重剂速效热痹饮治疗难治性类风湿关节炎24例临床观察

Clinical Observation on Large Doses of Quick Rebi Beverage for 24 Cases of Refractory Rheumatoid Arthritis

目的观察重剂速效热痹饮治疗难治性类风湿关节炎的临床疗效。方法将49例难治性类风湿关节炎患者随机分为对照组25例和治疗组24例。对照组给予甲氨蝶呤片20mg,每周1次口服;来氟米特片10mg,每日1次口服;尼美舒利胶囊100mg,每日2次口服;速效热痹饮每次20ml,每日3次口服。治疗组在对照组基础上将速效热痹饮剂量加大至每次40～60ml,每日3次口服。两组均治疗3个月后评价西医疗效及中医证候疗效,同时记录治疗前后肿胀关节数及指数、压痛关节数及指数、晨僵持续时间、疼痛评分、日常生活能力(HAQ)及DAS28评分,检测血沉(ESR)、C反应蛋白(CRP)。结果治疗组西医疗效为70.8%,对照组为36.0%,治疗组优于对照组(P<0.05)。治疗组中医证候疗效总有效率87.5%,对照组为52.0%,治疗组优于对照组(P<0.05)。治疗组除肿胀关节数外其余指标治疗前后比较差异均有统计学意义(P<0.05或P<0.01);对照组治疗前后比较仅压痛指数、晨僵、疼痛评分及CRP差异有统计学意义(P<0.05)。两组治疗后比较,除疼痛评分外其余指标治疗组均优于对照组(P<0.05或P<0.01)。结论重剂速效热痹饮治疗难治性类风湿关节炎能提高疗效,明显改善症状、体征及炎症指标。

Objective To observe the therapeutic effect of large doses of Quick Rebi Beverage （beverage for heat impediment） on refractory rheumatoid arthritis （RA）. Methods Totally 49 cases of refractory RA were randomized into treatment group of 24 cases and control group of 25 cases. The control group was given 20 mg Methotrexate Tablets once weekly, 10 mg Leflunomide Tablets once daily, 100 mg Nimesulide Capsules twice daily and 20 ml Quick Rebi Beverage three times daily. The treatment group was given 40 to 60 ml Quick Rebi Beverage three times daily in addition to treatment of the control group. The efficacy of both groups was evaluated after 3 months treatment. The number and indices of swollen joints and tender joints, duration of morning stiffness, score of visual analog scale （VAS） for pain, Health Assessment Questionnaire （HAQ） and DAS 28 score were recorded before and after treatment. The erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） was detected. Results The percentage of American College of Rheumatology 20% improvement （ACR 20） in the treatment group and control group was 70.8% and 36.0% respectively, with a significant difference between groups （P0.05）. The total TCM efficacy in the treatment group and control group was 87.5% and 52.0% respectively, with a significant difference between groups （P0.05）. There were significant differences between before and after treatment in the indices except the number of swollen joints in the treatment group （P0.05 or P0.01）. There were significant differences between before and after treatment in the tender index, morning stiffness, VAS score and CRP in the control group （P0.05）. The indices except VAS score in the treatment group were superior to those in the control group after treatment （P0.05 or P0.01）. Conclusion The large doses of Quick Rebi Beverage is effective for refractory RA. It can obviously relieve the symptoms, signs and inflammatory markers.