温经散寒方治疗风寒湿痹型类风湿关节炎临床研究

Clinical Study on Wenjing Sanhan Formula for Rheumatoid Arthritis of Wind-Cold-Damp Impediment Type

目的:观察温经散寒方对风寒湿痹型类风湿关节炎(RA)患者中医证候积分、受累关节功能及免疫炎症指标的影响。方法:选择142例风寒湿痹型RA患者作为研究对象,采用随机数字表法分为温经散寒组72例及甲氨蝶呤组70例。甲氨蝶呤组单纯口服甲氨蝶呤片治疗,温经散寒组在甲氨蝶呤组的基础上给予温经散寒汤治疗。比较2组治疗前后中医证候积分、受累关节功能、免疫炎症指标及RA血清相关指标的变化。结果:治疗前,2组晨僵、关节疼痛、关节肿胀、关节畸形、舌象、脉象中医证候积分比较,差异无统计学意义(P>0.05);治疗后,2组上述中医证候积分均降低(P<0.05),且温经散寒组低于甲氨蝶呤组(P<0.05)。治疗前,2组RA疾病活动度评级表(DAS28)评分比较,差异无统计学意义(P>0.05);治疗1个月及治疗2个月,2组DAS28评分均降低(P<0.05),且温经散寒组低于甲氨蝶呤组(P<0.05)。治疗前,2组C-反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、白细胞介素-1 (IL-1)水平比较,差异无统计学意义(P>0.05);治疗后,2组CRP、TNF-α、IL-1水平均下降(P<0.05),且温经散寒组低于甲氨蝶呤组(P<0.05)。治疗前,2组血清红细胞沉降率(ESR)、类风湿因子(RF)、基质金属蛋白酶-3(MMP-3)、骨保护素(OPG)水平比较,差异无统计学意义(P>0.05);治疗后,2组血清ESR、RF、MMP-3水平均下降(P<0.05),OPG水平上升(P<0.05),且温经散寒组ESR、RF、MMP-3水平低于甲氨蝶呤组(P<0.05),OPG水平高于甲氨蝶呤组(P<0.05)。结论:温经散寒方可降低风寒湿痹型RA患者的中医证候积分,有利于恢复患者关节功能,减轻炎症反应,促进骨恢复。

Objective: To observe the effect of Wenjing Sanhan Formula on the traditional Chinese medicine syndrome scores, affected joint function and immune inflammatory indexes in patients with rheumatoid arthritis(RA) of wind-cold damp impediment type. Methods: A total of 142 RA patients of wind-cold-damp impediment type were selected as the research objects,and were randomly divided into the Wenjing Sanhan Formula Group and the Methotrexate Group, with 72 and 70 cases in each group respectively. The Methotrexate Group was simply treated with Methotrexate Tablets orally, and the Wenjing Sanhan Formula Group was additionally treated with Wenjing Sanhan Decoction based on the treatment of the Methotrexate Group. The changes of traditional Chinese medicine(TCM) syndrome scores, affected joint function, immune inflammatory indexes and serum related indexes of RA were compared between the two groups before and after treatment. Results:Before treatment,there was no significant difference in the TCM syndrome scores of morning stiffness,joint pain,joint swelling,joint deformity, tongue manifestation and pulse manifestation between the two groups(P>0.05);after treatment,the scores of the above TCM syndromes in both groups were decreased(P<0.05),and the score in the Wenjing Sanhan Formula Group was lower than that in the Methotrexate Group(P<0.05).Before treatment,there was no significant difference in the score of RA Disease Activity Score-28(DAS28)between the two groups(P>0.05);after one month of treatment and two months of treatment, the DAS28 scores in both groups were decreased(P<0.05), and the score in the Wenjing Sanhan Formula Group was lower than that in the Methotrexate Group(P<0.05). Before treatment,there was no significant difference in the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α) and interleukin-1(IL-1) between the two groups(P>0.05);after treatment,the levels of CRP,TNF-α and IL-1 in the two groups were decreased(P<0.05),and the above levels in the Wenjing Sanhan Formula Group were lower than those in the Methotrexate Group(P<0.05). Before treatment,there was no significant difference in the levels of serum erythrocyte sedimentation rate(ESR),rheumatoid factor(RF),matrix metalloproteinase-3(MMP-3) and osteoptin(OPG) between the two groups(P>0.05);after treatment,the levels of serum ESR, RF and MMP-3 in the two groups were decreased(P<0.05), and the serum OPG levels were increased(P<0.05);the levels of ESR, RF and MMP-3 in the Wenjing Sanhan Formula Group were lower than those in the Methotrexate Group(P<0.05),and the serum OPG level in the Wenjing Sanhan Formula Group was higher than that in the Methotrexate Group(P<0.05). Conclusion: Wenjing Sanhan Formula can reduce the TCM syndromes of RA patients of wind-cold-damp impediment type,which is conducive to restoring the joint function of patients, alleviating inflammation and promoting bone recovery.