基于中医“温络疗痹”理论干预寒湿痹阻型类风湿关节炎中远期临床疗效观察

Observation on the mid-and Long-term Clinical Effect of Intervention on Rheumatoid Arthritis of ColdDampness Arthralgia Type Based on the Theory of“Warming Collaterals and Treating Arthralgia”of Traditional Chinese Medicine

目的基于中医“温络疗痹”理论干预寒湿痹阻型类风湿关节炎(RA)中远期临床疗效观察。方法参照纳入诊断标准筛选2016年1月-2017年6月收治且明确诊断寒湿痹阻型类风湿关节炎患者,据是否接受采用“温络疗痹”法强化干预作为分组唯一标准,将最终完成该临床试验合格的103例病例分为强化联合治疗组(QG组)52例和常规治疗组(CG组)51例。强化联合治疗组在规治疗基础上,给予“温络疗痹”疗法。检测两组间治疗前后临床疗效、28个关节疾病活动评分(DAS28)、实验室检查及RA预后相关因素评价并规律随访,对中远期疗效进行综合评估。结果强化联合治疗组治疗后临床疗效明显优于常规治疗组;强化治疗组患者血沉(ESR)、类风湿因子(RF)、压痛关节数、疼痛视觉模拟评分(VAS)、DAS28水平均低于常规对照组(P<0.05);相关预后多因素Logistic回归统计发现,采用温络疗痹疗法配合规律关节锻炼,对类风湿关节炎临床缓解及降低疾病活动度的维持具有保护性意义(P<0.05)。结论行温络疗痹法对寒湿痹阻型类风湿关节炎具有显著疗效,更易被患者接受,并能有效改善患者的中远期预后。

Objective To observe the mid-and long-term clinical effects of intervention on rheumatoid arthritis(RA)with cold dampness arthralgia type based on the theory of“warming collaterals and treating arthritis”.Methods According to the inclusion criteria,103 patients with rheumatoid arthritis of cold dampness Bi obstruction type who were admitted to our hospital from January 2016 to June 2017 were selected,and the clinical trial was designed with complete randomized,single center and parallel control.The 103 qualified cases who finally completed the clinical trial were divided into 52 cases in the intensive combined treatment group(QG group)and 51 cases in the conventional treatment group(CG group).On the basis of regular treatment,the intensive combined treatment group was given“warm collateral therapy”therapy.The clinical efficacy before and after treatment,28 joint disease activity scores(DAS28),laboratory examinations and evaluation of the prognostic factors of RA between the two groups were tested and followed up regularly to comprehensively evaluate the long-term efficacy.Results The clinical efficacy of the intensive combined treatment group was significantly better than that of the conventional treatment group;the intensive treatment group had lower erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),tender joints,pain visual analog score(VAS),and DAS28 levels,than those in the routine control group(P<0.05).There are more related prognosis Logistic regression analysis showed that warm yang therapy combined with regular joint exercise had protective significance for clinical remission of rheumatoid arthritis and maintenance of low disease activity(P<0.05).Conclusion The method of warming collaterals to treat rheumatoid arthritis of cold dampness-blocking type has a significant effect,which is more easily accepted by patients,and can effectively improve the long-term prognosis of patients.