桂枝汤类方联合甲氨蝶呤治疗早期类风湿关节炎疗效观察

Clinical Effect of Guizhi Decoction-associated Prescriptions Combined with Methotrexate in Treatment of Patients with Early Rheumatoid Arthritis

目的观察桂枝汤类方联合甲氨蝶呤治疗早期类风湿关节炎(rheumatoid arthritis,RA)的临床疗效。方法将120例早期RA患者按照随机数字表法分为治疗组和对照组,每组60例,最终治疗组完成56例,对照组完成55例。对照组给予常规西药甲氨蝶呤、叶酸治疗,治疗组在对照组治疗基础上,根据风寒湿痹以及风湿热痹两种不同证型,分别采用桂枝加附子汤、桂枝芍药知母汤。两组均治疗24周,观察并比较两组患者关节压痛数、关节肿胀数、晨僵时间、视觉模拟量表(visual analogue scale,VAS)评分、28个关节疾病活动性评分(disease activity score-28,DAS28)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、中医证候积分。结果治疗后两组患者的关节压痛数、关节肿痛数、晨僵时间、VAS评分、DAS28均明显降低(P<0.05),外周血ESR、CRP水平均明显降低(P<0.05),中医证候明显改善(P<0.05),且治疗组上述各项指标的改善程度均优于对照组(P<0.05)。结论桂枝汤类方联合甲氨蝶呤治疗早期RA的效果优于单用常规西药甲氨蝶呤的效果,能够明显改善早期RA患者的临床症状,控制RA的病情进展。

Objective To investigate the clinical effect of Guizhi Decoction-associated prescriptions combined with methotrexate in the treatment of early rheumatoid arthritis(RA).Methods A total of 120patients with early RA were divided into treatment group and control group using a random number table,with 60patients in each group,and finally 56patients in the treatment group and 55in the control group completed the study.The patients in the control group were given conventional Western medicine treatment with methotrexate and folic acid,and in addition to the treatment in the control group,the patients in the treatment group were given Guizhi Fuzi Decoction or Guizhi Shaoyao Zhimu Decoction according to the two different syndromes of wind-cold-damp arthralgia and wind-damp-heat arthralgia;the course of treatment was 24weeks for both groups.The two groups were observed and compared in terms of the number of times of joint tenderness and joint swelling,morning stiffness time,Visual Analogue Scale(VAS)score,Disease Activity Score of 28Joints(DAS28),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and traditional Chinese medicine(TCM)syndrome score.Results After treatment,both groups had significant reductions in the number of times of joint tenderness and joint swelling,morning stiffness time,VAS score,and DAS28(P<0.05),significant reductions in the levels of ESR and CRP in peripheral blood(P<0.05),and a significant improvement in TCM syndrome(P<0.05),and the treatment group had significantly better improvements in the above indices than the control group(P<0.05).Conclusion In the treatment of early RA,Guizhi Decoction-associated prescriptions combined with methotrexate have a better clinical effect than conventional Western medicine methotrexate alone and can significantly improve the clinical symptoms of patients with early RA and control the progression of RA.