients with cold-heat miscellaneous type.METHODS A total of 91 patients with rheumatoid arthritis of mixed cold-heat type were selected from Puyang Rheumatism Hospital from January 1,2017 to June 1,2018.The patients were divided into control group and observation group according to the matching principle of sex,age and course of disease.Fourty five cases in the control group were given oral methotrexate,46 cases in the observation group were given Qufeng Tongmai Decoction.The symptoms and signs,inflammatory factors[tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),interleukin-1 beta(IL-1β)]and rheumatoid factor[erythrocyte sedimentation rate(ESR),rheumatoid factor(RF)]were observed after treatment in both groups.The clinical efficacy and incidence of adverse reactions were compared between the two groups.RESULTS After treatment,the swelling score of the observation group was(0.96±0.12),lower than that of the control group(2.13±0.36),t=20.890,P<0.001.The joint pain score was(0.85±0.09),lower than that of the control group(2.23±0.41),t=22.289,P<0.001.The morning stiffness score was(0.76±0.10),lower than that of the control group(2.18±0.31),t=29.539,P<0.001.TNF-αlevel was(0.88±0.07)ng/ml,lower than the control group(1.53±0.11)ng/ml,t=33.548,P<0.001.CRP level was(19.85±2.03)mg/L,lower than the control group(26.96±5.02)mg/L,t=8.822,P<0.001.The level of IL-1βwas(1.08±0.07)pg/ml,lower than(2.13±0.31)pg/ml in the control group,t=22.175,P<0.001.ESR was(17.11±2.53)mm/h,lower than that of control group(25.02±5.11)mm/h,t=9.389,P<0.001.RF was(21.13±7.02)U/ml,lower than that of control group(30.01±8.11)U/ml,t=5.570,P<0.001.The total effective rate in the observation group was 93.48%,higher than77.78%in the control group,χ^2=4.579,P=0.032,and the incidence of adverse reactions was 6.52%,lower than24.44%in the control group,χ^2=5.613,P=0.018.CONCLUSION Integrated Chinese and Western medicine can effectively eliminate the symptoms and signs of rheumatoid arthritis patients,inhibit the inflammatory response,and have low adverse reactions.