黄芪五藤汤联合甲氨蝶呤治疗类风湿关节炎气虚络阻证的临床疗效

Clinical effect of Huangqi Wuteng Decoction combined methotrexate in the treatment of rheumatoid arthritis with qi deficiency and collaterals obstruction syndrome

目的:观察黄芪五藤汤联合甲氨蝶呤(MTX)对类风湿关节炎(RA)气虚络阻证患者的临床疗效及对滤泡辅助性T细胞(Tfh)的影响。方法:将59例RA气虚络阻证患者随机分为对照组(30例)和观察组(29例)。两组均予MTX 10 mg/周,塞来昔布0.2 g,每日2次,根据临床症状逐渐减停塞来昔布。观察组加用黄芪五藤汤,每日1剂,早晚分服。两组均连续用药12周。治疗前,治疗4、8、12周评估患者中医证候评分,检测红细胞沉降率(ESR)并计算患者28个关节病情活动指数(DAS28),评估健康评价问卷(HAQ)得分。治疗前、治疗12周检测外周血Tfh细胞比例、血清白细胞介素-21(IL-21)、抗环瓜氨酸(CCP)抗体。结果:RA患者Tfh细胞比例与中医证候评分、DAS28评分、抗CCP抗体滴度呈正相关(P<0.01)。与本组治疗前比较,治疗12周后观察组患者的中医证候评分、HAQ得分、Tfh细胞比例、IL-21显著降低(P<0.01,P<0.05),且除HAQ得分外,均显著低于同期对照组(P<0.05,P<0.01)。与本组治疗前比较,治疗8、12周后观察组患者ESR、DAS28评分显著降低(P<0.05,P<0.01),且观察组治疗12周时的ESR显著低于同期对照组(P<0.05)。结论:黄芪五藤汤联合MTX可改善RA气虚络阻证患者的临床症状,并降低Tfh细胞比例。

Objective:To observe the clinical effect of Huangqi Wuteng Decoction(HQWTD) combined with methotrexate(MTX) in the treatment of rheumatoid arthritis(RA) patients with qi deficiency and collaterals obstruction syndrome and their effect on follicular helper T(Tfh) cell.Methods:A total of 59 RA patients with qi deficiency and collaterals obstruction syndrome were randomly assigned to the control group(30 patients) and research group(29 patients).All patients took MTX 10 mg once a week and celecoxib 0.2 g twice a day,and the dosage of celecoxib was tapered according to the clinical symptoms.Patients in the research group additionally took HQWTD,take 1 dose daily in the morning and evening.The treatment course for all was 12 weeks.Traditional Chinese medicine(TCM) syndrome score,erythrocyte sedimentation rate(ESR),Disease Activity Score in 28 joints(DAS28),health assessment questionnaire(HAQ) were measured at the 0 week,4 weeks,8 weeks and 12weeks.Tfh cell,interleukin(IL)-21 and anti-cyclic citrullinated peptide(CCP) antibody were detected at 0 week and 12 weeks.Results:The ratio of Tfh cells in RA patients was positive correlation with TCM syndrome score,DAS28,and Anti-CCP(P<0.01).Compared with before treatment,TCM syndrome score,HAQ score,the ratio of Tfh cell and the level of IL-21 in the research group were significantly decreased at 12 weeks(P<0.01,P<0.05),and were significantly lower than those of control group at the same period(P<0.05,P<0.01),except HAQ score.Compared with before treatment,ESR and DAS28 in the research group were decreased at 8 weeks,12 weeks(P<0.05,P<0.01).At 12 weeks,the ESR in the research group was significantly lower than that in the control group(P<0.05).Conclusion:HQWTD combined with MTX could improved the clinical symptoms in RA patients with qi deficiency and collaterals obstruction syndrome,and decreased the ratio of Tfh cells.