自拟解毒通络除痹方治疗类风湿关节炎临床研究

Clinical Study on Self-made Jiedu Tongluo Chubi Recipe in the Treatment of Rheumatoid Arthritis

目的:探讨自拟解毒通络除痹方治疗类风湿关节炎患者的临床疗效。方法:选取类风湿关节炎患者87例,随机分为治疗组(45例)和对照组(42例),对照组患者应用甲氨蝶呤治疗,治疗组应用甲氨蝶呤联合自拟解毒通络除痹方治疗,比较两组患者临床症状积分、实验室指标、细胞因子、C反应蛋白(CRP)、胱抑素C及同型半胱氨酸水平及不良反应发生情况。结果:患者治疗后关节疼痛评分、晨僵评分、关节压痛指数、关节肿胀指数、血沉、血小板计数、类风湿因子(RF)、肿瘤细胞因子α(TNF-α)、白细胞介素(IL-1β、IL-17及IL-23)、CRP、胱抑素C及同型半胱氨酸水平较同组治疗前均降低,差异有统计学意义(P<0.05);治疗后治疗组上述指标水平均低于对照组,差异有统计学意义(P<0.05)。治疗组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:自拟解毒通络除痹方联合甲氨蝶呤对类风湿关节炎的治疗效果明显优于单用甲氨蝶呤,不仅可抑制患者炎性细胞因子表达,还可通过降低CRP、胱抑素C和同型半胱氨酸水平减轻动脉粥样硬化程度。

Objective:To explore the effects of self-made Jiedu Tongluo Chubi Recipe on cytokines and its protective effect against atherosclerosis in patients with rheumatoid arthritis.Methods:A total of 87 patients with rheumatoid arthritis admitted to the hospital from January 2017 to December 2019 were enrolled and randomly divided into observation group(45 cases)and control group(42 cases).The control group was treated with methotrexate,while observation group was treated with methotrexate and self-made Jiedu Tongluo Chubi Recipe.The clinical symptoms,laboratory indexes,cytokines,levels of C-reactive protein(CRP),cystatin C and homocysteine,and adverse reactions were compared between the two groups.Results:After treatment,scores of joint pain and morning stiffness,tender joint index,joint swelling index,erythrocyte sedimentation rate(ESR),platelet count,rheumatoid factor(RF),tumor necrosis factorα(TNF-α),interleukin(IL-1β,IL-17,IL-23),CRP,cystatin C and homocysteine levels in both groups were decreased(P<0.05).After treatment,levels of the above-mentioned indexes in observation group were lower than those in control group(P<0.05).The incidence of adverse reactions in observation group(4.44%)was lower than that in control group(P<0.05).Conclusion:The curative effect of self-made Jiedu Tongluo Chubi Recipe combined with methotrexate is significantly better than that of methotrexate on rheumatoid arthritis.It can not only inhibit the expression of inflammatory cytokines,but also alleviate atherosclerosis by reducing levels of CRP,cystatin C and homocysteine.