调痹饮治疗气血两虚型类风湿性关节炎

Efficacy of Tiaobi Decoction in Treating Rheumatoid Arthritis of Qi and Blood Deficiency and Its Effect on TNF-αand IL-6

目的:观察调痹饮治疗类风湿性关节炎气血两虚证的临床疗效及其对肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)的影响。方法:60例类风湿性关节炎患者随机分为对照组、观察组,每组各30例。对照组给予甲氨蝶呤,每周7.5 mg;来氟米特10 mg·d^(-1);洛索洛芬钠60 mg,3次·d^(-1)。观察组在对照组治疗基础上给予调痹饮煎剂。两组均治疗1个月。比较两组患者治疗后临床疗效,中医证候、疾病活动度评分(disease activity score 28,DAS28),C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、TNF-α、IL-6水平。结果:(1)观察组中医证候积分有效率为86.67%,对照组中医证候积分有效率为57.14%,两组比较,差异有统计学意义(P<0.05)。(2)治疗后,两组患者临床症状评分均低于本组治疗前;观察组关节压痛数为3(2,4)个、关节肿胀数为1(0,3)个、晨僵时间为30(0,38)min、视觉模拟量表(visual analogue scale,VAS)评分为3.00(2.00,4.00)分、健康评估问卷(health assessment questionnaire,HAQ)评分为12.00(9.00,14.00)分,均低于同期对照组(P<0.05)。(3)治疗后,两组患者中医证候积分均低于本组治疗前;观察组中医证候积分为(11.93±5.45)分,低于同期对照组(P<0.05)。(4)治疗后,两组DAS28均低于本组治疗前;观察组DAS28为(2.82±0.74)分,低于同期对照组(P<0.05)。(5)治疗后,两组实验室指标均低于本组治疗前;观察组CRP为4.52(2.08,10.07)mg·L^(-1),ESR为16.00(12.75,26.25)mm·h^(-1),TNF-α为7.69(5.63,11.28)ng·L^(-1),IL-6为17.99(10.91,29.98)ng·L^(-1),均低于同期对照组(P<0.05)。(6)两组观察期间血尿常规、肝肾功指标未见明显异常。结论:调痹饮联合抗风湿药治疗类风湿性关节炎(气血两虚证)疗效显著,可有效改善患者中医证候与临床症状,降低ESR、CRP、TNF-α、IL-6水平,且安全性良好。

Objective:To observe the clinical curative effect of Tiaobi decoction in treating rheumatoid arthritis with Qi and Blood deficiency syndrome.Methods:60 patients with rheumatoid arthritis were randomly divided into control group and observation group,with 30 cases in each group.The control group was given methotrexate,7.5 mg per week;leflunomide 10 mg·d^(-1);loxoprofen sodium 60 mg,3 times·d^(-1).The observation group was given Tiaobi decoction on the basis of the treatment of the control group.Both groups were treated for 1 month.The clinical efficacy,TCM syndrome,disease activity score 28(DAS28),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)levels were compared between the two groups after treatment.Results:①The effective rate of TCM syndrome integral in the observation group was 86.67%,and that in the control group was 57.14%.There was a statistically significant difference between the two groups(P<0.05).②After treatment,the clinical symptom scores of the two groups of patients were lower than those before treatment in the same group:the number of joint tenderness in the observation group was 3(2,4),the number of joint swelling was 1(0,3),and the time of morning stiffness was 30(0,38)minutes,the visual analog scale(VAS)score was 3.00(2.00,4.00)points,the health assessment questionnaire(HAQ)was 12.00(9.00,14.00)points,all lower than those in the control group at the same period(P<0.05).③After treatment,the TCM syndrome scores of the two groups were lower than those before treatment in the same group:the TCM syndrome score of the observation group was(11.935.45),which was lower than that of the control group(P<0.05).④After treatment,the DAS28 of the two groups was lower than that of the same group before treatment:the DAS28 of the observation group was(2.820.74),which was lower than that of the control group(P<0.05).⑤After treatment,the laboratory indexes of the two groups were lower than those before treatment in the same group:CRP in the observation group was 4.52(2.08,10.07)mg·L^(-1),ESR was 16.00(12.75,26.25)mm·h^(-1),TNF-αwas 7.69(5.63,11.28)ng·L^(-1),IL-6 was 17.99(10.91,29.98)ng·L^(-1),all lower than those of the control group(P<0.05).⑥During the observation period of the two groups,there were no obvious abnormalities in blood and urine routine,liver and kidney function indicators,and no significant changes with clinical significance.Conclusion:Tiaobi decoction combined with slow-acting antirheumatic drugs has a significant curative effect on rheumatoid arthritis(Qi and Blood deficiency syndrome),which can effectively improve TCM syndromes and clinical symptoms,reduce inflammatory indicators such as ESR and CRP,Down-regulate the levels of pro-inflammatory factors such as TNF-αand IL-6,and has safe drug reliability.