痹肿消汤对活动期类风湿关节炎骨侵蚀的作用:与甲氨蝶呤联合柳氮磺胺吡啶效果比较

Effects of heat-clearing and detoxicating (Bizhongxiao decoction) on bone erosion of rheumatoid arthritis:Compared with combination of methotrexate and sufasalazine therapy

背景:痹肿消汤对治疗活动期类风湿关节炎显示出良好的临床疗效。前期实验已从分子、基因水平初步验证了痹肿消汤对类风湿关节炎所发挥的多层、多靶点的治疗作用。目的:观察清热解毒法(痹肿消汤)对湿热型类风湿关节炎患者关节X射线分期及关节功能的影响。方法:选择2000-05/2006-05在中南大学湘雅医院中西医结合科治疗的活动期类风湿关节炎患者,随机分为两组,清热解毒组口服痹肿消汤,西药组选用甲氨蝶呤与柳氮磺胺吡啶联合用药。观察期为3年,比较两组患者治疗前和治疗后不同时期关节X射线摄片分期及关节功能评分的改变。结果与结论:清热解毒组治疗前与治疗3个月后的关节X射线摄片Ⅲ、Ⅳ级百分率明显降低,且在治疗1,2,3年后的关节X射线摄片Ⅲ、Ⅳ级所占百分率逐渐减少,关节功能评分也有显著降低(P<0.05)。西药组治疗3个月后的关节X射线摄片Ⅲ、Ⅳ级所占百分率无显著性改变,治疗1,2年后关节X射线摄片Ⅲ、Ⅳ级百分率下降,关节功能评分随之降低(P<0.05)。清热解毒组治疗3个月,2,3年与西药组同期比较关节功能评分显著降低(P<0.05)。同时清热解毒组仅有少数患者出现轻度不良反应。说明痹肿消汤在抑制类风湿关节炎患者关节骨质破坏及保护关节功能上的近期和远期疗效均明显优于甲氨蝶呤及柳氮磺胺吡啶的联合用药,且不良反应少。

BACKGROUND： The heat-clearing and detoxicating （Bizhongxiao decoction, BZXD） exhibits good curative effect in treating active rheumatoid arthritis （RA）. Previous experiments have identified the effectiveness of BZXD in treating rheumatoid arthritis at molecular and gene levels. OBJECTIVE： To observe the effect of BZXD on joint X-ray stages and functions in RA patients with damp-heat syndrome type. METHODS： Between May 2000 and May 2006, active RA patients received treatments at the Department of Combined Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, were randomly divided into 2 groups, namely, BZXD treated group and control group, which received combination of methotrexate and sufasalazine therapy, respectively. Both groups were treated for 3 years, and the staging of X-ray and the score of joint function before and after treatment in different times were compared. RESULTS AND CONCLUSION： Compared with prior to treatment, the percentage of grade Ⅲ and Ⅳ on joint X-ray of the BZXD group were obviously decreased at 3 months after treatment. The percentage of grade Ⅲ and Ⅳ were gradually reduced at 1, 2 and 3 years after treatment, and the joint function scores also improved significantly （P0.05）. In the control group, there were no notable changes in the percentage of grade Ⅲ, Ⅳ on joint X-ray at 3 months after treatment, which decreased at 1 and 2 years after the treatment, and the joint function score was also decreased （P0.05）. The joint function scores had notable difference between the treated group and control group at 3 months, 2 and 3 years after treatment （P 0.05）. Meanwhile, there were few patients suffered from slightly adverse reaction in the BZXD group. It proves that the short-term and long-term results of BZXD are obviously superior to the combination of methotrexate and sufasalazine therapy on RA patients in inhibiting joint bone destruction and protecting joint function, and the adverse effects of BZXD are obviously fewer.