芪黄健脾滋肾颗粒治疗类风湿关节炎的疗效观察

Observation of the clinical efficacy of Qihuang Jianpi Zishen Granule in the treatment of rheumatoid arthritis

目的观察芪黄健脾滋肾颗粒对类风湿性关节炎(RA)患者临床症状及相关实验室指标的影响。方法将60例RA患者分为两组,治疗组30例,对照组30例。对照组予以口服甲氨蝶呤片及来氟米特片,治疗组在对照组的基础上加芪黄健脾滋肾颗粒口服,治疗周期均为12周。观察治疗前后DAS28疾病活动度指数、ACR20、50、70达标率情况和中医症状评分的变化,检测治疗前后C反应蛋白(CRP)、血沉(ESR)、抑炎因子[白介素10(IL-10)、TGF-β]、促炎因子[白介素17(IL-17)、血清肿瘤坏死因子-α(TNF-α)]、基质金属蛋白酶指标[MMP-2、MMP-3、MMP-9]及血清趋化因子[CXCL9、CXCL10]水平。结果两组均无脱落病例,治疗后观察组ACR20达标率为86.7%,显著高于对照组的70.0%(χ^(2)=3.325,P<0.05);ACR50达标率为63.3%,显著高于对照组的36.7%(χ^(2)=5.487,P<0.05);与治疗前比较,两组治疗后临床疗效指标较前均有所改善。观察组治疗后DAS28、ACR、中医症状评分、CRP、RF、ESR、TNF-α、IL-17、MMP-2、MMP-3、MMP-9、CXCL9、CXCL10水平均显著低于对照组治疗后(P<0.05或P<0.01),IL-10、TGF-β显著高于对照组(P<0.05或P<0.01)。观察期间两组均未见明显不良反应。结论芪黄健脾滋肾颗粒可有效改善RA患者临床症状及实验室指标,安全性高,值得临床推广。

Objective To observe the effect of Qihuang Jianpi Zishen Granule on clinical symptoms and related laboratory indexes of patients with rheumatoid arthritis(RA).Methods The control group was given methotrexate tablets and leflunomide tablets orally,and the treatment group was given Qihuang Jianpi Zishen granules orally on the basis of the control group.The treatment cycle was 12 weeks.To observe the changes of DAS28 disease activity index,ACR20,50,70 achievement rate and TCM symptom score before and after treatment.The levels of C-reactive protein(CRP),erythrocyte sink(ESR),anti-inflammatory factor[interleukin-10(IL-10),TGF-β],pro-inflammatory factor[interleukin-17(IL-17),serum tumor necrosis factor-α(TNF-α)],matrix metalloproteinases[MMP-2,MMP-3,MMP-9],serum chemokine[CXCL9,CXCL10]levels before and after treatment were detected.Results After treatment,the ACR20 reached the standard in the observation group(86.7%),significantly higher than that in the control group(70.0%)(χ^(2)=3.325,P<0.05).The rate of ACR50 reaching the standard was 63.3%,significantly higher than 36.7%in the control group(χ^(2)=5.487,P<0.05).Compared with before treatment,the clinical efficacy indexes of both groups were improved after treatment.DAS28,ACR,TCM symptom score,CRP,RF,ESR,TNF-α,IL-17,MMP-2,MMP-3,MMP-9,CXCL9 and CXCL10 in the observation group were significantly lower than those in the control group after treatment(P<0.05 or P<0.01).IL-10 and TGF-βwere significantly higher than those in control group(P<0.05 or P<0.01).No obvious adverse reactions were observed in both groups during the observation period.Conclusion Qihuang Jianpi Zishen granules can effectively improve the clinical symptoms and laboratory indicators of RA patients,with high safety,worthy of clinical promotion.