类风湿关节炎骨代谢变化及清热解毒方药的干预作用

Bone Metabolism of Rheumatoid Arthritis and Intervention of Heat-clearing and Toxicity-reliving Drug

目的观察活动性类风湿关节炎(RA)骨代谢变化特点及清热解毒方药的干预作用。方法将105例活动性RA患者随机分为治疗组(54例)和对照组(51例),另选50例年龄、性别相匹配的健康体检者作为健康组。对照组以甲氨蝶呤(MTX)为基本药物,治疗组在此基础上复给予清解热毒方药——速效热痹饮,2组均治疗3个月。观察患者治疗前后疼痛关节数及程度、肿胀关节数及程度、晨僵时间、休息痛和医生对目前病情的评估,并检查红细胞沉降率(ESR)、C反应蛋白(CRP)、骨特异性碱性磷酸酶(BAP)和抗酒石酸酸性磷酸酶(TRACP5b)。结果 RA患者治疗前BAP和TRACP5b均较健康组增高(P<0.01),治疗后治疗组BAP和TRACP5b明显下降(P<0.05),对照组虽也呈下降趋势,但无统计学意义(P>0.05)。治疗后2组BAP和TRACP5b差异具有统计学意义(P<0.05)。结论活动性RA骨形成和骨吸收均表现为亢进,但以骨吸收为主。清热解毒方药能降低BAP和TRACP5b等骨代谢指标,表现为对骨破坏的抑制作用。

Objective To observe the characteristics of bone metabolism of activity rheumatoid arthritis （RA） and the intervention of heat-clearing and toxicity-reliving drug. Methods One hundred and five cases of activity RA was randomly divided into treatment group （n =54） and control group （n =51）. In addition, 50 healthy controls matched in age and sex were as healthy group. The control group used MTX as basic medicine, while the treatment group was given heat-clearing and toxicity-reliving herbs--quick acting potion for heat rigon additionally, for three months. The number and level of pain and swell of joint, morning stiffness, rest pain, condition valuation by doctor, and ESR, CRP, BAP, TRACP5b were observed before and after treatment. Results BAP and TRACP5b of RA patients were significantly higher than the healthy （P〈0.05）. After treatment, the level of BAP and TRACP5b of treatment group decreased significantly （P〈0.05）, while that of control group declined, but without significance （P〉0.05）. There was significant difference between the two groups （P〈0.05）. Conclusion Activity RA has high level of both bone formation and resorption, but bone resorption plays a more important role. The treatment of heat-clearing and toxicity-reliving can reduce BAP and TRACP5b of RA by suppressing bone damage.