中西医结合治疗湿热阻络型类风湿性关节炎患者的疗效观察

Efficacy of Combination of Traditional Chinese and Western Medicine in Treatment of Rheumatoid Arthritis of Damp-Heat Blocking Collateral Type

目的观察羌活地黄汤合三妙散辅助托法替布、甲氨蝶呤治疗湿热阻络型类风湿性关节炎(Rheumatoid arthritis,RA)的临床疗效及其对生长激素释放多肽(Ghrelin)、Ⅰ型胶原吡啶交联终肽(ICTP)血清水平的干预作用。方法选取2019年2月—2021年2月期间河北北方学院附属第一医院风湿免疫科收治的RA患者97例,依据简单随机数字表法分为研究组49例和对照组48例。对照组采取甲氨蝶呤、托法替布,研究组在对照组基础上采取羌活地黄汤合三妙散。治疗6个月后,观察比较两组患者临床疗效、不良反应,以及治疗前后中医证候积分、疾病活动度(Disease Activity Score 28,DAS28)、血沉(Erythrocyte sedimentation rate,ESR)、类风湿因子(Rheumatoid factor,RF)、C-反应蛋白(C-reactive protein,CRP)、ICTP、Ghrelin水平。结果治疗后研究组ACR50%(71.43%)、ACR70%(67.35%)明显高于对照组ACR50%(50.00%)、ACR70%(45.83%),差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者DAS28评分均较治疗前降低,差异有统计学意义(P<0.05);且研究组DAS28评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ESR、RF、CRP水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组ESR、RF、CRP水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组Ghrelin水平较治疗前增高,ICTP水平较治疗前降低,差异有统计学意义(P<0.05);且研究组Ghrelin水平明显高于对照组,ICTP水平明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论采取羌活地黄汤合三妙散辅助托法替布、甲氨蝶呤治疗湿热阻络型RA,可有效缓解患者临床症状,改善疾病活动度,调节血沉及ICTP、Ghrelin水平,提升整体治疗效果,且安全性良好。

Objective To explore the efficacy of Qianghuo Dihuang Decoction and Sanmiao Powder assisted with tofacitinib and methotrexate in the treatment of rheumatoid arthritis(RA)of damp-heat blocking collateral type,and observe their intervention effects on the serum levels of growth hormone releasing polypeptide(Ghrelin)and type I collagen pyridine intervention of cross-linking terminal peptide(ICTP).Methods Ninety-seven patients with RA in the Department of Rheumatology and Immunology,the First Affiliated Hospital of Hebei North University from February 2019 to February 2021 were included and divided into a study group(n=49)and a control group(n=48)by the simple random number table.The control group took methotrexate and tofacitinib,and the study group took Qianghuo Dihuang Decoction and Sanmiao Powder based on the treatment of the control group.Both groups were treated for 6 months.The clinical efficacy,the incidence of adverse reactions,traditional Chinese medicine(TCM)syndrome scores,Disease Activity Score 28(DAS28),erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),C-reactive protein(CRP),ICTP,and Ghrelin levels of the two groups before and after treatment were compared.Results After treatment,the ACR50(71.43%)and ACR70(67.35%)of the study group were higher than those of the control group[ACR50(50.00%)and ACR70(45.83%)](P<0.05).After treatment,the TCM syndrome scores in the two groups were lower than those before treatment(P<0.05),and the scores of the study group were lower than those of the control group(P<0.05).After treatment,the DAS28 of the two groups was lower than that before treatment(P<0.05),and the DAS28 of the study group was lower than that of the control group(P<0.05).After treatment,the ESR,RF,and CRP levels of the two groups were lower than those before treatment(P<0.05),and the levels of the study group were lower than those of the control group(P<0.05).After treatment,Ghrelin levels in the two groups were higher and ICTP levels were lower(P<0.05).As compared with the control group,the Ghrelin level in the study group was higher and the ICTP level was lower(P<0.05).There was no significant difference in the incidence of adverse reactions between the study group and the control group during treatment(P>0.05).Conclusion Qianghuo Dihuang Decoction and Sanmiao Powder combined assisted with tofacitinib and methotrexate can effectively alleviate the clinical symptoms of patients with RA of damp-heat blocking collateral type,improve the disease activity,regulate ESR,ICTP,and ghrelin levels,and improve the overall effects and safety.