祛邪止痛方内服外洗联合西药对活动期RA寒湿痹阻证患者临床症状、生活质量、MMP-3及TIMP-1水平的影响

Effect of internal administration and external washing of Quxie Zhitong decoction combined with western medicine on clinical symptoms,quality of life,level of MMP-3 and TIMP-1 in patients with rheumatoid arthritis

目的探讨祛邪止痛方内服外洗联合西药对活动期类风湿关节炎(RA)寒湿痹阻证患者临床症状、生活质量、基质金属蛋白酶-3(MMP-3)及金属蛋白酶抑制剂-1(TIMP-1)水平的影响。方法将150例活动期RA寒湿痹阻证患者随机分为2组,对照组75例给予西药单用治疗,观察组75例在此基础上加用祛邪止痛方内服外洗辅助治疗,比较2组患者近期疗效,治疗前后中医证候积分,中文版健康调查简表评分(SF-36)、C反应蛋白(CRP),血沉(ESR)、类风湿因子(RF)、MMP-3及TIMP-1水平。结果观察组近期总有效率显著高于对照组(P<0.05);2组治疗后关节疼痛、关节肿胀、屈伸不利、畏恶风寒及晨僵积分和CRP、ESR、RF及MMP-3水平均显著低于治疗前(P均<0.05),SF-36评分和TIMP-1水平均显著高于治疗前(P均<0.05),且观察组各指标改善情况均明显优于对照组(P均<0.05)。结论祛邪止痛方内服外洗联合西药治疗活动期RA寒湿痹阻证可有效缓解受累关节症状,提高日常生活质量,降低炎性因子水平,并有助于调节关节腔内MMP-3和TIMP-1浓度。

Objective It is to study the effect of internal administration and external washing of Quxie Zhitong decoction combined with western medicine on clinical symptoms,quality of life,level of matrix metalloproteinases-3（MMP-3） and metal protease inhibitors-1（TIMP-1） in patients with rheumatoid arthritis（RA）.Methods 150 cases of patients with active RA of cold-wet stasis syndrome were randomly divided into 2 groups,the control group（n = 75） was treated with western medicine therapy alone,the observation group（n = 75） was treated with internal administration and external washing of Quxie Zhitong decoction combined with western medicine.The recent curative effect,the changes of TCM syndrome scores,Chinese health survey profile score（SF-36）,levels of C-reactive protein（CRP） and blood sedimentation（ESR）,rheumatoid factor（RF）,MMP-3 and TIMP-1 level before and after treatment in both groups were compared.Results The total effective rate recent in observation group was significantly higher than that in control group（P〈0.05）; the TCM scores of joint pain,joint swelling,inconvenient flexion,fearing wind and cold,morning stiffness scores and the levels of CRP,ESR,RF and MMP-3 were significantly lower,SF-36） score and TIMP-1 level were significantly higher after treatment than that before treatment（P〈0.05）in both groups,and the improvements in observation group were significantly better than that of control group（P〈0.05）.Conclusion Internal administration and external washing of Quxie Zhitong decoction combined with western medicine can effectively alleviate symptoms of the affected joints,improve quality of daily life,decrease levels of inflammatory cytokines,and is helpful for regulating the MMP-3 and TIMP-1 concentration in articular cavity in the patients with with active RA of cold-wet stasis syndrome.