甲氨蝶呤片联合痹通方治疗活动期类风湿关节炎的临床观察

Clinical observation on active rheumatoid arthritis with methotrexate tablets and Bitong decoction

目的观察痹通方联合甲氨蝶呤片(MTX)治疗活动期类风湿关节炎(RA)患者的效果。方法选取68例就诊于辽宁中医药大学附属医院风湿病科门诊的RA患者,按照入组先后顺序分为治疗组和对照组,每组分别为34例。对照组患者给予甲氨蝶呤片(MTX)治疗,治疗组在此基础上给予痹通方,两组均连续治疗12周。治疗后观察两组患者的中医证候积分、关节肿胀、关节疼痛、晨僵时间、临床疗效,检测血沉(ESR)、C反应蛋白(CRP),记录DAS28、健康评价调查表(HAQ)等指标变化。结果治疗组总有效率91.17%优于对照组总有效率76.47%,两组比较差异有统计学意义(P<0.05)。两组治疗后中医证候积分较治疗前均有改善,差异有统计学意义(P<0.05);治疗后组间比较,治疗组优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的DAS28、HAQ指标均优于治疗前,差异有统计学意义(P<0.05),且治疗组优于对照组,差异有统计学意义(P<0.05)。两组患者治疗后ESR、CRP两项指标与治疗前比较差异均有统计学意义(P<0.05),且治疗组的ESR及CRP水平改善情况均优于对照组(P<0.05)。治疗过程中未发生严重不良反应。结论痹通方联合MTX能很好地改善RA临床症状、中医证候,控制RA病情活动,提高RA患者生活质量,安全可靠。

Objective To observe the effect on active rheumatoid arthritis(RA)with methotrexate(MTX)tablets and Bitong decoction.Methods Sixty-eight RA patients were selected from the outpatient department of rheumatology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.They were divided into treatment group and control group according to the order of enrollment,with 34 cases in each group.Patients in the control group were given MTX tablets,and patients in the observation group were given Bitong decocotion and MTX tablets.Both groups were treated continuously for 12 weeks.After treatment,TCM syndrome points,joint swelling,joint pain,morning stiffness time and clinical efficacy of the two groups were observed,ESR and CRP were detected,and the scores of DAS28 and HAQ were recorded.Results The total effective rate of the treatment group was 91.17%higher than that of the control group(76.47%),indicating significant difference(P<0.05).Compared with the before treatment,the TCM symptom scores of the two groups improved after treatment,indicating significant difference(P<0.05),and the treatment group was better than the control group after treatment.The indexes of DAS28 and HAQ both two groups were better than those after treatment,and the treatment group was superior to the control group after treatment,indicating significant difference(P<0.05).There were significant differences in ESR and CRP between the two groups before and after treatment(P<0.05),and the improvement of ESR and CRP in the treatment group was better than that in the control group(P<0.05).No serious adverse reactions occurred during the treatment.Conclusion Bitong Decoction and MTX can effectively improve the clinical symptoms and TCM syndromes,control the disease activity,improve the quality of life in the treatment of RA,which is safe and reliable.