关节克痹丸联合甲氨蝶呤片治疗RA的效果及对临床症状与骨代谢的影响

Effect of Guanjie Kebi pills combined with methotrexate tablets on clinical symptoms and bone metabolism in the treatment of rheumatoid arthritis

目的观察关节克痹丸联合甲氨蝶呤片治疗类风湿关节炎(RA)的效果及对临床症状与骨代谢的影响。方法选取2020年1月—2021年1月首都医科大学附属北京中医医院风湿病科门诊就诊的RA患者73例,按照随机数字表法分为观察组36例和对照组37例。在常规治疗的基础上,对照组采用甲氨蝶呤片治疗,观察组在对照组基础上采用关节克痹丸治疗,2组均治疗2个月。比较2组治疗前后临床症状评分、骨代谢指标[骨钙素(OCN)、总维生素D(Vit-D)、β-胶原特殊序列(β-CTX)及总Ⅰ型胶原氨基端延长肽(PⅠNP)]、类风湿因子(RF)与炎性指标[C反应蛋白(CRP)、红细胞沉降率(ESR)]及不良反应。结果治疗2个月后,2组关节肿胀、关节压痛、晨僵评分较治疗前降低,且观察组低于对照组(P均<0.01);2组OCN、Vit-D、PⅠNP水平较治疗前升高,β-CTX水平较治疗前下降,且观察组升高/下降幅度大于对照组(P均<0.01);2组RF、CRP水平及ESR较治疗前下降,且观察组低于对照组(P均<0.01)。观察组不良反应总发生率为8.33%,低于对照组的27.03%(χ^(2)=4.356,P=0.036)。结论关节克痹丸联合甲氨蝶呤片治疗可明显缓解RA患者的临床症状,有效改善机体骨代谢,降低炎性指标,且不良反应发生率低。

Objective To observe the effect of Guanjie Kebi pills combined with methotrexate tablets on clinical symptoms and bone metabolism in the treatment of rheumatoid arthritis(RA).Methods A total of 73 patients with rheumatoid arthritis treated in the department of Rheumatology,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from January 2020 to January 2021 were selected and divided into two groups according to random number table method:observation group(36 cases)and control group(37 cases).On the basis of conventional treatment,the control group was treated with methotrexate tablets,and the observation group was treated with Guanjie Kebi pills on the basis of the control group.The two groups were treated for 2 months.The clinical symptom scores,bone metabolism indexes(OCN,Vit-D,β-CTX,PⅠNP),rheumatoid factor(RF),inflammatory indexes(CRP,ESR)before and after treatment,and adverse reactions between the two groups were compared.Results After 2 months of treatment,the scores of joint swelling,joint tenderness and morning stiffness in the two groups were lower than those before treatment,and the observation group was lower than that in the control group(P<0.01).The levels of OCN,Vit-D and PⅠNP in the two groups were higher than those before treatment,β-CTX level was lower than that before treatment,and the increase/decrease amplitude of the observation group was greater than that of the control group(P<0.01).The levels of RF,CRP and ESR in the two groups decreased compared with those before treatment,and the observation group was lower than that in the control group(P<0.01).The total incidence of adverse reactions in the observation group was 8.33%,which was lower than 27.03%in the control group(χ^(2)=4.356,P=0.036).Conclusion Guanjie Kebi pills combined with methotrexate tablets can effectively improve the clinical symptoms of patients with RA,improve the level of bone metabolism,reduce the level of inflammation and the incidence of adverse reactions.