蠲痹汤加减治疗活动期类风湿关节炎临床观察

Efficacy observation of modified Juanbi decoction on rheumatoid arthritis in active stage

目的:观察蠲痹汤加减治疗活动期类风湿关节炎患者的临床疗效及对炎症极化的影响。方法:选取84例活动期类风湿关节炎患者,随机分为两组各41例。对照组予甲氨蝶呤口服,治疗组在对照组基础上予蠲痹汤加减口服。两组疗程均为8周。比较两组患者临床疗效、中医症状积分、VAS疼痛评分、28关节疾病活动评分(DAS28)、血沉(ESR)、超敏C反应蛋白(hs-CRP)、免疫球蛋白G (IgG)、类风湿因子(RF)、抗环瓜氨酸肽抗体(CCP-Ab)、炎症细胞因子(IL-6、IL-4、IL-10、TNF-α)。结果:治疗组总有效率为92.68%,高于对照组的78.05%(P<0.05)。治疗后两组中医症状积分、VAS评分、DAS28评分,ESR、hs-CRP、IgG、RF、IL-6、TNF-α水平均显著低于治疗前(P<0.05);IL-4、IL-10水平显著高于治疗前(P<0.05)。治疗组治疗后中医症状积分、VAS评分、DAS28评分,IgG、RF、IL-6水平均明显低于对照组(P<0.05);IL-4、IL-10水平高于对照组(P<0.05)。结论:蠲痹汤加减治疗活动期类风湿关节炎疗效较好,可降低患者炎症指标水平,其作用机制可能与调节炎症因子有关。

Objective:To observe the clinical efficacy of modified Juanbi decoction on rheumatoid arthritis(RA)in active stage and the effect on inflammatory polarization.Methods:84 cases of patients with RA in active stage were selected and randomly divided into two groups,41 cases in each group.The control group was treated with oral methotrexate,while the treatment group was treated plus with oral modified Juanbi decoction on the basis of control group.Clinical efficacy,TCM symptom score,VAS pain score,Disease Activity Score in 28 joints(DAS28),erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(hs-CRP),immunoglobulin G(IgG),rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(CCP-Ab)and inflammatory cytokines(IL-6,IL-4,IL-10,TNF-α)of patients were compared between two groups.Results:The total effective rate of treatment group was 92.68%,which was higher than 78.05%of control group(P<0.05).After treatment in both groups,the levels of TCM symptom score,VAS score,DAS28 score,ESR,hs-CRP,IgG,RF,IL-6 and TNF-αwere significantly lower than those before treatment(P<0.05),while the levels of IL-4 and IL-10 were significantly higher than those before treatment(P<0.05).After treatment,the levels of TCM symptom score,VAS score,DAS28 score,IgG,RF and IL-6 of treatment group were significantly lower than those of control group(P<0.05),while the levels of IL-4 and IL-10 of treatment group were higher than those of control group(P<0.05).Conclusion:The clinical efficacy of modified Juanbi decoction on rheumatoid arthritis(RA)in active stage is significant,which can reduce the level of inflammatory indexes of patients.Its mechanism may be related to the regulation of inflammatory factors.