补肾祛寒治尫汤加减联合外洗治疗类风湿性关节炎

Clinical Observation on Rheumatoid Arthritis Treated with Busheng Quhan Zhiwang Decoction and External Bathing

目的:观察补肾祛寒治尫汤内服、外洗对类风湿性关节炎(RA)患者的有效性和安全性。方法:将100名患者分为试验组和对照组各50例,试验组采用补肾祛寒治尫汤加减口服+外洗。对照组采用塞来昔布胶囊,0.2 g·d-1,口服;甲氨喋呤片(MTX)10 mg,1次/周,口服;来氟米特片(LEF)20 mg·d-1,口服;白芍总苷胶囊0.6 g,2次/d,口服;并加用中药汤剂口服。两组疗程均为24周,观察治疗前后两组临床症状的改善情况,检测血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)的变化以及不良反应。结果:治疗24周后两组ACR20的改善率比较无统计学差异;两组治疗后中医证候、晨僵时间、休息痛、关节肿痛指数、关节压痛指数、双手平均握力、20米步行时间、健康评价问卷(HAQ),ESR,CRP,RF等均较治疗前显著改善,但组间无统计学差异;两组共同的不良反应主要为消化系统反应,对照组患者容易出现血液系统的损害。结论:与中西医结合疗法比较,补肾祛寒治尫汤加减联合外洗在改善临床症状、体征和控制炎症方面与之疗效相当,且不良反应较轻,值得推广应用。

Objective：To observe the efficacy and safety of rheumatoid arthritis treated with Busheng Quhan Zhiwan decoction and external bathing.Method：One hundred patients were divided into treatment group（Busheng Quhan Zhiwan decoction and external bathing） and control group（Celebrex 0.2 g,qd ig,methotrexate 10 mg qw ig,leflunomide 20 mg qd ig,total glucosides of paeonia 0.6 g,bid ig and symptomatic Chinese medicinal decoctions）.After 24 weeks treatment,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,Rheumatoid factor（RF） and clinical scales was measured and safety was evaluated.Result：There was no significant difference in the effective rate of ACR 20 between two groups.The traditional Chinese medicine syndrome scores,joint pressure pain index number,joint swell index number,early morning stiffness,sufferers＇ break pain,20-metre walking times,equally hold dint,Health Assessment Questionnaire（HAQ）,ESR,RF and CRP of both groups was significantly improved after the treatments,but there were no significant difference between two groups.The common side effect of two groups was digestive system reaction while blood system impairment was found in the control group.Conclusion：Rheumatoid arthritis treated with Busheng Quhan Zhiwan decoction and external bathing had the same efficacy in clinical improvement and inflammation reduction with few adverse reactions,compared with the integrative therapy with both Chinese and western medicine.Busheng Quhan Zhiwan decoction and external bathing was suggested for clinical aplication.