加味木防己汤联合甲氨蝶呤治疗类风湿关节炎急性发作期的疗效

Efficacy of Modified Mufangji decoction combined with methotrexate in the treatment of acute onset of rheumatoid arthritis

目的观察加味木防己汤联合甲氨蝶呤治疗类风湿关节炎急性发作期的疗效。方法选择2018年10月-2020年10月厦门市中医院收治的类风湿关节炎急性发作期患者70例,以随机数字表法将其分为观察组(n=35)和对照组(n=35)。对照组患者应用甲氨蝶呤治疗,观察组患者应用加味木防己汤联合甲氨蝶呤治疗,2组均持续治疗2个月。比较2组患者临床疗效、中医证候疗效,治疗前后DAS28评分、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)水平及不良反应。结果观察组患者临床总有效率和中医证候总有效率均高于对照组,差异均有统计学意义(P <0.05)。治疗2个月后2组患者DAS28评分均高于治疗前,ESR、CRP及RF水平均低于治疗前,且观察组升高/降低幅度高于对照组(P <0.01)。观察组患者不良反应总发生率为2.9%,低于对照组的20.0%,差异有统计学意义(χ^(2)=5.081,P=0.024)。结论加味木防己汤联合甲氨蝶呤治疗类风湿关节炎急性发作期的疗效显著,能改善患者症状及相关指标,降低不良反应发生率,具有很高的应用价值。

Objective To observe the efficacy of Modified Mufangji decoction combined with methotrexate in the treatment of acute onset of rheumatoid arthritis.Methods Seventy patients with acute rheumatoid arthritis admitted to Xiamen Hospital of Traditional Chinese Medicine from October 2018 to October 2020 were selected,and they were divided into observation group(n = 35) and control group(n = 35) by random number table method.Control group was treated with methotrexate,observation group was treated with Modified Mufangji decoction,both groups continued treatment for 2 months.The clinical efficacy,TCM syndrome efficacy,DAS28 score,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF) levels before and after treatment,incidence of adverse reactions were compared between 2 groups.Results The total clinical effective rate and TCM syndrome effective rate in observation group were higher than those in control group,and the differences were statistically significant(P < 0.05).After 2 months of treatment,DAS28 score in both groups were higher than before,ESR,CRP and RF levels were lower than before,and the increase/decrease of observation group was higher than control group(P < 0.01).The total incidence of adr in the observation group was 2.9%,lower than that in the control group’s 20.0%,and the difference was statistically significant(χ^(2)= 5.081,P = 0.024).Conclusion Modified Mufangji decoction combined with methotrexate has a significant curative effect in the treatment of rheumatoid arthritis at the acute attack stage,which can improve the symptoms and related indicators of patients and reduce the incidence of adverse reactions,and has a high application value.