甲氨蝶呤联合硫酸羟氯喹治疗类风湿性关节炎中医不同证型疗效分析

Analysis of the Efficacy of Methotrexate and Hydroxychloroquine Sulfate on Different Syndromes of Rheumatoid Arthritis

目的:观察甲氨蝶呤(methotrexate,MTX)联合硫酸羟氯喹(hydroxychloroquine sulfate,HCQ)治疗中医不同证型类风湿性关节炎(rheumatoid arthritis,RA)的疗效差异。方法:回顾分析125例以MTX联合HCQ治疗RA患者12周的完整病史,按照中医辨证标准将其分成风湿痹阻证组、寒湿痹阻证组、湿热痹阻证组、肝肾亏虚证组、肾气虚寒证组,统计分析治疗前后关节肿胀数、关节压痛数、晨僵时间、患者疼痛评分(Visual Analogue Score,VAS)、类风湿因子(rheumatoid factors,RF)、C反应蛋白(c reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、疾病活动指数(disease activity index,DAS28)。结果:与治疗前相比,治疗12周后5组晨僵时间、关节肿胀数、关节压痛数、VAS均减少,RF、ESR、CRP均降低,差异有统计学意义(P<0.05);风湿痹阻证组、寒湿痹阻证组、湿热痹阻证组、肝肾亏虚证组治疗后晨僵时间、关节肿胀数、关节压痛数、VAS、RF、ESR等观察指标的降低幅度均明显大于肾气虚寒证组(P<0.05),5组不良反应比较无统计学意义(P>0.05)。结论:MTX联合HCQ治疗中医RA风湿痹阻证组、寒湿痹阻证组、湿热痹阻证组、肝肾亏虚证组疗效优于肾气虚寒证组。

Objective： To observe the difference of the efficacy on rheumatoid arthritis（ RA） between methotrexate（ MTX） and hydroxychloroquine sulfate（ HCQ）. Methods： Review the complete history of 12 weeks of the 125 RA patients treated with MTX combined with HCQ and divide them into wind-damp syndrome group,cold-damp syndrome group,damp-heat syndrome group,liver-kidney deficiency syndrome group,kidney-qi deficient cold syndrome group,and analyze the scores of joint swelling,joint tenderness,duration of morning stiffness,VAS,rheumatoid factors（ RF）,c reactive protein（ CRP）,erythrocyte sedimentation rate（ ESR） and disease activity index（ DAS28） before and after the treatment. Results： Compared with before treatment,the duration of morning stiffness,joint swelling,joint tenderness and VAS in 5 groups declined after 12 weeks of treatment,and the levels of RF,ESR and CRP decreased; the difference had statistical significance（ P〈0. 05）. The decline of duration of morning stiffness,joint swelling,joint tenderness,levels of RF,ESR and CRP in kidney-qi deficient cold syndrome group was less than those in the other 4 groups（ P〈0. 05）. There was no obvious difference among 5 groups in terms of adverse reactions（ P〉0. 05）. Conclusion： MTX combined with HCQ has better therapeutic effects on wind-damp syndrome group,cold-damp syndrome group,damp-heat syndrome group and liver-kidney deficiency syndrome group than kidney-qi deficient cold syndrome group of RA patients.