补益气血、祛湿通络法治疗类风湿关节炎的临床研究

Treatment rheumatoid arthritis with therapies of tonifying qi and replenishing blood, and dispelling dampness and freeing collateral vessels

目的观察补益气血、祛湿通络法治疗气血不足、寒湿痹阻型类风湿关节炎的临床疗效。方法将50例气血不足、寒湿痹阻型类风湿关节炎患者随机分为治疗组25例、对照组25例。对照组口服来氟米特片、正清风痛宁片;治疗组口服来氟米特片,同时口服补益气血、祛湿通络中药。2组均以4周为1个疗程。比较2组疾病疗效,症状体征评分变化,血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)、血小板(PLT)等实验室指标的变化,生活质量评分变化。结果治疗组25例中,显效3例(12%),进步10例(40%),有效8例(32%),无效4例(16%),总有效率为84%;对照组25例中,显效1例(4%),进步6例(24%),有效10例(40%),无效8例(32%),总有效率为68%。经Ridit分析,U=-2.086,P=0.043,P<0.05,说明治疗组的疾病疗效优于对照组。治疗后治疗组关节疼痛、关节肿胀、关节压痛、晨僵时间、恶寒喜温、乏力气短、面色、肌肉麻木、多梦健忘评分均较本组治疗前降低(P<0.05)。对照组关节疼痛、关节肿胀、关节压痛、晨僵时间、恶寒喜温、乏力气短、面色评分均较本组治疗前降低(P<0.05),肌肉麻木、多梦健忘评分与本组治疗前比较差异均无统计学意义(P>0.05)。治疗组关节疼痛、关节肿胀、关节压痛、晨僵时间、恶寒喜温、乏力气短、面色、肌肉麻木、多梦健忘治疗前后评分差值与对照组比较差异均有统计学意义(P<0.05),治疗组优于对照组。治疗后2组ESR,CRP,RF,PLT较本组治疗前均降低(P<0.05),治疗组治疗前后各差值与对照组比较差异均有统计学意义(P<0.05),治疗组优于对照组。治疗后2组生活质量评分较本组治疗前均降低(P<0.05),生活质量均有改善,治疗组治疗前后评分差值与对照组比较差异有统计学意义(P<0.05),治疗组优于对照组。结论补益气血、祛湿通络法治疗气血不足、寒湿痹阻型类风湿关节炎具有较好的临床疗效。

Objective To observe the curative effect of the therapies of tonifying qi and replenishing blood, and dispelling dampness and freeing collateral vessels on rheumatoid arthritis （RA, type of deficiency of qi and blood and type of cold-dampness obstruction）. Methods The patients （n=50） with RA （type of deficiency of qi and blood and type of cold-dampness obstruction） were randomly divided into treatment group and control group （each n=25）. The control group was orally given leflunomide pills and Zhengqingfeng Tongning Pian, and treatment group was orally given leflunomide pills and Chinese medicinal with the actions of tonifying qi and replenishing blood, and dispelling dampness and freeing collateral vessels. A therapeutic course was 4 weeks. The curative effect, integral changes of symptom and signs, ESR, CRP, RF and PLT, and quality of life were compared between two groups. Results In treatment group, there were 3 cases （12%） with significant effect, 10 （40%） with advanced effect, 8 （32%） with effect and 4 （16%） without effect, and the total effective rate was 84%. In control group, there was 1 case （4%） with significant effect, 6 （24%） with advanced effect, 10 （40%） with effect and 8 （32%） without effect, and the total effective rate was 68%. The result of Ridit analysis showed that U=-2.086, P=0.043 and P〈0.05. After treatment, the scores of symptoms, including arthralgia, arthroncus, joint tenderness, morning stiffness time, aversion to cold, preferring warmth, lack of strength, short of breath, complexion, muscle numbness, dreaminess and forgetfulness, were lower in treatment group than those before treatment （P〈0.05）. The scores of arthralgia, arthroncus, joint tenderness, morning stiffness time, aversion to cold, preferring warmth, lack of strength, short of breath and complexion were lower （P〈0.05）, and those of muscle numbness, dreaminess and forgetfulness had no statistical significance （P〈0.05） in control group compared with those before treatment. The D-value of symptom scores before and after treatment had statistical significance （P〈0.05） between two groups. After treatment, the levels of ESR, CRP, RF and PLT decreased in two groups （P〈0.05）, and D-value of laboratory indexes before and after treatment had statistical significance （P〈0.05） between two groups. The scores of quality of life decreased （P〈0.05） in two groups than those before treatment, and D-value of scores of quality of life before and after treatment had statistical significance （P〈0.05） between two groups. Conclusion The therapies of tonifying qi and replenishing blood, and dispelling dampness and freeing collateral vessels have good curative effect on RA （type of deficiency of qi and blood and type of cold-dampness obstruction）.