联合雷公藤合剂治疗湿热痹阻型类风湿关节炎的临床疗效评价

Clinical efficacy evaluation of combining Tripterygium mixture in the treatment of rheumatoid arthritis with damp-heat-blockage syndrome

目的:探讨联合雷公藤合剂治疗湿热痹阻型类风湿关节炎的疗效。方法:按疾病活动度,将72例合格受试者随机分成治疗组36例,对照组36例。治疗组:西药予甲氨蝶呤+来氟米特,中药予雷公藤合剂+宣痹二妙散。对照组:西药予甲氨蝶呤+来氟米特,中药予宣痹二妙散。观察12周。检测指标:治疗前、治疗后4周、8周、12周分别记录指关节压痛数(TJC)、指关节肿胀数(SJC)、血沉(ESR)、C反应蛋白(CRP)及患者对疾病的自我总体评分(GH)、疾病活动度评估(DAS28评分)。结果:①治疗前两组的6个指标比较,均P>0.05,无显著性差异,具有可比性。②治疗组6个指标在治疗后4周、8周、12周分别与治疗前比较,均P<0.05,有显著性差异;对照组ESR、CRP在治疗后4周与治疗前比较,P>0.05,无显著性差异,在治疗后8周、12周与治疗前分别比较,P<0.05,具有显著性差异。说明在改善炎性指标方面,治疗组较对照组起效快。对照组TJC、SJC、DAS28治疗后4周、8周、12周与治疗前分别比较,均P<0.05,有显著性差异。③炎性指标ESR、CRP分别在治疗后4周、8周、12周进行两组间比较,均P<0.05,两组间均有差异。TJC、SJC在治疗后4周、8周、12周进行两组间比较,均P>0.05,两组间无差异。DAS28、GH在治疗后4周、8周分别进行两组间比较无差异,均P>0.05;在治疗后12周两组间比较有差异,P<0.05。结论:联合雷公藤合剂治疗湿热痹阻型类风湿关节炎在改善炎性指标方面起效快,改善程度优于对照组;治疗12周后患者对疾病的自我总体评分优于对照组,满意度高;DAS28亦提示在治疗后12周治疗组优于对照组。

Objective： To explore the clinical efficacy evaluation of the treatment of rheumatoid arthritis with damp-heat-blockage syndrome combining tripterygium mixture. Methods： According to disease activity, divided 72 cases of eligible subjects randomly into the treatment group （36 cases） and the control group （36 cases）. Treatment groups were given methotrexate combined use of leflunomide （Western medicine） and tripterygium mixture combined use of xuanbi ermiao San （traditional Chinese medicine）. Control groups were given methotrexate combined use of leflunomide （Western medicine） and xuanbi ermiao powder （traditional Chinese medicine）. Observe them for 12 weeks. Detection index： pre-treatment, 4 weeks, 8 weeks and 12 weeks after treatment TJC （tender joint count）, SJC （swollen joint count）, ESR （erythrocyte sedimentation rate）, CRP （c-reactive protein）, GH and DAS 28 （disease activity assessment 28） were recorded. Results： ①There was no significant differences in six indicators before treatment （P〉0.05）, they were comparable. ②There was significant differences in six indicators after 4 weeks, 8 weeks, 12 weeks from those before treatment respectively（P〈0.05）. There was no significant differences in the ESR, CRP of the control group after four-week treatment from those before treatment（P〉0.05）, While after 8-week and 12-week treatment P〈0.05, there were significant differences, which indicated that thetreatment group got rapid onset of improvement of inflammatory index than the control group. There was significant differences in TJC, SJC and DAS28 of the control group after 4 weeks, 8 weeks and 12weeks from those before treatment（ P〈0.05）,③There were differences in inflammatory index ESR, CRP, after 4 weeks, 8 weeks and 12 weeks respectively between the two groups（P〈0.05）. There were no differences in TJC and SJC after 4 weeks, 8 weeks and 12 weeks respectively between the two groups （P〉0.05）. There were differences in DAS28 and GH after 4 weeks and 8 weeks respectively between the two groups（P〉0.05）, but after 12 weeks there were differences between the two groups （P〈0.05）. Conclusion： Treatment of damp-heat-blockage rheumatoid arthritis combined use of tripterygium mixture made a fast onset of improving inflammatory index, better than that of the control group, GH of the patients was higher than that of the control group after 12 weeks, and so was the DAS28.