辨证分型治疗类风湿性关节炎的临床研究

Clinical Observation on Rheumatoid Arthritis Treated through Differentiating Syndromes

目的观察中医药辨证分型结合西药治疗类风湿性关节炎的疗效。方法选择类风湿性关节炎患者60例,随机分为对照组(采用西药治疗:双氯芬酸钠+柳氮磺胺吡啶+甲氨蝶呤)、寒湿组(寒湿方+西药治疗)、湿热组(湿热方+西药治疗)各20例,每组均治疗3个月,观察临床症状、体征和实验室指标的改善情况。结果 3组在治疗前后均有统计学意义(P<0.05);组间比较,寒湿组、湿热组在改善休息痛、肿胀个数、肿胀指数、压痛个数、压痛指数、晨僵时间、抗CCP抗体及类风湿因子(RF)与对照组相比无统计学差异(P<0.05),改善关节功能分级、双手握力和及降低红细胞沉降率(ESR)、C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)与对照组比较,具有统计学意义(P<0.05),寒湿组、湿热组组间比较无统计学差异(P>0.05)。结论中医药辨证分型结合西药治疗对类风湿性关节炎关节功能的改善、病情活动的控制与单纯西药治疗相比,具有一定的优势。

OBJECTIVE To observe the effect of TCM differentiation accompanied with western medicine on rheumatoid arthritis.METHODS 60 patients were randomized into control group（western medicine： Diclofenac,SASP and MTX）,cold and dampness group（formula for cold dampness syndrome plus western medicine）,dampness and heat group（formula for heat dampness syndrome plus western medicine）.They were all treated for 3 months to observe their clinical symptoms,physical signs and laboratory indexes.RESULTS The three groups all showed statistic significance（P0.05）.Compared with control group,there was no significance in the improvement of rest pain,the number and degree of swellings,pressing pain,morning stiffness,TNF-α and ESR of cold dampness and heat dampness groups（P0.05）,while the improvement of joint function grading,hand grip and decrease of PF,CRP,IL-6 and anti-CCP showed a significant difference（P0.05）.In addition,the comparison between cold dampness and heat dampness groups exhibited no statistical significance（P0.05）.CONCLUSION TCM differentiation accompanied with western medicine treating rheumatoid arthritis has its advantages in the aspect of improving joint function and controlling the patients＇ condition.