甲氨喋呤联合加味活络效灵丹治疗类风湿关节炎40例临床观察

Clinical Observation of Rheumatoid Arthritis Treated with Jiawei Huoluo Xiaoling Dan in Combination with Methotrexate

目的:观察甲氨蝶呤联合加味活络效灵丹治疗类风湿关节炎的临床疗效。方法:选取80例活动期瘀血痹阻型类风湿关节炎,随机分为对照组和观察组,每组40例,对照组予甲氨蝶呤治疗;观察组在对照组基础上予加味活络效灵丹治疗,两组均持续治疗12周,观察两组治疗前后中医证候积分、视觉模拟评分(VAS)、疾病活动度评分(DAS28)、简化疾病活动指数(SDAI),比较两组治疗前后红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、25羟维生素D[25(OH)D]、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、关节超声中关节腔积液、滑膜增生、滑膜血流分级及不良反应。结果:治疗后,两组的中医证候积分、VAS、DAS28、SDAI评分均改善,且观察组优于对照组(P<0.05)。治疗后,两组的ESR、CRP、RF、IL-6、TNF-α水平均降低,25(OH) D水平升高,且观察组优于对照组(P<0.05),治疗后,两组关节超声中关节积液、滑膜血流及滑膜增生均有所改善,且观察组优于对照组(P<0.05)。观察组的总有效率高于对照组(P<0.05)。结论:采用甲氨蝶呤联合加味活络效灵丹治疗活动期类风湿关节炎的临床疗效确切,可有效缓解患者中医证候及临床症状,可减轻机体炎性反应,改善关节病变,疗效优于单用甲氨蝶呤治疗,可明显提高患者的生活质量,且安全性较高。

Objective To observe the clinical efficacy of Jiawei Huoluo Xiaoling dan in combination with methotrexate within the treatment of rheumatoid arthritis.Methods Eighty cases of active rheumatoid arthritis with blood stasis and paralysis were randomly divided into observer group and control group,40 cases in each group.In the control group,methotrexate was administered,and in the observer group,Jiawei Huoluo Xiaoling dan was administered on the basis of the control group.Both groups were treated for 12 weeks,and the clinical efficacy of both groups was observed,as well as the Chinese medicine evidence score,visual analog score(VAS),disease activity score(DAS28)and simplified disease activity index(SDAI)before and after treatment.In the meantime,the erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),25 hydroxyvitamin D[25(OH)D],interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),joint cavity effusion,synovial hyperplasia,synovial blood flow grading and adverse reactions were compared between the two groups before and after treatment.Results After treatment,the TCM evidence score,VAS,DAS28,and SDAI scores improved in both groups,and the observer group was better than the control group(P<0.05).After treatment,ESR,CRP,RF,IL-6,and TNF-αlevels decreased and 25(OH)D levels increased in both groups,and the observer group was better than the control group(P<0.05).After treatment,joint effusion,synovial blood flow and synovial hyperplasia improved in the joint ultrasound of both groups,and the observer group was better than the control group(P<0.05).The overall effective rate of the observer group was higher than that of the control group(P<0.05).Conclusion The clinical efficacy of treating active rheumatoid arthritis with Jiawei Huoluo Xiaoling dan in combination with methotrexate is definite.This treatment method can effectively alleviate the Chinese medical symptoms and clinical symptoms,reduce the inflammatory response of the body,improve the joint lesions,and is more effective than methotrexate treatment alone,which can significantly improve the quality of life of patients and with higher safety.