补肾强督清化汤联合依那西普治疗肾虚湿热证强直性脊柱炎患者的疗效观察

Efficacy of Bushen Qiangdu Qinghua Decoction Combined with Etanercept in Trea-ting Ankylosing Spondylitis Patients with Kidney Deficiency and Damp-Heat Syn-drome

目的探讨补肾强督清化汤联合依那西普治疗肾虚湿热证强直性脊柱炎的疗效。方法选取2021年2月-2023年2月期间在山东省临沂市中医医院风湿病科就诊的肾虚湿热证强直性脊柱炎患者86例,按随机数字表法分为对照组和治疗组,每组各43例。对照组予依那西普治疗,治疗组在对照组基础上加用补肾强督清化汤。持续用药12周。观察两组患者治疗前后中医证候积分、炎症反应指标[红细胞沉降率(Erythrocyte sedimentation rate,ESR)、血清白细胞介素4(Interleukin-4,IL-4)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、C反应蛋白(C-neactveprotein,CRP)]水平、疾病活动度[Bath功能指数(Bath andylosing spondylitis function index,BASFI)、Bath强直性脊柱炎活动性指数(Bath ankylosing spondylitis metroloty index,BASDAI)],临床疗效及不良反应情况。结果治疗后两组患者中医证候积分均较治疗前明显降低,差异有统计学意义(P<0.05);且治疗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ESR、IL-4、TNF-α及CRP水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组ESR、IL-4、TNF-α及CRP水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者BASFI、BASDAI评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组BASFI、BASDAI评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组临床总有效率95.35%(41/43)明显高于对照组79.07%(34/43),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情况比较,差异无统计学意义(P>0.05)。结论补肾强督清化汤联合西药治疗肾虚湿热证强直性脊柱炎能够有效减轻炎症反应,缓解临床症状,其临床疗效确切,且无明显不良反应。

Objective To explore the therapeutic effect of Bushen Qiangdu Qinghua decoction combined with etanercept in treating ankylosing spondylitis with kidney deficiency and damp-heat syndrome.Methods 86 patients with ankylosing spondylitis exhibiting kidney deficiency and damp-heat syndrome,who visited the Rheumatology Department of Linyi Hospital of Traditional Chinese Medicine from February 2021 to February 2023,were selected for the study.They were divided into a control group and a treatment group using the random number table method,with 43 patients in each group.The control group received etanercept,while the treatment group received Bushen Qiangdu Qinghua decoction in addition to etanercept.The treatment lasted for 12 weeks.Observations were made on the traditional Chinese medicine(TCM)syndrome scores,inflammatory response indicators[erythrocyte sedimentation rate(ESR),serum interleukin-4(IL-4),tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)],disease activity[Bath Ankylosing Spondylitis Function Index(BASFI),Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)],clinical efficacy,and adverse reactions before and after treatment.Results After treatment,the TCM syndrome scores in both groups significantly decreased compared to before treatment,with a statistically significant difference(P<0.05).The TCM syndrome scores in the treatment group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).The levels of ESR,IL-4,TNF-α,and CRP in both groups significantly decreased after treatment compared to before treatment,with a statistically significant difference(P<0.05).The levels of these inflammatory markers in the treatment group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).The BASFI and BASDAI scores in both groups significantly decreased after treatment compared to before treatment,with a statistically significant difference(P<0.05).The BASFI and BASDAI scores in the treatment group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).The total clinical effective rate in the treatment group after treatment was 95.35%(41/43),significantly higher than 79.07%(34/43)in the control group,with a statistically significant difference(P<0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Bushen Qiangdu Qinghua decoction combined with etanercept is effective in reducing inflammatory responses and alleviating clinical symptoms in patients with ankylosing spondylitis exhibiting kidney deficiency and damp-heat syndrome.The combined treatment demonstrates significant clinical efficacy and does not cause notable adverse reactions.