摘要
目的观察中药温化蠲痹方治疗类风湿关节炎(rheumatoid arthritis,RA)的临床疗效及其减少西药用量及稳定病情作用,初步探讨中药温化蠲痹方治疗RA的机制。方法100例RA患者随机分为两组:中药温化蠲痹方加西药治疗组(治疗组)50例,对照组50例,其中对照组口服甲氨喋呤(MTX,每周1次,每次7.5 mg),柳氮磺吡啶片(每天3次,每次0.5g),美洛昔康片(莫比可,每天2次,每次7.5 mg)。治疗组在口服上述西药的同时,加用温化蠲痹方(每天1剂,分两次口服)治疗,疗程3个月。观察两组临床疗效,治疗前后症状、体征及实验室指标包括外周血肿瘤坏死因子-α(TNF-α)、白细胞介素1β(IL-1β)及抗环瓜氨酸肽抗体(抗CCP抗体)变化、西药用量和治疗后3个月病情复发情况。结果治疗组总有效率(88.0%)优于对照组(76.0%,P<0.05);在改善症状体征积分〔关节疼痛度(0.61±0.59)分、肿胀度(1.49±1.20)分、压痛度(0.90±0.69)分、活动度(0.68±0.62)分、握力(68.56±6.50)mm Hg、晨僵时间(23.26±9.26)min],与本组治疗前及对照组治疗后比较,差异均有统计学意义(P<0.05,P<0.01);治疗组美洛昔康[(108.85±16.13)mg]及MTX[(82.11±11.35)mg]用量、病情复发率显著少于对照组[(189.63±18.44)mg,(94.75±10.23)mg,P<0.05,P<0.01]。两组TNF-α、IL-1β、抗CCP抗体、类风湿因子(RF)、血沉(ESR)、C反应蛋白(CRP)、血小板(PLT)、免疫球蛋白(Ig)等指标,与本组治疗前比较,差异均有统计学意义(P<0.05,P<0.01),治疗组治疗后上述指标改善优于对照组(P<0.05,P<0.01)。结论中药温化蠲痹方加西药治疗RA的疗效优于单独西药治疗,具有减少西药用量,减少病情复发率,稳定病情作用。温化蠲痹方具有抗炎等免疫调节作用,可能是通过抑制TNF-α、IL-1β等细胞因子而达到治疗RA的作用。
Objective To observe the clinical effect of Wenhua Juanbi Recipe（WJR） in treating rheumatoid arthritis（RA）,its effects in reducing the dosage of Western medicine used and stabilizing condition of disease,as well as its influences on peripheral blood levels of tumor necrosis factor α（TNF-α）,interleukin 1β（IL-1β） and anti-cyclic citrullinated peptide antibody（anti-CCP）,for the sake of exploring its preliminary acting mechanism.Methods One hundred patients with RA were randomly assigned to 2 groups,the control group and the treated group,50 in each group.All were treated with oral administration of methotrexate（MTX,7.5 mg per week）,sulfasalazine（0.5 g,tid） and meloxicam（Mobic,7.5 mg,bid）,but to the treated group WJR was given additionally.The therapeutic course for both groups was 3 months.Clinical effect,changes of symptoms and physical signs,dosages of western medicines used,and laboratory indices in 2 groups after treatment were observed,and cases of relapse 3 months after treatment were figured out.Results The total effective rate in the treated group was higher than that in the control group（88.0% vs 76.0%,P〈0.05）.The improvements in scores of symptoms and signs [joint pain（0.61±0.59）,swelling（1.49±1.20）,tenderness（0.90±0.69）,movement（0.68±0.62）,griping strength（68.56±6.50） mm Hg,morning stiff time（23.26±9.26） min],and in levels of laboratory indices（TNF-α,IL-1β,anti-CCP,RF,ESR,CRP,PLT and Ig） in the treated group after treatment were significantly superior to those in the control group（P〈0.05 or P〈0.01）.The dosages of MTX [（82.11±11.35）mg vs（94.75±10.23）mg] and meloxicam [（108.85±16.13）mg vs（189.63±18.44）mg] used,and the relapse rate in the treated group were lower significantly（P〈0.05,P〈0.01） than those in the control group respectively.Conclusions Effect of combined therapy of WJR and Western medicines is superior to that of using Western medicines alone in treating RA;WJR can reduce the dosages of Western medicines used and the relapse rate,as well as stabilize the condition of illness.It has the effects of immune regulating and anti-inflammatory reaction.Its mechanism for treating RA is possibly the inhibition on cytokines of TNF-α and IL-1β.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2009年第9期787-790,共4页
Chinese Journal of Integrated Traditional and Western Medicine
基金
浙江省中医药科技计划基金资助项目(No.2007CB195
2008CA086)
