类风湿关节炎寒热属性分类及其对中西药疗效的影响

Cold and Hot Pattern Differentiation and Its Influence on the Efficacy of Chinese Medicine and Western Medicine in Rheumatoid Arthritis

目的:探讨类风湿关节炎(RA)患者寒热属性分类规律及其对中、西药疗效的影响。方法:397例来自多中心的RA随机对照临床研究病例,随机分为中药组203例和西药组194例,西药治疗方案包括非甾体抗炎药和慢作用药,中药治疗包括基础治疗和辨证用药。按ACR20标准评价治疗3个月和6个月的疗效。观察患者初诊时寒热相关症状和舌象13项,采用因子分析方法将患者分为寒证和热证,分类结果与中医师辨证结果进行对比分析,并比较寒、热证患者的疗效差异。结果:因子分析分类结果与医生辨证的结果一致。西药组3个月疗效中寒证患者有效率51.67%,热证为29.09%;6个月疗效中寒证有效率为88.52%,热证为55.36%,寒证疗效均高于热证,差异有显著性(P<0.05)。结论:依据中医理论对疾病再分类有利于提高治疗方案的针对性。

Objective：To explore the cold and hot pattern differentiation of rheumatoid arthritis＇s（RA）patients and its influence on the efficacy of Chinese and western medicine.Methods：Three hundred and ninety seven patients were included in the clinical trial from nine clinical centers.They were randomly divided into Western medicine（WM）treated group,194 cases;and traditional herbal medicine（CM）treated group,203 cases.The WM therapy included voltaren extended action tablet,methotrexate and sulfasalazine.The CM therapy included Glucosidorum Tripterygll Totorum tablet and Yishen Juanbi Tablet.The curative effects were evaluated with ACR20 criterion after treating 3 and 6 months.Thirteen symptoms and pictures of tongue related with cold and hot attributives in CM were observed in preliminary diagnosis,and the patients were classified into cold and hot type with factor analysis.All data were analyzed in SAS 8.2 package.Results：The classifications from factor analysis were conformed to the differentiation in CM.In WM,the effective rate after treatment for 3 months was 51.67% and 29.09% in the cases with cold pattern and hot pattern respectively,and after treatment for 6 months,the effective rate was 88.52% and 55.36% in the cases with cold pattern and hot pattern respectively.The difference in the efficacy of WM in the cases with cold and hot pattern was significant（P〈0.05）.Conclusions：Patient stratification based on CM could contribute more for understanding the specific effects of therapeutic regimens.