基于改良Sharp评分观察补肾治尪汤对类风湿关节炎肝肾不足证骨破坏的延缓作用

Delaying effect of Bushen Zhiwang Decoction on bone destruction in rheumatoid arthritis with deficiency of liver and kidney based on modified Sharp score

目的 基于改良Sharp评分(mTSS)探讨补肾治尪汤对类风湿关节炎(RA)肝肾不足证骨破坏的延缓作用。方法 以前瞻性随机对照试验的方法,纳入2020年9月—2021年9月就诊于中日友好医院中医风湿病科的RA肝肾不足证患者共170例。采用随机分组的方法将患者分配进入试验组或对照组,试验组使用补肾治尪汤联合常规剂量传统改善病情抗风湿药(cDMARDs),对照组仅使用常规剂量cDMARDs,观察周期为12个月。以mTSS为主要研究指标,观察治疗后2组患者骨破坏进展程度。结果 共153例患者完成了观察,其中试验组76例,对照组77例。2组患者基线特征差异无统计学意义。经过12个月的治疗,试验组患者较对照组患者红细胞沉降率和中医证候积分改善更加明显(P<0.05)。2组患者mTSS均随时间增加而升高,但试验组治疗后mTSS增长值小于对照组(P<0.01)。试验组中59例(77.6%)患者发生骨破坏放射学进展,与对照组中75例(97.4%)比较,差异有统计学意义(P<0.01)。可视化累积概率分布图显示,试验组mTSS增长值持续低于对照组。结论 补肾治尪汤联合cDMARDs的治疗方案可以有效延缓RA肝肾不足证骨破坏进展。

Objective To explore the delaying effect of BuShen ZhiWang Decoction(a compound prescription of tonifying kidney to treat arthritis)on bone destruction in rheumatoid arthritis(RA)with deficiency of liver and kidney based on the modified total Sharp score(mTSS).Methods A total of 170 patients with RA attending the Department of Traditional Chinese Medicine and Rheumatology in China-Japan Friendship Hospital from September 2019 to September 2021 were prospectively enrolled in a randomized controlled trial.A random sampling method was used to assign patients into the experimental group or the control group,and the experimental group was treated with BuShen ZhiWang Decoction combined with regular doses of conventional synthetic disease-modifying antirheumatic drugs(cDMARDs),and the control group was treated with regular doses of cDMARDs only,with an observation period of 12 months.The mTSS was used as the main study index to observe the degree of bone destruction progression in both groups after treatment.Results A total of 153 patients completed the final observation,with 76 in the experimental group and 77 in the control group.There were no significant differences in baseline characteristics between the two groups.After 12 months of treatment,patients in the experimental group showed a more significant improvement in ESR and traditional Chinese medicine syndrome score compared to patients in the control group(P<0.05).Radiographic evaluation revealed an increase in mTSS in both groups,but the increase in mTSS was significantly smaller(P<0.001)in experimental group.Radiological progression of bone destruction occurred in 59 patients(77.6%)in the experimental group,a much lower proportion than in the control group (75 patients, 97.4%) (P<0.001). Visualisation of the proportionaldistribution showed that mTSS growth values were consistently lower in the experimental groupthan in the control group. Conclusion The treatment of BuShen ZhiWang Decoction combinedwith cDMARDs can effectively delay the progression of bone destruction in RA with deficiencyof liver and kidney.