桂枝芍药知母汤与改善病情药联合应用治疗老年活动期类风湿性关节炎疗效研究

目的:探讨中药桂枝芍药知母汤与剂量减半后的甲氨蝶呤和来氟米特联用,治疗老年活动期类风湿性关节炎的临床疗效与安全性。方法:76例老年活动期类风湿性关节炎患者随机分为3组,甲氨蝶呤+来氟米特组(28例)每周服甲氨蝶呤15 mg,来氟米特20 mg;桂枝芍药知母汤组(22例)每日服桂枝芍药知母汤1剂;中西医联合用药组(26例)每周口服甲氨蝶呤7.5 mg,来氟米特10 mg,每日加服1剂桂枝芍药知母汤。疗程12周,治疗前后观察关节肿胀、关节压痛、晨僵持续时间、患者疼痛度自我评分、患者对疾病总体活动性评分、医师对疾病总体活动性评分、健康评价问卷评分、红细胞沉降率和C反应蛋白等指标,并记录不良反应。结果:与治疗前相比,治疗12周后3组各项观察指标指标均有不同程度的改善,治疗总体有效率分别为85.37%、77.27%和96.16%。其中甲氨蝶呤+来氟米特组与桂枝芍药知母汤组疗效差别无统计学意义;联合用药组与其他两组相比,疗效皆改善明显(P值均<0.05)。3组不良反应发生率分别为42.86%、13.64%和15.38%,联合用药组与桂枝芍药知母汤组不良反应发生率无统计学差异,两者均低于MTX+LEF组(P值均<0.05)。结论:3种治疗方案对老年类风湿性关节炎患者均有效,但中西医结合治疗方式的综合疗效和安全性明显优于其他两种治疗方式。

Study on Effect of Guizhi Shaoyao Zhimu Decoction Combined with Disease-Modifying Drugs to Treat Senile Active Rheumatoid Arthritis

Objective:To discuss the effect and safety of Guizhi Shaoyao Zhimu Decoction combined with MTX and LEF on treating senile active RA.Methods:76 cases were randomly divided into three groups:MTX+LEF group(28 cases each week took 15 mg MTX and 20 mg LEF),Guizhi Shaoyao Zhimu Decoction group(22 cases took a dose for each day),combined group(26 cases each week took 7.5 mg MTX,10 mg LEF and Guizhi Shaoyao Zhimu Decoction one dose a day).The course was 12 week.The symptoms,scores and adverse reactions were observed and recorded.Results:Compared with those before treatment,the indexes in three groups after treatment had been decreased to different degrees.The total effect rates were 85.37%,77.27% and 96.16% respectively.MTX+LEF group and Guizhi Shaoyao Zhimu Decoction group had no significance.The combined group had obvious significance(all P<0.05)when compared with the other two groups.The adverse reaction rate in three groups were 42.86%,13.64% and 15.38% respectively.Both combined group and Guizhi Shaoyao Zhimu Decoction group had fewer adverse reactions with significance compared with MTX+LEF group(P<0.05).Conclusion:The three treatments all have effect on senile RA and the combined treatment has obvious advantages than the other two.