散寒除湿方联合西医常规治疗寒湿痹阻型类风湿关节炎的疗效及对实验室指标、超声造影参数的影响

Clinical efficacy of Sanhan Qushi Formula with Western medicine for rheumatoid arthritis of cold dampness type and how to impact on the parameters change laboratory index and contrast-enhanced ultrasound

目的观察散寒除湿方联合西医常规治疗寒湿痹阻型类风湿关节炎的临床疗效及对患者实验室指标、超声造影参数变化的影响。方法将85例寒湿痹阻型类风湿关节炎患者按照随机数字表法分为2组。对照组42例予甲氨蝶呤片+来氟米特片+锝[99 Tc]亚甲基二膦酸盐注射液治疗,治疗组43例在对照组治疗基础上加用散寒除湿方治疗。2组均治疗12周后统计疗效,比较2组治疗前后类风湿关节炎患者28个关节疾病活动度(DAS28)评分和实验室指标红细胞沉降率(ESR)、类风湿因子(RF)、抗环瓜氨酸蛋白抗体(ACCP)、C反应蛋白(CRP)、白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)水平变化情况,比较2组患者治疗后超声造影参数滑膜面积、峰值强度、曲线下面积、平均通过时间、内洗斜率水平变化。结果治疗组总有效率95.35%(41/43),对照组总有效率78.57%(33/42),治疗组疗效优于对照组(P<0.05)。2组治疗后DAS28评分均较本组治疗前降低(P<0.05),且治疗组治疗后DAS28评分低于对照组(P<0.05)。2组治疗后ESR、RF、ACCP、CRP、IL-1、TNF-α水平均较本组治疗前降低(P<0.05),且治疗组治疗后各指标均低于对照组(P<0.05)。治疗组治疗后超声造影参数滑膜面积、峰值强度、曲线下面积、平均通过时间、内洗斜率水平均低于对照组(P<0.05)。结论散寒除湿方联合西医常规治疗寒湿痹阻型类风湿关节炎临床疗效确切,可明显控制患者病情活动,改善临床症状,抑制炎性反应,改善病变关节超声造影表现。

Objective To observe the clinical efficacy of Sanhan Qushi Formula combined with Western medicine for rheumatoid arthritis(RA)of cold dampness type(CDT)and how to impact on the parameters change of laboratory index and contrast-enhanced ultrasound(CEUS).Methods Totally 85 patients with RA(CDT)were randomly assigned into two groups,patients in control group were treated with methotrexate+leflunomide tablets+technetium[99 Tc]methylene diphosphonate injection[99 Tc-MDP],and patients in treatment group with Sanhan Qushi Formula based on control group.A 12-week treatment was performed,28-joint Disease Activity Score(DAS28),laboratory index[erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),anti cyclic citrullinated peptide(ACCP)antibody,c reactive protein(CRP),interleukins-1(IL-1),tumor necrosis factor-α(TNF-α)],CEUS parameters[surface area of synovial membrane,peak intensity(PI),area under curve(AUC),mean transmit time(MTT),wash in slope(WIS)]were included as comparators;the curative effect was counted.Results The total effective rates were 95.35%(41/43)in treatment group,better than those of 78.57%(33/42)in control group.After treatment,reduced DAS28 score in groups was found(P<0.05),and treatment group was lower than control group(P<0.05);decreased ESR,RF,CCP,CRP,IL-1,TNF-αin groups were recorded(P<0.05),which decreased in treatment group compared with control group(P<0.05);CEUS parameters in treatment group were decreased in comparison with control group(P<0.05).Conclusion For patients with RA(CDT),Sanhan Qushi Formula with Western medicine has a definite curative effect,which is obviously capable of controlling disease,improving clinical symptoms and CEUS performance in diseased joints,inhibiting inflammatory response.