藤莓汤联合来氟米特、甲氨蝶呤治疗热毒瘀阻型类风湿关节炎的疗效观察

Therapeutic effect of Tengmei decoction combined with leflunomide and methotrexate in the treatment of patients with rheumatoid arthritis

目的 探讨藤莓汤联合来氟米特、甲氨蝶呤治疗热毒瘀阻型类风湿关节炎患者的临床疗效.方法 选择2015年2月至2017年2月临海市中医院收治的热毒瘀阻型类风湿关节炎患者72例进行观察,采用随机数字表法分为治疗组和对照组各36 例,对照组给予来氟米特(20 mg/次、1 次/d)联合甲氨蝶呤(15 mg/次、1次/周)治疗,治疗组在对照组的基础上给予藤莓汤治疗,两组患者均治疗12周.比较两组患者治疗前后的中医症状积分、红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP)、血小板(PLT)、关节疾病活动(DAS)评分、关节压痛指数(TJC)及关节肿胀数(SJC)水平变化情况,以及治疗后的临床疗效和不良反应情况.结果 治疗组的临床总有效率为88.89%(32/36),明显高于对照组的69.44%(25/36),差异有统计学意义(χ^2 =4.126,P=0.042);两组患者治疗后的晨僵、关节肿胀及关节疼痛等中医症状积分,DAS评分、TJC及SJC水平均明显降低(t治疗组 =28.935、26.430、25.824、6.889、9.222、5.437;t对照组 =23.790、21.704、21.685、3.312、8.134、2.379,均 P <0.05),且治疗组降低更明显(t =10.004、5.488、7.593、3.511、2.554、3.764,均P <0.05);治疗后,治疗组的 ESR、RF、CRP、PLT 及对照组的 ESR、RF、CRP 水平均明显降低(t治疗组 =3.969、2.821、5.970、2.791,t对照组 =5.240、2.246、5.452,均P<0.05),且治疗组ESR、CRP水平明显低于对照组(t=2.394、3.989,均P<0.05).结论 藤莓汤联合来氟米特、甲氨蝶呤治疗热毒瘀阻型类风湿关节炎患者临床疗效确切,可有效降低炎性指标,改善中医症状积分,且安全可靠.

Objective To investigate the clinical efficacy of Tengmei decoction combined with leflunomide and methotrexate in the treatment of patients with rheumatoid arthritis.Methods From February 2015 to February 2017,72 patients with heat -tolerant rheumatoid arthritis were enrolled in Linhai Hospital of Traditional Chinese Medicine(TCM).They were randomly divided into treatment group and control groupaccording to the digitaltable,with 36 cases in each group.The control group was given leflunomide(20mg/time,1 time/d)combined with methotrexate(15mg/time,1 time/week).The treatment group was given Tengmei decoction on the basis of the control group.Both two groups were treated for 12 weeks.TCM symptom scores,erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),C-reactive protein(CRP),platelet(PLT),joint disease activity(DAS)score,tender joint count(TJC)and swollen joint count(SJC)before and after treatment were compared between the two groups.The clinical efficacy and adverse reactions after treatment were observed.Results The total effective rate of the treatment group was 88.89%,which was significantly higher than that of the control group(69.44%),the difference was statistically significant(χ^2 =4.126,P=0.042).After treatment,the TCM symptom scores(morning stiffness,joint swelling and joint pain etc.),DAS score,TJC and SJC levels in the two groups,were significantly decreased(ttreatment group =28.935,26.430,25.824,6.889,9.222,5.437;tcontrol group =23.790,21.704,21.685,3.312,8.134,2.379,all P<0.05),and those in the treatment group decreased more significantly(t =10.004,5.488,7.593,3.511,2.554,3.764,all P<0.05).After treatment,the ESR,RF,CRP,PLT levels of the treatment group and ESR,RF,CRP levels of the control group were significantly decreased(ttreatment group =3.969,2.821,5.970,2.791,tcontrol group = 5.240,2.246,5.452,all P<0.05),and the ESR and CRP levels in the treatment group were significantly lower than those in the control group(t =2.394,3.895,all P <0.05).Conclusion The efficacy of Tengmei decoction combined with leflunomide and methotrexate in the treatment of patients with heat-toxic phlegm-restricted rheumatoid arthritis is effective,which can effectively reduce inflammatory indicators and improve TCM symptom scores,and is safe and reliable.