风湿骨痛胶囊联合抗风湿药治疗类风湿关节炎疗效观察

The curative effect of Fengshi Gutong capsules combined with antirheumatic drugs on rheumatoid arthritis

目的:探讨风湿骨痛胶囊联合抗风湿药治疗类风湿关节炎(Rheumatoid Arthritis,RA)的效果及对相关骨代谢指标水平的影响。方法:选取2020年1月―2022年12月贵州医科大学附属白云医院收治的60例RA患者,分为对照组和试验组,每组30例。对照组采用醋酸泼尼松联合甲氨蝶呤、艾拉莫德治疗,试验组采用风湿骨痛胶囊联合甲氨蝶呤、艾拉莫德治疗,持续3个月。比较两组治疗前后关节肿胀数、关节压痛数、视觉模拟评分法(Visual Analogue Scale,VAS)评分、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、C反应蛋白(C-reactive Protein,CRP)、白细胞介素(Interleukin,IL)-6水平、疗效和不良反应。比较两组治疗前后25-羟基维生素D[25(OH)D]、Ca和碱性磷酸酶(Alkaline Phosphatase,ALP)水平,评价骨代谢情况。结果:治疗后试验组总有效率为86.7%,对照组为76.7%,差异无统计学意义(P>0.05)。治疗后两组患者关节肿胀数、关节压痛数及疼痛VAS评分均较治疗前改善(P<0.05),试验组VAS评分低于对照组(P<0.05)。治疗后两组患者ESR、CRP、类风湿关节炎28项疾病活动度评分(Disease Activity Score-28,DAS28)均较治疗前明显下降(P<0.01),IL-6水平较治疗前下降(P<0.05);组间比较,试验组ESR、CRP水平低于对照组(P<0.05),两组患者IL-6、DAS28评分的差异无统计学意义。治疗后两组患者血清25(OH)D水平较治疗前明显升高(P<0.01),试验组ALP水平较治疗前明显升高(P<0.01),对照组血清Ca水平较治疗前明显升高(P<0.01);组间比较,试验组血清25(OH)D和ALP水平高于对照组(P<0.05),试验组血清Ca水平低于对照组(P<0.05)。治疗后试验组患者的不良反应发生率为3.33%,低于对照组的16.67%,差异无统计学意义(P=0.085)。结论:风湿骨痛胶囊在RA治疗中能更好地改善关节症状、降低炎症指标,对骨代谢有一定调节作用,安全性较高,临床上值得推荐。

Objective:To investigate the effect of Fengshi Gutong capsules(风湿骨痛胶囊)combined with antirheumatic drugs in the treatment of rheumatoid arthritis and its effects on the level of related bone metabolism indexes.Methods:A total of 60 patients with rheumatoid arthritis admitted and treated in Baiyun Hospital Affiliated to Guizhou Medical University from January 2020 to December 2022 were selected and divided into the control group and the experimental group,with 30 cases in each group.The control group was treated with prednisone acetate combined with methotrexate and eramode,while the experimental group was treated with Fengshi Gutong capsules combined with methotrexate and eramode for 3 months.The number of joint swelling,joint tenderness,VAS score,ESR,CRP,IL-6 level,efficacy and adverse reactions were compared between the two groups before and after treatment.The levels of 25(OH)D,Ca and ALP were compared between the two groups before and after treatment to evaluate the bone metabolism.Results:After treatment,the total effective rate in the experimental group was 86.7%and 76.7%in the control group,and the difference was not statistically significant(P>0.05).After treatment,the number of joint swelling,the number of joint tenderness and the VAS score in the two groups were ameliorated(P<0.05),and the VAS score in the experimental group was lower than the control group(P<0.05).After treatment,ESR,CRP and DAS28 scores in two groups were significantly decreased compared with those before treatment(P<0.01),and IL-6 level was significantly decreased compared with that before treatment(P<0.05).Comparison between the two groups showed that the levels of ESR and CRP in the experimental group were lower than those in the control group(P<0.05),and there was no statistical significance in IL-6 and DAS28 between the two groups.After treatment,serum 25(OH)D level in two groups was significantly increased compared with that before treatment(P<0.01),ALP level in the experimental group was significantly increased compared with that before treatment(P<0.01),and serum Ca level in the control group was significantly increased compared with that before treatment(P<0.01).The serum 25(OH)D and ALP levels in the experimental group were higher than the control group(P<0.05),and the serum Ca level in the experimental group was lower than that in the control group(P<0.05).After treatment,the incidence of adverse reactions in the experimental group was 3.33%,which was lower than 16.67%in the control group,and the difference was not statistically significant(P=0.085).Conclusion:Fengshi Gutong capsules can better relieve joint symptoms and reduce inflammatory indicators in the treatment of rheumatoid arthritis,and it has certain regulatory effects on the bone metabolism with high safety,and is clinically recommended.